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Terms in this set (38)
-"stoppage of blood flow"
-complex set of reactions via several pathways, known as the coagulation cascade
Hemostasis is necessary for ______. When systems are not working right, there are two major problems.
necessary for healing of traumatic injuries
-hemorrhage vs. thrombosis
coagulation process starts upon _____, and continues through until ______ occurs
process starts upon injury and continues until clot lysis occurs
Virchow's Triad - what are the components and what does the triad do?
-sets the patient up for clotting
-Venous stasis= vessels not moving, blood flow compromised
-Hypercoagulability - some people are more likely to clot than everyone else ex: cancer patients, polycythemia
You don't need to have all 3 to have a clot
process of clotting if "set up" acronym and meaning
first line of defense?
process of becoming a platelet (different cells)
-Pluripotent stem cell
-megakaryote which divides and "explodes" - cell fragments are platelets
what is responsible for the proliferation, maturation of megakaryocytes
thrombopoietin which is turned off/on by need
where is thrombopoietin found?
liver, kidney, smooth muscle, bone marrow
life span of platelets ? where do you find platelets in the body?
life span = 8-12 days
1/3 in spleen as reserve, rest are in circulation
what is located on the platelet membrane and why is that important?
factors V, VIII, IX, various proteins, enzymes and von Willebrand's factor important here in that they make the platelet "sticky" and able to stick at site of action
______ inside platelets have _______(serotonin), ______(___), ______, _______(allow for binding), _______
Granules inside platelet have vasoconstrictors (serotonin), aggregators (ADP), fibrinogen, platelet factors ( allow for binding), electrolytes
_____ is a major mediator for coagulation
coagulation process list out steps
-vessel spasm- vasoconstriction from thromboxane A (a prostaglandin)
-Platelet plug formation - smallest damage is handled in this way, adhesion, then aggregation
-Fibrin clot development- actual formation of a clot via clotting factors
-Clot retraction-"tying the boot"
-Clot dissolution - clot starts dissolving shortly after formation (fibrinolysis)
thrombosis vs hemostasis
thrombosis= formation of an unwanted blood clot
hemostasis= normal stoppage of bleeding following a vessel injury
how many clotting factors are there? what are they?
-Fifteen factors (aka procoagulants) in all (13 with Roman numerals, 2 without
- they are all plasma proteins (except 3 and 4 thromboplastin and calcium) ; most are inactive while circulating in blood
if a clotting factor has an "a" after the number what does it mean?
factor is dormant unless activated
what factors get the process rolling in response to an injury?
contact factors: XII, XI, prekallikrein, high-molecular weight kininogen (HMWK)
what is the site of synthesis for most factors? what factors are not produced here?
liver! (except factors VIII, XI, XIII)
where does vitamin K synthesis take place? What is it necessary for?
Vitamin K synthesis (which takes place in gut) necessary for synthesis of II (aka prothrombin), VII, IX, X
Most factors also act as ______, which activates the succeeding ________. Factor ____ and ____ are the "busiest" factors which helps lead both individual pathways to a ______-.
Most factors also act as enzymes, which activates the succeeding procoagulants. Factor VIII and X are the "busiest" factors which helps lead both individual pathways to a common pathway.
What are the two major pathways? please describe them
Intrinsic pathway:initiated when contact is made between blood and exposed endothelial surfaces; relatively slow
Extrinsic pathway: initiated upon vascular injury or trauma which leads to exposure to tissue factor (a/k/a factor III); faster
what does the intrinsic pathway involve? blood is exposed to what?
Endothelium: inner lining of blood vessels
what does the extrinsic pathway involve? vascular injury or trauma leading to exposure to what?
Tissue factor: found as a protein on cells; activated upon injury
coagulation cascade step by step
1) vascular injury occurs
2) vasoconstriction and platelet adhesion
3) unstable platelet plug forms
4) "Simultaneous" activation of intrinsic pathway (with exposure of factor XII) and extrinsic pathway (turned on by tissue factor)
5) common pathway activated
6) Xa converts prothrombin to thrombin
7) thrombin converts fibrinogen to fibrin
8) factor XIII stabilizes clot into meshwork
9) fibrin strands retract (like tying a boot)
10) injury site is sealed
intrinsic pathway - speed? begins where?
extrinsic pathway- speed? trigger? what is released?
intrinsic pathway- slow process, begins in blood/plasma itself
extrinsic pathway- faster, trigger is trauma to blood vessel or surrounding tissues; tissue factor is released by endothelium starts process - requires components extrinsic to blood ?
both extrinsic and intrinsic pathways activate _____
factor X (10)
coagulation by the numbers- intrinsic
this is a slower process that is happening in the blood/plasma itself
PK, K, HMWK (contact factors)
8 → 8a
coagulation by the numbers- extrinsic
this is a faster process that is happening in the endothelium- trauma to bv triggers endothelium to release tissue factor
TF + 7 →7a
coagulation by the numbers-common
5a → ProT → T
Fibrinogen → fibrin
13 → 13a =
clot retraction or dissolution is a process known as
there are natural inhibitors that limit clot formation such as _____, ________, _________
antithrombin III, plasminogen activators, tissue factor pathway inhibitor
fibrin is eventually split by what happening ? what is left over and what happens to the left overs?
conversion of plasminogen to plasmin causes fibrin to split which leads to degradation products - plasmin digests fibrin strands and clotting factors
what safeguards are there to prevent body-wide fibrinolysis?
-circulating plasmin is inactivated by alpha-2 plasmin inhibitor, which limits fibrinolysis to affected clot
what are our natural anticoagulants ?
- antithrombin III
what does antithrombin III do? what does thrombin do?
antithrombin III= inactivates coagulation factors and neutralizes thrombin
thrombin= helps with conversion of fibrinogen to fibrin
what does Protein C do? Protein S?
Protein C=inactivates factor V and VIII
Protein S= accelerates protein C
examples of lab studies of coagulation used in clinical practice
- prothrombin time (PT) and international normalized ratio (INR)
-Partial thromboplastin time (PTT)
-Activated PTT (aPTT)
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