Coagulation-diagnostics

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Author:
mrman
ID:
119485
Filename:
Coagulation-diagnostics
Updated:
2011-11-28 21:46:36
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Coagulation
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Coagulation-diagnostics
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  1. Procoagulant acitivity
    causes clotting

    -Clotting factors
  2. Anticoagulant activity
    inhibit clotting

    • -Protein C
    • -Protein S
    • (both Vit. K dependent)
  3. 4 phases of hemostasis
    • 1. Initiate/form platelet plug
    • 2. Propogation of clotting cascade
    • 3. Cascade termination by anithrombotic control mech.
    • 4. Fibrinolysis removes clot
  4. Platelets
    circulating cytoplasmic fragments from megakaryocytes in bone morrow

    -spleen holds RBC and 1/3 platelets; constricts to squeeze out platelets in trauma

    -normal count 150-450 bil/L
  5. Clotting factors
    -synthesized in liver (except VIII, vWF made by EC)

    -most are serine proteases the cleave other factors into active/inactive fragments
  6. Gamma-carboxylated Vit. K dependent factors
    • II
    • VII
    • IX
    • X
    • protein C
    • protein S
  7. Extrinsic pathway
    TF + Ca + VII turns on Extrinsic Xase complex
  8. prothrombinase complex
    cleaves Factor II (prothrombin) to Factor IIa (thrombin)

    -end of step 2
  9. Intrinsic Xase complex
    XII act + XI act +IX act + Ca + phospholipid + VIII

    turns on intrinsic xase complex
  10. Cascade termination
    • 1. Thrombin activates APC -> cleaves VIII & Va
    • -destroys intrinsic xase and prothrombinase complex

    • 2. Endothelium releases heparin -> binds to ATIII
    • -inhibits activation of several clotting factors

    • 3. Dilution by blood flow
    • 4. Activated clotting factors cleared by reticuloendothelial cells in liver and spleen
  11. Major screening tests
    • -CBC w/platelet and Hb
    • -PT/INR
    • -PTT
    • -Fibrinogen level
    • -FDPs, FSPs, D-dimers
  12. FDPs
    • fibrin degredation products
    • -also known as FSPs, D-dimers

    • -activated plasmin breaks down clot into FDPs
    • -FDPs can coat platelets and act as weak anticoagulant

    -can tell you how far along clotting has ocurred
  13. synthetic t-PA
    purified urokinase/streptokinase

    • -used therapeutically for fibrinolysis
    • -breaks down clots in coronary and pulmonary arteris

    t-PA + plasminogen --> plasmins --> FDP
  14. Follow-up tests to screening tests
    • Specific factor assays
    • -Antigen (quantity/protein)
    • -Activity (quality/function)
    • -VII, VIII, IX, Xa

    • Tests of Fibrinolysis
    • Specific Platelet function test

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