Term
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Definition
| a pathological hemostatic plug in the absence of bleeding |
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Term
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Definition
Endothelial injury (i.e.atheromatous plaque rupture)
Hypercoaguability (i.e. thrombophilia)
Altered blood flow (i.e. stasis in AF) |
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Term
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Definition
A red thrombus is formed in a vein and is made up of blood products
A white thrombus is formed in an artery and is mainly platelets, leucocytes and fibrin mesh (associated with atherosclerosis) |
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Term
| Three targets of coagulation therapy? |
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Definition
Blood coagulation/Fibrin formation
Platelet function
Fibrin removal (fibrinolysis) |
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Term
| Brief understanding of CC? |
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Definition
Contact pathway (intrinsic) activate 12, 11 (activated by contact with artificial surface)
In vivo (extrinsic) activates tissue factor and factor VII (not all products are in the blood)
Common pathway activation of 10 -->thrombin --> fibrin --> formation of clot. |
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Term
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Definition
| antithrombin III and vascular endothelium |
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Term
| As well as coagulation, thrombin causes? |
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Definition
| Platelet aggregation, cell proliferation and modulation of smooth muscle contraction. |
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Term
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Definition
| Heparin sulfate is an intrinsic endothelium molecule that acts as a antithrombin II cofactor promoting a non-thrombogenic surface. |
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Term
| The endothelium synthesises which important procoagulation compounds? Roles? |
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Definition
| vWF, TF and plasminogen activator inhibitor. Prothrombotic factors involved in platelet adhesion, coagulation and clot stabilisation respectively. |
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Term
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Definition
| is secreted in response to angiotensin IV. |
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Term
| The endothelium generates which important antithrombotic factors? |
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Definition
| PGI2 and NO (inhibitis platelet function), tissue plasminogen activator, thrombomodulin (a thrombin receptor) |
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Term
| Thrombomodulin and thrombin |
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Definition
| when combined activate protein C (vit K dependant) anticoagulant. This plus protein S inactivate factors VIIa and Va. Important in factor Va leiden mutation makes resistant to protein C --> thrombophilia. |
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Term
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Definition
| malignancy and sepsis increase endotoxin, ctyokines and TNF which increase prothrombotic endothelial function --> multiple organ failure. |
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Term
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Definition
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Term
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Definition
| Christmas disease or lack of factor IX (far more rare) |
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Term
| Treatment of factor deficiencies? |
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Definition
| FFP or concentrated factor replacement |
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Term
| Vitamin K (and dependant factors) |
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Definition
| is a fat soluble vitamin, essential for formation of factor II, VII, IX, X + protein C and S. Used to treat r prevent bleeding in warfarinised patients or neonates or vit K deficiencies in sprue, coeliacs, steatorrhea or lack of bile (fat soluble). |
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Term
| Consequences of thrombosis? |
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Definition
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Term
| Main drugs used for white thrombi? |
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Definition
| antiplatelet and fibrinolytic |
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Term
| Main drugs for red thrombi? |
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Definition
| anticoagulants (injectable or oral) |
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Term
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Definition
| is indicated in acute anticoagulation. LMWH > UF. Activation of antithrombin III, this inhibits thrombin and factor Xa. and other serine proteases. Must be given subcut or IV.Longer half life than UF, more predictable. do not prolong APTT. renal excretion. AEs --> haemorrhage, can be reversed by protamine sulphate. HIT --> heparin induced thrombocytopenia. |
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Term
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Definition
| is indicated in thromboprevention, prophylaxis for virchows triad (i.e. preoperatively, AF, hemodialysis, unstable angina). It is a vit K antagonist. require frequent blood tests. several days of onset. Protein C and S go first. oral absorption.affects PT monitored with INR. |
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Term
| Factors that affect oral anticoagulants? |
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Definition
| Liver disease, drug interactions +++ (antibiotics, antiarrhythmics), p450 inducers (anticonvulsants) |
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Term
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Definition
| is a direct thrombin inhibitor. oral anticoagulant. does not require INR checks. is not reversible.major risk is bleeding. indicated in AF, warfarin is still first line. CI in renal impairment and concurrent antifungal therapy and high risk bleeders. |
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Term
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Definition
| is a direct factor Xa inhibitor. non-reversable. prevention of VTE. |
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Term
| Role of the platelet in coagulation? |
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Definition
| adhesion, secretion (of granules with ADP, coat factors and PDGF), synthesis of TXA2, aggregation, activated thrombin formation promoting |
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Term
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Definition
| inhibits platelet synthesis of TXA2, thromboprevention indicated in high cardiovascular risk patients. (must outweigh GI bleeding. AE gi bleed. inhibition of COX 2, inhibits PGI2 |
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Term
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Definition
| inhibits platelet aggregation, complex MoA. AEs headache, dizzyness and GI disturbances. no increase bleeding. can be additive. |
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Term
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Definition
| inhibition of ADP- prevents platelet aggregation. oral absorption. CI PPI. inidicated in stroke prevention. |
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Term
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Definition
| GPIIb/IIIa receptor antagonist - inhibits platelet activation. non-human MAb. used in high risk patients undergoing coronary angioplasty. Single use, prevents restenosis. |
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Term
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Definition
| is a PGI2 agonist which inhibits platelet aggregation and causes vasodilation. it is added to the blood in dialysis in heparin contraindication. |
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Term
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Definition
| is a fibrinolytic, it activates plasminogen, antibodies against drug develop, indicated in acute myocardial infarction (when cath lab is unavailable. |
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Term
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Definition
| are clot selective, clinically for MI. counters antibody to strep. |
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Term
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Definition
| bleeding (treated with tranexamic acid, FFP or coag factors)allergic reaction, contraindicated in haemorrhage & pregnancy & hypertension uncontrolled. only reduce mortality if given within 12 hrs. |
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Term
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Definition
| inhibits plasminogen activation preventing fibrinolysis. used to treat life threatening haemorrhage, menorrhagia, and reduce risk of bleeding following dental extraction of prostatectomy. |
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Term
| 4 main components of blood |
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Definition
| RBC, WBC, plasma and platelets |
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Term
| Site of RBC formation and destruction? |
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Definition
| Bone marrow and spleen respectively. |
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Term
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Definition
| is the reduced concentration of Hb in the blood |
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Term
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Definition
Microcytic hypochromic - iron deficiency, chronic blood loss)
Macrocytic (large red cells few in number, folate B12)
Normochromc normocytic
Mixed picture |
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Term
| Anaemia can be caused by nutrient deficiency, which nutrients? |
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Definition
| iron, folate, B12, pyridoxine and vit C |
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Term
| Anemia can be caused by bone marrow suppression, what causes this? |
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Definition
| drug toxicity, radiation, leukemias, reduction in erythropoeitin by kidneys. |
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Term
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Definition
| Increased red cell destruction i.e. sickle cell anemia, drugs or immune reactions |
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Term
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Definition
| Requires an acidic environment, in the duodenum and upper jejunum. |
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Term
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Definition
| indicated in the treatment of chronic blood loss (menorrhagia), increased demand (pregnancy), dietary insufficiency, absorption impairment (gastrectomy). Usually oral. IM or IV in cases of decreased absorption. AEs dose related nausea, cramps and diarrhoea. |
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Term
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Definition
| rare, but seen generally in pediatric patients who mistakenly overdose on iron tablets --> acute necrotizing gastritis. |
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Term
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Definition
| Iron overload occurs in hemolytic anemia, hemochromatosis and thalasemias and require regularvenesection. |
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Term
| Desferrioxamine (Deferiprone) |
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Definition
| Iron chelator given in iron toxicity, it binds to iron and allows it be excreted in the urine (Deferiprone is the alternative used for thalasemmia major patients) |
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Term
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Definition
| is given orally, absorbed in the ileum, inactive until methylated by b12 dependant reaction. (Folinic acid is converted much more rapidly. Note if the activating enzyme is blocked folic acid is pointless i.e. methotrexate. indicated in treatment of megaloblastic anemia (malabsorption, diet, drugs) prophylaxis in pregnancy, pernicious anemia loss of intrinsic factor after surgery. |
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Term
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Definition
| regulates the red cell line and signals erythrocyte production in response to blood loss or loss tissu oxygen. produced by the juxtatubular cells in the kidney and by macrophages. |
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Term
| Colony stimulating factors |
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Definition
| regulate the white cell line, the main stimulus for productn is infection. |
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Term
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Definition
| indicated in erythropoietin deficiency. Darb is long half life and less frequent adminstration. AEs transient flulike symptoms, hypertension, headache, iron deficiency must be given in combo with iron and folate b12 therapy/ they must be corrected. |
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Term
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Definition
| Granulyte CSF (normally produced by macrophages, fibroblasts and endothelial cells) indicated to reduced severity of neutropenia (cancer treatment), harvest progenitor cells, HIV infection, aplastic anemia. |
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Term
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Definition
| made in liver and kidneys, stimulates platelet formation, not used clinically. |
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Term
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Definition
| human MAb indicated in treatment of hemolytic anemia, reduced hemolysis and transfusion requirements |
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Term
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Definition
| lowers red cell and platelet count to treat chronic myeloid leukaemia. |
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