SECONDARY HEMOSTASIS Flashcards by Pressamae Pedrera

Fibrin clot is digested by

plasmin

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Sequential process by which multiple plasma
enzymes, cofactors, and other related
substances interact in sequence to form an
insoluble fibrin clot

Coagulation

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May be subdivided into zymogens and cofactors

procoagulants

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To maintain a complex and delicate balance
between thrombosis and abnormal bleeding

regulatory proteins

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Proteins that promote clotting

procoagulants

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Physiologic inhibitors

Present in the plasma
o Anti-thrombin III
o Complement inhibitor
o A2 macroglobulin
o A1 anti-trypsin

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During clotting, procoagulants are sequentially
activated, producing a

localized thrombus

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Factor IV is

calcium

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All are serine proteases except:

Factor I, III, V, VIII, HMWK, XIII
(transglutaminase)

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o Highest concentration
o Heaviest
procoagulant

fibrinogen

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I PN

I Fibrinogen

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II PN

II Prothrombin

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III PN

III Tissue Factor

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IV PN

IV Calcium

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V Pn

V Proaccelerin

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VIII:C

VIII:C Antihemophilic
Factor (AHF)

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IX PN

IX Plasma
Thromboplastin
Component (PTC)

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X PN

X Stuart-Prower Factor

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XI PN

XI Plasma
thromboplastin
Antecedent

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XII Factor

XII Hageman Factor

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XIII

XIII Fibrin Stabilizing
Factor

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Fletcher Factor

Prekallikrein

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High Molecular
Weight Kininogen

Fitzgerald Factor
Contact Activation Factor
Williams Factor
Flaujeac Factor

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DIVISION: Characteristic

Characteristic
o Fibrinogen
o Prothrombin
o Contact

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3 Pathways

Intrinsic o Extrinsic o Common

group Consumed in clotting, not present in serum

Fibrinogen group

Fbrinogen Group • Factors:

brinogen Group • Factors: I, V, VIII, XIII

Only group that acts as substrates for PLASMIN

Fibri group

Only group present in alpha granules of platelets (except XIII and VIII:C)

Fibri group

Factor XIII is cleaved by ______ when activated

thrombin

Prothrombin Group • Factors:

• Factors: IX, X, VII, II

Carboxylation of glutamic acid to gamma glutamic carboxyl acid

Prothrombin group

Adsorbed by BaSO4 and Al(OH)3

Proth group

Primary group affected by Warfarin

Proth group

first affected by warfarin in prothrombin group

Factor VII

Inhibits epoxide reductase needed in the reduction of Vit K

prothrombin group

Not consumed in clotting, present in serum (except II)

prothrombin group

Contact Group • Factors:

Factors: XI, XII, HMWK, Prekallikrein

Activated by contact with negatively charged surfaces:

collagen and endothelium

Activates intrinsic pathway and fibrinolysis

Contact group

Extrinsic tenase complex activates?

IX and X

Intrinsic tenase activates?

Prothrombinase activates?

Prothrombin

T OR F: Slow the activation of procoagulants and suppress thrombin production

TF: Ensure coagulation is localized and systemic

F: not systematic

Principal regulator of the tissue factor pathway

Tissue Factor Pathway Inhibitor

Synthesized by Epithelial cells and expressed on platelets

Tissue Factor Pathway Inhibitor

Not functional until Factor X is activated

Tissue Factor Pathway Inhibitor

Tissue pathway factor inhibitor Inhibits coagulation via two steps:

o Inactivating Xa o TFPI:Xa complex binds to TF:VIIa

Neutralizes all serine proteases, except Factor VIIa

Antithrombin

Inactivates thrombin

Heparin cofactor II

Inhibits Xa and XIa

ZPI (Protein Z-dependent inhibitor)

Inhibits APC, thrombin, Xa, Xia, and urokinase

Protein C inhibitor

• Activated by thrombin-thrombomodulin

Protein C

Protein S as cofactor o 40% - ??? o 60% - ???

Protein S as cofactor o 40% - free (cofactor) o 60% - bound to C4bBP

Activated protein C inactivates Factor and

Factor Va and VIIIa

Systemic and accelerated hydrolysis of fibrin by bound plasminogen

Fibrinolysis

Contains 5 glycosylated loops (kringles)

Plasminogen

Enable plasminogen, along with TPA and UPA, to bind fibrin lysine molecules during polymerization

Kringles

Digest clots by hydrolysis of arginine-related and lysine-related peptide bonds

plasmin

plasmin Capable of digesting:

o Plasma fibrinogen o Factor V o Factor VIII o Fibronectin o (Factor XIII)

Hydrolyzes fibrin-bound plasminogen and convert it to plasmin initiation fibrinolysis

Tissue Plasminogen Activator (TPA)

Produced by urinary tract epithelial cells, monocytes, and macrophages

Urokinase Plasminogen Activator (UPA)

Plasma concentration: 2-4 ng/mL • Does not bind firmly to fibrin • Has a minor physiologic effect

UPA

Primary inhibitor of free plasmin

Alpha-2-antiplasmin

Prevents plasmin's premature and uncontrolled digestion of fibrin

A2A

Activated by thrombin-thrombomodulin complex

Thrombin-Activatable Fibrinolysis Inhibitor (TAFI)

Prevents binding of TPA and plasminogen to fibrin and blocking plasmin formation

TAF

Cleaving exposed carboxy-terminal lysine residues from fibrin

TAF

SECONDARY HEMOSTASIS Flashcards

(69 cards)