Term
| What are the 3 stages of coagulation and the 2 stages of fibrinolysis? |
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Definition
Coagulation:
1. vascular phase
2. platelet phase
3. coagulation phase- activation of clotting system and clot formation
Fibrinolysis:
4. Clot retraction: contraction of blood clot
5. Clot destruction: enzymatic break down of clot by plasmin |
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Term
| Coagulation is a set of reactions that causes blood to go from a liquid to a ___. It is a defense mechanism against blood loss. |
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Definition
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Term
| Coagulation is initiated by ___ stimuli arising from vascular injury, triggering the ___ and ___ pathways leading to the final three steps. List these final three steps. |
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Definition
- external
- extrinsic
- intrinsic
1. Prothrombin activator is formed
2. Prothrombin is converted to thrombin
3. Thrombin assists the forming of fibrinogen into a fibrin mesh. |
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Term
Last 3 steps in coagulation:
- Prothrombin ___ is formed.
- Prothrombin is converted to ___.
- ___ facilitates the joining of ___ into a ___ network |
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Definition
- activator
- Thrombin
- Thrombin, fibrinogen, fibrin |
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Term
| stimuli to lining of vessel> ___ and other thrombogenic substances exposed> ___ adhere forming a plug>>___ clot forms |
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Definition
- collagen
- platelets
- fibrin |
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Term
| Primary hemostasis is the time of ___ ____ and is mediated by ___ ___ ___ aka ___. This factor is made by ___ cells and ___. |
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Definition
- platelet adhesion
- von Willebrand Factor (vWF) aka velcro
- endothelial cells and megakaryocytes |
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Term
| platelet secretion is also called: |
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Definition
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Term
| platelet secretion aka the release reaction rapidly proceeds ___. |
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Definition
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Term
| During platelet secretion granules release their contents which are: . The release of the substances results in production of a ____ complex. |
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Definition
- ADP
- calcium
- vasoactive substances
results in production of phospholipid complex and shape change |
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Term
| During platelet aggregation platelet adherence is promotoded by ___, ___, and ___. This results in a ___ ___ which is reversible. Thrombin converts fibrinogen to fibrin which is reversible. |
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Definition
- ADP, TxA2, and thrombin
- primary plug |
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Term
| Prothrombin can be activated by the ___ or ___ pathway. |
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Definition
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Term
| explain intrinsic pathway of activating prothrombin. |
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Definition
| endothelium ruptures and collagen is exposed |
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Term
| explain extrinsic pathway of activating prothrombin: |
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Definition
| - tissue cell trauma causes release of tissue factor, tissue factor acts with calcium |
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Term
coagulation sequence:
collagen or tissue factor and calcium>> platelets aggregate>> release PF3>>>factor X gets activated >>factor X complexes with calcium ions, PF3, and factor V to form the prothrombin activator complex. |
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Definition
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Term
| what makes up the prothrombin activator complex? |
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Definition
| - activated factor X complexed with PF3, calcium, and factor V |
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Term
| give 3 physiological examples of limited proteolysis: |
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Definition
- digestive enzyme activation
- proinsulin>>insulin
- activation of capsases |
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Term
| Briefly describe in coagulation phase 1 and 2: |
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Definition
Coagulation phase 1: 2 pathways to prothrombin activation
Coagulation phase 2: Pathway to Thrombin |
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Term
| prothrombin activator catalyzes the transformation of ___ to ___ and also helps polymerize fibrin into a fibrin clot. |
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Definition
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Term
| what two important sequences does fibrin have that allows for its polymerization? |
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Definition
- Gly-His-Arg
- Gly-Pro-Arg |
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Term
| the cross-linking mechanism of fibrin clot is catalyzed by ___ __. |
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Definition
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Term
| List the 4 components that limit fibrin formation: |
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Definition
- tissue factor pathway inhibitor
- serine protease inhibitors
- protein C system
- fribrinolytic system |
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Term
| The tissue factor pathway inhibitor inhibits ___ ___ ___ ___ and thereby inhibits ___ formation. |
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Definition
- factor VIIa tissue factor
- thrombin formation |
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Term
| Serine protease inhibitors neutralize ___ and ___ ___, thereby inhibiting ___ formation and activity. |
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Definition
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Term
| Protein C system causes proteolysis of factors __ and ___, which inhibits ___ formation. |
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Definition
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Term
| Fibrinolytic system causes proteolysis of ___ and removes the excess fibrin clot. |
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Definition
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Term
| What system regulates Secondary (excess) coagulation? |
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Definition
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Term
| The major effector of the fibrinolytic system is ___. |
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Definition
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Term
| ___ converts plasminogen to ___. This enzyme requires ___ as a cofactor. |
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Definition
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Term
| plasmin binds to ___ and degrades ___. |
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Definition
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Term
| the fibrinolytic system puts the breaks on blood coagulation by breaking down ___ and ___ protelytically with ___. |
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Definition
- fibrinogen
- fibrin
- plasmin |
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Term
| Activators of plasminogen are present in the ____, ___ of blood vessels, and in the ___. These activators are proteolytic enzymes. |
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Definition
- plasma
- endothelium of blood vessels
- urine |
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Term
| The urine plasminogen activator, called ____, does not require ___ as a cofactor like the other plasminogen activators do. |
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Definition
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Term
| Urokinase may be the endothelial factor which has filtered through the renal glomeruli or it may be formed in the renal tubules. Urokinase is currently used for what? |
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Definition
| - thrombolytic agent for treatment of myocardial infarction |
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Term
| list the plasminogen activators: |
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Definition
- urokinase
- streptokinase
- tissue plasminogen activators (tPAs) |
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Term
| tPAs and urokinase can be used as ____ factors to counteract acute MIs. |
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Definition
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Term
| plasmin breaks up fibrin and fibrinogen. the break down products of fibrin feed back and inhibit the formation of more fibrin. |
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Definition
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Term
| 3 main functions of the fibrinolytic system: |
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Definition
1. brake on the clotting system
2. causes dissolution of fibrin which could block circulatory flow
3. cleans up fibrin debris as blood passes through capillaries |
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Term
| small amounts of plasminogen are being ___ activated to plasmin within circulation. however, circulating plasmin is usually absent in detectable quantities b/c: |
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Definition
- continuously
absent b/c:
- anti plasminogen activators (inhibitors of activators) are usually in the plasma |
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Term
| In patients with shock, undergoing thoracic surgery, or in eclampsia with pregnancy, ____ ___ may occur b/c there are too many antiplasmins in the plasma preventing plasmin from working. |
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Definition
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Term
| Fibrin acts as an ____ by binding to thrombin. |
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Definition
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Term
| 3 ways fibrin is an anticoagulant: |
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Definition
- binds thrombin preventing thrombin from having positive feed back effects on coagulation
- prevents thrombin from speeding up production of prothrombin activator via factor V
- prevents thrombin from accelerating the intrinsic pathway by activation of platelets |
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Term
| free thrombin, not absorbed by fibrin, may be inactivated by ____ __. |
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Definition
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Term
| Heparin is an ___ that inhibits __ activity after combining with ___ ___ ___. |
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Definition
- anticoagulant
- thrombin
- antithrombin III |
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Term
| Coumadin and dicoumarol are ____ that are ____ ___. |
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Definition
- anticoagulants
- vitamin K antagonists |
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Term
| aspirin works as an ___ b/c it has ___ ___ activity. |
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Definition
- antiocoagulant
- anti-platelet activity |
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Term
| Vitamin K aka ___ promotes blood coagulation via aiding in synthesis of factors II, VII, IX, and X. What are two vitamin K antagonists and thus anticoagulants? |
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Definition
- thiamine
antagonists:
- Dicumarol
- Warfarin |
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Term
| vitamin K is cofactor in synthesis of ___ from ____. |
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Definition
- gamma- carboxyglutamate
- glutamate |
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Term
| Prothrombin binds ___ ions at sites of modified ___ ___ ___ residues (done by vitamin K) and thus promotes formation of thrombin and subsequently the formation of ___ from ___. |
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Definition
- calcium
- gamma carboxy glutamate residues
- fibrin
- fibrinogen |
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Term
| In the instrinsic system what factors activate factor X? Factor X is what goes on to form the prothrombin activator complex with calcium, factor V, and PF3. |
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Definition
| - factors IXa and VIII activate factor X in the intrinsic system |
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Term
| in the extrinsic system, what factors activate factor X? |
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Definition
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Term
| The intrinsic and extrinsic systems are inactivated by ___. This substance binds ___ ___ which activates proteolytic enzymes. |
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Definition
- heparin
- antithrombin III
- proteolytic enzymes |
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Term
| What are three treatment options to reduce clotting? |
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Definition
- anticoagulants
- antiplatelet drugs
- thrombolytics |
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Term
| what are two treatments to facilitate clotting? |
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Definition
- replacement factors (VIII, IXa, etc.)
- plasminogen inhibitors |
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Term
| compromise of what organ will result in insufficient clotting factors? |
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Definition
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Term
| Hemophilias A have deficiency of what? |
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Definition
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Term
| Hemophilia B have a deficiency of: |
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Definition
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Term
| Hemophilia C have a deficiency of : |
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Definition
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Term
| another hemophilia disease is : |
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Definition
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Term
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Definition
- deficient vitamin K
- deficient procoagulants |
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Term
| A ___is a clot that develops and persists in an unbroken vessel. it can block circulation leading to tissue death. |
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Definition
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Term
| An ___ is a thrombus freely floating in the bloodstream. pulmonary emobli can't get oxygen. cerebral emboli> stroke. |
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Definition
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Term
| bleeding time is most general test of ___ ___. |
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Definition
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Term
| Prothrombin time (PT) is measure of the function of the ___ pathway. it is also a good indicator for prognonsis of those with hepatocellular disease. |
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Definition
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Term
| Partial Thromboplastin time (PTT) measures the function of the ___ pathway. |
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Definition
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Term
| thrombin time tests for abnormalities in ____. |
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Definition
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Term
| fibrin stability test checks for ___ ___. |
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Definition
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Term
| look at slide 33 for widespread disseminated intervascular coagulation DIC |
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Definition
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Term
| - DIC: No injury occuring, but coagulation system gets triggered. Widespread microvascular thrombosis- small clots form all over coagulation system without an injury site. So no positive purpose for this. Plasmin and fibrinolisis will occur and fibrin clots degraded and cycle just keeps going. As cycling continues, coagulation factors and platelets get depleted so if challenge for system arises via an injury the system can’t do its job anymore b/c its depleted by DIC. |
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Definition
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Term
| major disorders associated with DIC: |
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Definition
OBSTETRIC
Abruptio placentae
Retained dead fetus
Septic abortion
Toxemia
INFECTIONS
Gram negative sepsis
Meningococcemia
Rocky Mountain spotted fever
Histoplasmosis
Aspergillosis
Malaria
NEOPLASMS
Carcinomas of pancreas, prostate
lung and stomach
Acute promyelocytic leukemia
MASSIVE TISSUE INJURY
Trauma
Burns
Extensive surgery
MISCELLANEOUS
Acute intravascular hemolysis
Snakebite
Giant hemangioma
Shock
Heat stroke
Vasculitis
Aortic aneurism
Liver disease |
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Term
| . Continuous veno-venous hemodialysis (HD) with IV bicarbonate infusion was initiated due to the patient’s renal failure. Low dose IV heparin, antithrombin III, and multiple packed red blood cell transfusions were administered for ongoing DIC and hemolytic anemia. |
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Definition
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