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Chapter 26 Patho

Terms in this set (59)

_____ is designed to maintain the integrity of the vascular compartment
hemostasis
What are the 5 reasons blood clots?
Infection
Volume
Oxygen production
Tissue damage
Healing
What are the 5 stages of hemostasis?
1. Vessel spasm
2. Formation of the platelet plug
3. Blood coagulation or development of an insoluble fibrin clot
4. Clot retraction
5. Clot dissolution
_____ is the inappropriate formation of clots within the vascular system
thrombosis
_____ is failure of blood to clot in responses to appropriate stimulus
bleeding
_____ is initiated by endothelial injury and caused by local and humoral mechanisms.
vessel spasm
Vessel spasm constricts the vessel and reduces _____
blood flow
_____ is a transient event that usually lasts minutes to hours
vascular constriction
1. Attracted to a damaged vessel wall
2. Activation by subendothelial tissue
3. Change from smooth disks to spiny spheres
4. Exposing glycoprotein receptors in their surfaces
What part of the platelet plug formation are these?
adhesion and aggregation
What three things are requirements for the blood clotting process?
1. Presence of platelets produced by bone marrow
2. Von Willebrand factor generated by vessel endothelium
3. Clotting factors synthesized in the liver using vitamin K.
The _____ provides a non-thrombogenic surface
endothelium
The endothelium provides a non-thrombogenic surface:
1. The maintenance of a _____
2. The release of _____ activator
3. the activation of _____
4. The generation of _____
5. The release of _____
transmural negative electrical charge
plasminogen
protein C
heparin-like proteoglycans
PGI2
In intrinsic and extrinisic coagulation pathways, the terminal steps in both pathways are _____
the same
What things combine to form prothrombin activator?
Calcium
factors X and V
platelet phospholipids
Prothrombin activator converts _____ to _____
prothrombin
thrombin
The conversion of prothrombin to thrombin causes conversion of _____ in fibrin strands that create the insoluble blood clot.
fibrinogen
_____ inactivates coagulation factors and neutralizes thrombin
antithrombin III
When antithrombin III is complexed with naturally occurring _____, its action is accelerated, and provides protection against uncontrolled thrombus formation on the endothelial surface.
heparin
_____, a plasma protein, acts as an anticoagulant by inactivating factors V and VIII.
protein C
_____, another plasma protein, accelerates the action of protein C
protein S
_____ breaks down fibrin into fibrin degradation products that act as anticoagulants
plasmin
_____ disorders form thrombi
inherited
1. Antithrombin
2. Protein C
3. Protein S
4. FV leiden mutation
5. Hyperhomocysteinemia
6. Prothombin 20210
inherited disorders
_____ disorders increase in risk of blood clotting within the heart
acquired
1. Arrhythmia
2. Primarily atrial fibrillation
3. Placement of mechanical heart valves
4. Prolonged bed rest
5. Cancer
acquired disorders
_____ is an endogenous anticoagulant
antithrombin
_____ is a member of the serine protease inhibitor (serpin) family
antithrombin
_____ inactivates serine proteases IIa, IXa, Xa, XIa, and XIIa
antithrombin
Defects in the natural anticoagulants result in an increased risk of _____
venous thrombosis
_____ serves as an essential cofactor for the carboxylase that catalyzes carboxylation of glutamic acid resiudes on vitamin K-dependent proteins
vitamin K
_____ is found in leafy greens, cauliflower, and liver
vitamin K
The chief source of vitamin K is synthesis by bacteria in the _____ and in most cases, absence of dietary vitamin K is not at all deleterious
large intestine
The _____ obtains vitamin K from its mother by transplacental transfer
fetus
Vitamin K is an essential cofactor for the synthesis of _____
clotting factors
Vitamin K is a _____ soluble vitamin that is synthesized by intestinal bacteria
fat
In vitamin K deficiency, the liver produces _____ resulting in abnormal bleeding
inactive clotting factor
What are these? Factors II (prothrombin), VII, IX, and X
coagulation proteins
What are these? proteins C, S, and Z
anticoagulation
Vitamin K undergoes a cycle of _____ and _____ that allows its reuse
oxidation
reduction
Vitamin K (K1) is reduced to _____
vitamin KH2
_____ of vitamin KH2 provides the energy to drive the carboxylation reaction, leading to formation of gamma-carboxyglutamic acid residues and vitamin K oxide
oxygenation
_____ is reduced by another reductase back to vitamin K, ready to enter another cycle
vitamin K oxide
Anticoagulants such as _____ block the reduction of vitamin K oxide of vitamin K, explaining their antagonistic effects on this cycle.
Warfarin
1. Poisoning with vitamin K antagonists
2. Liver disease
3. Intestinal disease
4. Vitamin K deficiency in human infants
5. Reduced bone density may result from inadequate intake of vitamin K

What are these deficiencies in?
vitamin K
_____ can lead to death or permanent brain damage
vitamin K deficiency
At birth, the _____ has essentially no vitamin K reserves and a lack of vitamin K intake or situations that somehow interfere with absorption of bacterially-synthesized vitamin K
liver
Vitamin K has important role in production of bone proteins such as _____
osteocalcin
Several clinical trials support the proposition that, in certain situations, _____ supplements enhance the integrity of bone
vitamin K
_____ is the process of fibrin digestion by plasmin
fibrinolysis
_____ remodels the thrombus and limits its extension by proteolytic digestion of fibrin
plasmin
_____ preserves fibrin in wound while removing
plasmin
Endothelial cells synthesize and release _____ and _____
PAI
tPA
Clot retraction and clot dissolution are also significant to _____
hemostasis
_____ involves the interaction of substrates, enzymes, protein cofactors, and calcium ions that circulate in the blood or are released from platelets and cells in the vessel wall.
clot retraction and clot dissolution
Depletion of platelets must be _____ before hemorrhagic tendencies of spontaneous bleeding occur.
relatively severe
Bleeding results from _____ deficiency commonly occurs in small vessels and is characterized by petechiae and purpura.
platelet
_____ results from a decrease in platelet production
thrombocytopenia
_____ results from increased sequestration of platelets in the spleen
thrombocytopenia
_____ results from decreased platelet survival
thrombocytopenia
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