Coagulation

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Corissa.Stovall
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248098
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Coagulation
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2013-11-21 14:12:47
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A&P Exam 5
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  1. What are the 3 layers of the normal vessel wall??
    • 1. intima
    • 2. media
    • 3. adventitia
  2. The intima is the _____ layer.
    innermost
  3. What is the function of the intima layer of a vessel?
    Separates the blood from the vessel

    • Notes from book
    • *forms a barrier separating the fluid contents within the BV from the highly thrombogenic material in the subendothelial space
    • *repels blood contents from vessel wall preventing activation of clotting mechanism
    • *when damage occurs.. this process does not occur
  4. What is the intima made up of??
    endothelial cells
  5. Name 5 things that are synthesized and secreted by endothelial cells...
    • 1. Von Willebrand factor
    • 2. Tissue factor
    • 3. ADP
    • 4. NO
    • 5. Prostacyclin
  6. What does Von Willebrand factor do within the intima layer??
    it is a cofactor for the adherence of platelets to the vessel wall
  7. What does tissue factor do within the intima layer?
    activates the clotting cascade
  8. What does ADP do within the intima layer?
    controls blood flow by vasoconstriction
  9. What does NO and prostacyclin do within the intima layer??
    controls blood flow by vasodilation
  10. What is the 2nd layer of the vessel wall called?? what is another name for it??
    • Media
    • or
    • Thombogenic layer
    • or
    • subendothelial
  11. What does the media layer of the vessel wall contain?? and what does it do?
    collagen --- which stimulates platelet attachment to the vessel wall

    • notes from book
    • this layer if very active.. it facilitates the anchoring of fibrin during the formation of a plug
  12. What is the 3rd layer of the blood vessel called? and what is it responsible for?
    Adventitia

    controls blood flow and influences vessel contraction
  13. What influences the adventitia layer and where do these influences come from??
    NO and prostacyclin

    these are produced by endothelial cells
  14. Within the adventitia layer, what does NO do??
    (4 things)
    • 1. inhibits platelet adhesion
    • 2. inhibits aggregation
    • 3. inhibits binding of fibrinogen between glycoprotein IIb/IIIa complex
    • 4. promotes smooth muscle relaxation resulting in vascular vasodilation
    • from book --- this vasodilation causes increased blood flow which allows for procoagulant mediators to be washed away
  15. NO causes a metabolic reaction to occur within the endothelial lining of the vessel... what exactly happens??
    L-arginine is converted into NO which activates guanylate cyclase producing cyclic GMP which causes muscle relaxation
  16. What is prostacyclin synthesized from??
    prostaglandin
  17. Prostacyclin is a powerful ________.
    vasodilator
  18. What does prostacyclin do??
    interferes with platelet formation and aggregation
  19. What are platelets formed from??
    formed in bone marrow from megakaryocytes
  20. Where are platelets typically located within the vessel???
    they tend to be pushed against the lining of the vessel

    • from book
    • they are smaller than other constituents of blood, therefore they are strategically pushed away to the vessel edge to be available to react to injuries
  21. Platelets contain contractile proteins..what are these proteins in charge of??
    storing large amounts of calcium and enzymes
  22. Platelets contain alpha and dense granules..what do each of these granules do??
    alpha --- store proteins such as vWf, fibrinogen, fibronectin, platelet factors4, platelet growth factor

    dense --- store nonproteins such as serotonin, ADP, ATP, histamine, epi
  23. What do platelet granules synthesize??
    prostaglandins

    these help to promote vascular and local tissue reactions
  24. What do platelets produce during the initial portion of vessel injury?? and what does this do??
    thrombin

    activates some of the coagulation factors, recruits platelets to the site of injury
  25. Platelets are typically unactivated... what activates them???
    vascular injury
  26. What occurs in response to injury the vessel???
    the formation of a clot
  27. What are the steps of hemostasis when vessel injury occurs?
    • 1. vessel spasm
    • 2. formation of the platelet plug
    • 3. blood coagulation
    • 4. clot retraction
    • 5. clot dissolution
  28. What initiates the constriction of the vessel during injury??
    neural reflexes

    vessel wall will immediately contract to decrease blood flow via ANS
  29. When the vessel spasms to constrict the tissue what is released??
    thromboxane A2, ADP and prostacyclin
  30. What does Prostacyclin do when released during vessel spasm after injury??
    dilates the surrounding tissue to prevent further bleeding, sends blood to surrounding organs and tissues instead of site of injury
  31. The outer coating of a platelet is covered by _____.
    glycoproteins

    GPIIb/IIIa binds fibrinogen and bridges one platelet to another.
  32. After the vessel contracts, then what occurs??
    Formation of the platelet plug
  33. What occurs during the formation of a platelet plug??
    vWF moves from endothelial cells and adheres to the damaged vessel
  34. Platelets change their shape once activated..what is this shape and why do they do this???
    change from round disc like shape to an odd shaped form (oval and irregular) to create a block and prevent bleeding

    when they change shape they also release their contents
  35. What are the parts called that stick out from the platelet??
    glycoproteins...these parts help the platelets stick together

    they also help in promoting healing
  36. Platelet adhesion can not occur without??
    vWF
  37. What activates the platelet??
    Thrombin (factor IIa)

    also vascular injury starts the whole process
  38. When they platelet is activated what is released from the platelet??
    thromboxane A2 and ADP


    **at different parts through the repair of the vessel, they also release thrombin and growth factors
  39. What does P-selection have to do with the platelet plug formation??
    it participates in aggregation
  40. Defective platelet plug formation occurs in patients who are deficient in ___ or ____ ____ ____.
    platelets or Von Willebrand's Factor
  41. Platelets also release growth hormones during the formation of the platelet plug..why is this??
    they are released for endothelial and arterial smooth muscle cells...they help maintain normal vascular integrity.
  42. Name a few drugs that inhibit platelet function??
    • ASA
    • ticlid
    • plavix
    • integrillin
    • aggrostat
    • reopro
  43. What does ASA block to inhibit platelet function?? How long does ASA work??
    blocks cycloxgenase --- blocks enzyme TXA2

    works for the life of the platelet
  44. What does Plavix and ticlid inhibit to block platelet function??
    ADP pathway
  45. What do integrilen, aggrostat and reopro block??
    fibrinogen receptors
  46. What are 3 requirements for the blood clotting process???
    • 1. presence of platelets
    • 2. vWF
    • 3. clotting factors synthesized
  47. What is the platelet plug reinforced by??
    fibrin clot
  48. Name these clotting factors:
    1
    2
    3
    4
    8
    9
    13
    • 1. fibrinogen
    • 2. prothombin
    • 3. tissue thromboplastin
    • 4. ionized calcium
    • 8. antihemophilic factors
    • 9. plasma thromboplastic component or Christmas factor
    • 13. fibrin stabilizing factor
  49. What does the "a" after a factor mean??
    it has been activated
  50. Once these factors are activated..what are they called??
    1
    2
    8
    9
    • 1. fibrin
    • 2. thrombin
    • 8. hemophilia A
    • 9. hemophilia B
  51. List the clotting factors in the INTRINSIC pathway...
    • 12 ----> 12a
    • 11 ----> 11a
    • 9 ---->9a
    • 8a

    then combines with extrinsic to make the common pathway
  52. List the clotting factors in the EXTRINSIC pathway...
    factor 3 and 7

    combine with 10 to complete the common pathway
  53. List what happens in the common pathway
    • factor 10 ---- 10a
    • prothrombin (2)--->thrombin (2a)
    • converts
    • fibrinogen (1) ----> fibrin (13)
  54. What is the result of the common pathway?
    fibrin
  55. What does proteolysis mean??
    breaking down the precursor to release the active form of a clotting factor
  56. What part of the pathway does heparin work on?? and how can heparin be measured???
    Intrinsic

    PTT
  57. What part of the pathway does Coumadin work on?? and how can you measure it??
    Extrinsic

    PT/INR
  58. LMWH inhibits which clotting factor??
    10

    has no real other effects on other factors
  59. Once the vessel is sealed thrombin will act like an _____.
    anticoagulant
  60. Once the vessel is sealed how does thrombin work???
    • releases TPA---tissue plasminogen activator
    • stimulates proteins C&S
    • works with antithombin III
  61. Coagulation proteins are made where??
    in the liver
  62. What factors are depending on vit k?
    2, 7, 9, 10
  63. When does the clot retract and what exactly does this mean?
    20 to 60 mins after the clot is formed

    this means that the clot is pulled together using actin and myosin
  64. The clot will start to break down short after retraction once the vessel is sealed...how does plasminogen act here???
    • plasminogen activates to plasmin
    • plasmin digests fibrin strands causing the clot to dissolve
  65. What are two activators of plasminogen??
    tissue plasminogen activator and Urokinase type plasminogen activator
  66. What does antithrombin III do??
    inactivates clotting factors and neutralizers thrombin
  67. What does protein C do?
    inactivates factors 5 and 8
  68. What does protein S do??
    accelerates the action of protein C
  69. What is the normal bleeding time??
    3-7 secs


    *this is not a routine test
  70. What is the normal platelet count?
    150,000 to 300,000 mm3
  71. What is the normal PT? what is this value altered by?
    12-14 sec

    coumadin
  72. What is the normal INR??
    1.5-2.5
  73. What is the normal PTT?  What alters this level??
    25-32

    heparin/lovenox
  74. What is the normal fibrogen level??
    >150 mg/dl
  75. what is the normal value of fibrinogen degradation products??
    <10mcg/ml

    measures by products of clot dissolution
  76. What is the normal D dimer?
    <500mg/ml


    degradation products secondary to fibrinolysis
  77. What is the normal value for antithrombin III???
    80-120%

    if this is decrease---can explain reason for heparin not working well

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