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Clinical Coagulation
Thrombosis
36
Medical
Undergraduate 4
11/04/2009

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Term
Arterial thrombosis causes what
Definition
Myocardial infaction and stroke
Term
Venous thrombosis causes what
Definition
Pulmonary embolism
Term
Artery
Definition
Vessle wall abnormality, higher blood flow,high shear and turbulence, thrombus associated with vascular abnormalities *atherosclerosis)most often, high platelets, low fibrin, white thrombus, use thrombolytic therapy
Term
Vein
Definition
Normal vessle walls, slower blood flow, high fibrin, RBCs, PLTs. Thrombus most often occurs in cases of stasis (inadequate flow) or biochemical abnormalities (non motile people-airplane dont flush out coag factors)
Term
Thrombosis
Definition
Formation of a solid mass of platelets, RBCs WBCs and fibrin within a living blood vessel or the heart
Term
Thrombus
Definition
Intravascular, living vessel or heart
Term
Blood clot
Definition
Extravascular, hematoma, postmortem, in vitro
Term
Embolus
Definition
fragment of thrombus that moves to a new site
Term
Cerebral artery thrombosis
Definition
Stroke
Term
Mesenteric artery thrombosis
Definition
Bowel infarction
Term
Coronary artery thrombosis
Definition
Miocardial infarction
Term
Arterial thromboembolism
Definition
Fragment of thrombus from heart wall or heart valve travels downstream to smaller vessel, may lead to strike or MI
Term
Venous thromboembolism
Definition
Fragment of venous thrombus that breaks off and travels upstream towards the heart, may lead to pulmonary embolism
Term
How can thrombosis occur
Definition
Injury or activation of endothelium, Alteration in blood flow, Alteration in hemostatic system (biochemical abnormalities)
Term
Antithrombotic function of normal endothelium
Definition
Inhibits platelets, coagulation, stimulates fibrinolysis
Term
prothrombicc function of damaged endothelium
Definition
Activates platelets, stimulates coagulation, blocks fibrinolysis
Term
Injury or activation of enothelium can be
Definition
Atherosclerosis (block vessles with fat), Immune mediated (HIT, Antiphospholipid antibody syndrom (lupus), trauma, artificial surfaces, inflammation/infection
Term
Alteration in hemostatic system: biochemical abnormalities can be due to:
Definition
Coagulation system, fibrinolytic system, platelets, vessle wall/endothelium
Term
Thrombophilia
Definition
Young age (20s, 30s, 40s), unusual or unexplained thrombosis, spontaneous, idiopathic, essential, recurrent unusual site (arm), multiple sites, extensive. Trigger- pregnancy, trauma, surgery
Term
Coagulation regulation
Definition
Accelerated coagulation due to reduced inhibition of coagulation, or due to elevated levels of coag factors
Term
Antithrombin function
Definition
regulates coagulation by inhibiting thrombin, F9, 10, 11, 12. Complexes are cleared by the liver, complex is consumed in the process.
Term
Hereditary antithrombin deficiency
Definition
Autosomal dominant, 1 gene abnormal, one normal (heterozygous), activity levels 50% of normal, incresed risk of venous thrombosis, venous thromboembolism, first episode in 20-40s, associated with pregnancy, trauma or surgery. Common thrombosis sites: lower extremities, pulmonary embolus, mesenteric vein thrombosis, superior sagittal sinus thrombosis
Term
Cause of decreased antithrombin
Definition
Heparin therapy, nephrotic syndrome, asparaginase therapy, DIC, hereditary deficiency (reduced production or abnormal molecule)
Term
Protein C is activated by
Definition
Thrombin/thrombomodulin complex on endothelial cells
Term
What are the 3 abnormalities in protein C system
Definition
Protein C deficiency, Protein S deficiency, Mutation of factor V cleavage site (activated protein C resistance)
Term
Hereditary protein C deficiency
Definition
Autosomal dominant, 1 gene abnormal, activity levels 50% of normal, increases risk of venous thrombosis
Term
Causes of decreased protein C
Definition
warfarin, ongoing thrombosis, vitamin K deficiency, liver disease, post-operative state, hereditary deficiency (reduced production or abnormal molecule)
Term
Mutated factor 5
Definition
Has glutamine instead of argenine, prevents APC from cleaving factor V, increased risk of venous thrombosis
Term
Assay for factor V leiden
Definition
PCR, followed by hybridization with oligonucleotide probe for each specific allele
Term
APC resistance assay
Definition
determine PTT in plasma before and after addition of activated protein C (dilute sample in factor 5 deficient plasma)
Term
Prothromin gene mutation
Definition
Mutation of guanine to adenine in 20210 position of prothrombin gene results in elevated levels of prothromin in blood, leads to increase of venous thrombosis.
Term
Factor 8 activity in blood can be increased due to
Definition
transient acute phase response, or long term, which is associated with increased risk of venous thrombosis
Term
If factor VIII levels are high, what must be proved
Definition
That it is not a transient response- C reactive protein will be normal in acute phase
Term
Hyperhomocysteinemia
Definition
modest elevation of homocysteine in plasma due to endothelial injury, increased arterial thrombosis, venous thrombosis
Term
Multiple hit hypothesis
Definition
development of venous thrombosis requires multiple risk factors or a strong stimulusL hip surgery, AT defiviency+plane ride, prothrombin deficiency+oral contraceptives.
Term
Thrombosis in children
Definition
Children have fewer spontaneous thromboses than adults, children and young adults may require 3 or 4 risk factors before thrombosis occurs: central venous catheters, disease (cancer, heart, infection), hereditary deficiencies
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