Term
| what are 4 causes of endothelial injury |
|
Definition
hypercholesteremia
smoking byproducts
radiation
bacterial endotoxins |
|
|
Term
|
Definition
| megakaryocyte cytoplasmic fragments |
|
|
Term
| how long do platelets live |
|
Definition
|
|
Term
| what are the three types of granules in platelets |
|
Definition
A granules
D granules
lysosomal granules |
|
|
Term
| what is the function of platelet A granules |
|
Definition
|
|
Term
| what is the function of platelet D granules |
|
Definition
|
|
Term
| what are the 6 platelet A granules |
|
Definition
| fibrinogen, fibronectin, factor v, factor VII, PGDF, TGFB |
|
|
Term
| what are the 6 platelet D granules |
|
Definition
| ADP/ATP, Ca, histamine, serotonin, epinepherine, thromboxane A2 |
|
|
Term
| after a vessel is injured what is the first step to forming a clot, why cant it just stop here |
|
Definition
arteriolar vasoconstriction via
intrinsic sympathetic mechanism and thromboxane A2
this is temporay (bleeding would resume without the next steps) |
|
|
Term
| after arteriolar vasoconstrtion what is the next step in the formation of a clot, what is the significance of this step |
|
Definition
exopsure of ECM on endothelium exposes collagen which is thrombogenic
this is the dominant influence of thrombus formation |
|
|
Term
| what are the two main factors in formation of the platlet plug forms (after thrombogenic collagen is exposed on the ECM) |
|
Definition
TNF and IL-1 induce release of tissue factor from endothelial cells which activates extrinsic coagulation cascade
von willibran factor is released from endothelial cells |
|
|
Term
| how do platelets know to go to a certian location |
|
Definition
| adenosine diphsophate thromboxane A is released from platelets |
|
|
Term
| what is the cause of hemophilia A |
|
Definition
| factor VIII (anti-hemopoetic) or von willibran factor deficiency |
|
|
Term
| what is the number one cause of serious hemophelia |
|
Definition
| factor VIII deficiency (hemophelia A) |
|
|
Term
| what is the number one cause of hemophelia |
|
Definition
| von willibran factor deficiency |
|
|
Term
| why does von willibran factor deficiency cause hemophelia A which is normally considered to be a factor VIII deficiency |
|
Definition
| because it protects factor VIII |
|
|
Term
| what does von willibran factor do in pletelet formation |
|
Definition
| accumulates on exposed collagen and anchors platelets |
|
|
Term
| what is the key protein in platelet formation |
|
Definition
|
|
Term
| where doe the coagulation factors for a secondary platelet plug come from |
|
Definition
| made in liver and circulate in active form |
|
|
Term
| how is the process of making a secondary platelet plug initiated |
|
Definition
contact with collagen (intrinsic pathway)
cell damage causes tissue factor (III) to be released (extrinsic pathway) |
|
|
Term
| explain the intrinsic clotting pathway |
|
Definition
contact with collagen turns XII to XIIA
XIIA turns XI to XIA
XIA turns IX to IXA (with ViI, Ca, K)
IXA turns X to Xa (with K, Ca) |
|
|
Term
| what is the cause of hemophelia B |
|
Definition
| factor IX (christmas factor) deficiency in the intrinsic pathway |
|
|
Term
| explain the extrinsic clotting pathway |
|
Definition
cell damage releases tissue factor III
III turns VII to VIIA (with Ca, K)
VIIA turns X to XA (with Ca, K) |
|
|
Term
| explain the combined clotting pathway |
|
Definition
XA turns prothrombin (II) into thrombin (IIA) (with V, Ca, PF3, K)
thrombin (IIA) turns fibrinogen (I) to fibrin (IA) (with XII and Ca) |
|
|
Term
|
Definition
|
|
Term
| what is factor V, when is it used, what is a disease involving it |
|
Definition
labile factor
helps convert prothrombin to thrombin
deficiency is a pro-clot formation! |
|
|
Term
| what is factor VIII, when is it used, what does a deficiency cause |
|
Definition
anti-hemolytic factor
turns christmas factor (IX) to IXA
hemophelia A |
|
|
Term
| after fibrin is formed for the permanent plug what does it do |
|
Definition
| forms mes around platelet plug and gel like thrombus or clot causes permanent platelet plug which allows RBC aggregation and traps PMN |
|
|
Term
| what are three ways platelets adhere in the platelet plug |
|
Definition
Gp 1b adheres to von willibran factor on endothelium
Gp 1B/111b complex: allows fibrinogen attachment to adhere platelets to each other
fibrin: cements platelets in place |
|
|
Term
| once in the plug what 5 things to platelets secrete and why |
|
Definition
Ca: for coagulation cascade
ADP: mediate eggregation
phospholipid complex: binding site for Ca and coagulation factors
ADP and thromboxane A2: stimulate formation and recruitment of platelets |
|
|
Term
| ok, the permanent platelet plug is formed, now what |
|
Definition
| clot retracts in 20-60 mines then dissolution (fibrinolysis) |
|
|
Term
| how does clot retraction work |
|
Definition
| sqeezes serum from clot joining separated vessel walls (need many platelets) |
|
|
Term
| explain the process of clot dissolution |
|
Definition
plasminogen activating fator (tPA) activates plasminogen to plasmid
plasmid digests clotting factors and fibrin
blood can now enter the area for repair |
|
|
Term
| what are 6 ways endothelium regulates clotting (just name each) |
|
Definition
when in tact ECM isnt exposed and is an anticoagulant
prostacyclin-2
thrombomodulin pathway
NO
tPA
heparin like molecules |
|
|
Term
| explain the thrombomodulun pathway |
|
Definition
| thrombomoduliin binds thrombin making an anti-coagulant which activates protein S and C and using vitamin K it cleaves factors VA and VIIA |
|
|
Term
| how do prostacyclin (PGI-2) and NO regulate clotting |
|
Definition
| inhibit platelet aggregation in platelet plug |
|
|
Term
|
Definition
breaks down fibrin, inhibits polymerization, limits plug to site of injury
products of split fibrin are anti-coagulants |
|
|
Term
| what are 3 naturally circulating regulators of clotting |
|
Definition
anti-thrombin 3
protein C
vitamin K |
|
|
Term
| what does anti-thrombin 3 do |
|
Definition
| enhanced by heparin like molecules it inactivates thrombin and clotting factors XA and IXA |
|
|
Term
| which clotting factors are vitamin K sensitivie, which is the most sensitivie |
|
Definition
|
|
Term
| what considerations need to be taken when proscribing cumadin |
|
Definition
| it knocks out protein C so give heparin first until factors 2, 7, 9, and 10 are gone (7 goes first) |
|
|
Term
| what is the function of vitamin K |
|
Definition
|
|
Term
| why is it risky to give babies antibiotics |
|
Definition
| it can wipe out their vitamin K |
|
|
Term
| what are 7 ways to test coagulation |
|
Definition
partial thromboplastin test (PTT)
prothrombin time (PT)
international normalization ratio standards (INR)
bleeding time
fibrinogen
factor assays
platelet counts |
|
|
Term
| what is a normal platelet count |
|
Definition
|
|
Term
| what tests can screen for hemophelia which is the best |
|
Definition
|
|
Term
| what does a bleeding time test for, what is normal |
|
Definition
|
|
Term
|
Definition
| standartized parient results used to monitor warfarin, coumadin, and liver function |
|
|
Term
| what happens to the INR in liver failure |
|
Definition
|
|
Term
|
Definition
tissue factor (intrinsic) patnwah
coumadin function |
|
|
Term
|
Definition
contact (extrinsic) pathway
heparin function
hemophelia A and B |
|
|
Term
| what is PTT measured in, what happens when vitamin K decreases |
|
Definition
time increases with vitamin K decrease
measured in seconds |
|
|
Term
| what is the definition of a thrombosis |
|
Definition
| activatin of hemostasis when vessels are in tact causes thrombus (clot) formation blocking blood to vital areas |
|
|
Term
| what are the three main influences on thrombus formation, what are they called, which is #1 |
|
Definition
virchow triad...
1. entothelial injury
stasis or turbulence of blood flow
blood hypercoaguability |
|
|
Term
| what are the two types of thrombus |
|
Definition
|
|
Term
| what is the causes of a venous thrombous, why |
|
Definition
| stasis: brings platelets in contact with endothelium preventing dilution and flow of clotting factors |
|
|
Term
| what is the cause of an arterial thrombus, why |
|
Definition
| turbulence: brings platelets in contact with endothelium preventing dilution and flow of clotting factors |
|
|
Term
| what are three ways to identify a venous thrombus: composition, locations, shape |
|
Definition
grows towards direction of blood flow
more in lower extremities
made of RBC thrombi |
|
|
Term
| what are three ways to identify a venous thrombus: composition (4), locations, shape |
|
Definition
composition: platelets, fibrin, RBC, degrading leukocytes
more in coronary, cerebral, and femoral arteries (bifurcation and areas of endothelial damage)
grow retrograde from point of attachment |
|
|
Term
| what is an example of an arterial thrombi |
|
Definition
| mural thrombi: in heart chamber wall or aorta |
|
|
Term
| what are two examples of a venous thrombi |
|
Definition
emboli: tail of clot fragments off
deep vein thrombosis: post-op patient is confined to bed causing stasis |
|
|
Term
| what are 5 possible outcomes from a thrombus, briefly describe each |
|
Definition
propagation: accumulation of platelets and fibrin causes occlusion
embolization: dislodged thrombi
dissolution/resolution: removed by fibrinolytic activity
orgnization: inflammation induces immune response which re-opens vessel
recannalization: openings in vessels created in thrombus allowing blood through |
|
|
Term
| what are three major complications of thrombi |
|
Definition
vascular obstruction / infarction
venous thrombi causing congestion and edema
embolization in lungs causes dath (usually venous thrombi) |
|
|
Term
| what are two ways thrombi can be diagnosed |
|
Definition
post mortum clots are not attached
laminated thrombi |
|
|
Term
| how is laminated thrombi nterperted |
|
Definition
different colored layers (lines of zhan)
red lines are RBC
white lines are WBC, fibrin, platelets |
|
|
Term
| cause of benard soulier syndrome |
|
Definition
| deficiency in Gp 1b receptors |
|
|
Term
| cause of glansmann thrombasthenia |
|
Definition
| deficiency in Gp 11b/111b receptor |
|
|
Term
| cause of von willebrand disease |
|
Definition
| deficiency in von willebrand factor |
|
|
Term
| how does asprin cause problems with clotting |
|
Definition
| inhibits synthesis of thromboxane A2 so platelets cannot aggregate |
|
|
Term
| why does liver disease cause problems with clotting |
|
Definition
| it makes clotting factors |
|
|
Term
| why can pregnancy cause problems with thrombus |
|
Definition
| amniotic fluid influsion into the circulation (and post-partum) |
|
|
Term
| why can cancer cause thrombus |
|
Definition
| tumor releases procoagulants |
|
|
Term
| what does a genetic mutation in factor V cause |
|
Definition
| protein C anti-coagulation resistanc |
|
|
Term
| what are som bag habits or body changes that can cause changes in coaguability (4) |
|
Definition
smoking
obesity
age
immobolization |
|
|
Term
| what is trousseau's synfrome |
|
Definition
| paraneoplastic syndrome with hyperocaguability |
|
|
Term
| why does arthersclerotic plaque cause thrombus |
|
Definition
| rupture of plaque exposes endothelial collagen inducing thrombus formation |
|
|
Term
| what is thrombocytopenia, what are the main symptoms |
|
Definition
low platelet level
spontaneous bleeding
prolonged bleeding time |
|
|
Term
| what are 5 causes of thrombocytopenia |
|
Definition
uremia
marrow failure: aplastic anemia, leukemia
immune system
destriction of platelets in prostatetic valve
hematological manifestation of AIDs |
|
|
Term
| what is a major complication of thrombocytopenia |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are three causes of DIC |
|
Definition
delivery: obestrical complications
infection: usually gram negative bacilli
cancer: mucin producing |
|
|
Term
|
Definition
secondary complication of disease
causes tissue factor or thromboplastic substance release into circulation
activation of clotting causes microthrombi through out the body
increased clotting consumes platelets, fibrin, coagulation factors activating, fibrinolytic mechanisms causing hemorrhage |
|
|
Term
| what is the treatment for DIC |
|
Definition
| treat underlyind disorder |
|
|
