Hemostasis

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julieaburch
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84864
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Hemostasis
Updated:
2011-05-11 09:58:57
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Hemostasis
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Hemostasis
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  1. This is the stoppage of blood loss from a damaged vessel while continuing to maintain the blood in a fluid state within the vessels
    Hemostasis
  2. What are the three types of Primary Hemostasis?
    • Platelet Adhesion via vWF
    • Platelet Aggregation
    • Platelet Plug Formation
  3. What are the two types of Secondary Hemostasis?
    • Coagulation Activation
    • Fibrin Clot Formation
  4. What are the three components of Hemostasis?
    • Vessels -- endothelium & sub-endothelium
    • Platelets
    • Plasma Proteins -- coag pathways, fibrinolytic pathways, & regulatory mechansims
  5. What initiates the platelet system?
    Collagen
  6. What initiates the clotting system?
    Tissue Factor
  7. What happens upon damage to the epithelium?
    Platelets come into contact with collagen & bind to it
  8. What is the bridging protein between Glycoprotein Ib in platelets and collagen in the sub-epithelium?
    von Willebrand Factor
  9. What factor complexes to von Willebrand Factor?
    Factor VIII
  10. What factor is synthesized by endothelial cells and megakaryocytes, and is found in plasma and platelet granules? It is stored in endothelial cells
    von Willebrand Factor
  11. When von Willebrand Factor complexes with GP Ib, it causes the release of ________ _______ from the platelet membrane. This activates the Prostaglandin Pathway, and Arachidonic Acid is converted to ___________ ______.
    • Arachidonic Acid
    • Thromboxane A2
  12. What are the four functions of Thromboxane A2?
    • Activation of Glycoprotein IIb/IIIa
    • Release of Platelet Granules
    • Activates Platelet Surface for Coagulation Reactions
    • Recruit Other Platelets via GP IIb/IIIa Activation
  13. What molecule forms the bridge between two glycoprotein molecules in a platelet plug?
    Fibrinogen
  14. What lab test is used to assess the function of the Intrinsic Pathway?
    PTT
  15. What lab test is used to assess the function of the Extrinsic Pathway?
    PT
  16. What factors are involved in the Intrinsic Pathway?
    • FXII
    • FXI
    • FIX
    • FVIII
  17. What factors are involved in the Extrinsic Pathway?
    FVII
  18. What factors are involved in the Common Pathway?
    • FX
    • FV
    • Thrombin
    • Fibrinogen
  19. What molecule cleaves Fibrinogen into Fibrin?
    Thrombin
  20. What factor adds the covalent bonds between the Fibrin molecules, forming the permanent cross-links?
    Factor VIII
  21. A deficiency of which Intrinsic Pathway factor does not bleed?
    FXII
  22. What is the mechanism for removing clots for wound healing? This system must be inactive unless needed, and must remain localized where the clot is present. These must not work in solution (plasma or blood), must be slow to be activated, and must be slow to break down the clot structure.
    Fibrinolytic System
  23. What is the most important co-enzyme complex in the Fibrinolytic System?
    Fibrin Clot
  24. What enzyme breaks down the fibrin clot within the fibrinolytic system?
    Plasmin
  25. What are the three regulatory mechanisms of the Fibrinolytic System?
    • Antithrombin
    • Protein C System
    • Tissue Factor Pathway Inhibitor
  26. What Fibrinolytic System regulatory mechanism inhibits coagulation enzymes, mainly thrombin & factor Xa? It inhibits at the active site, and is potentiated by heparin-like molecules on the EC surface.
    Antithrombin
  27. What Fibrinolytic System regulatory mechanism inactivates cofactors FV & FVIII? This requires complex formation.
    Protein C System
  28. What Fibrinolytic System regulatory mechanism inhibits factors VIIa and Xa? This inhibits the active site.
    Tissue Factor Pathway Inhibitor
  29. Which type of Hemostasis is the following symptoms associated with?

    Bruising, Purpura, Gum Bleeding, Tooth Extract Bleeding, Rectal Bleeding, Menorrhagia, Hematuria, & Nose Bleeds
    Primary: Platelet & von Willebrand Defects
  30. Which type of Hemostasis is the following symptoms associated with?

    Hemathrosis (bleeding in joints), Muscle Bleeds, Hematoma, Retroperitoneal Bleeds, Circumcision Bleeding, & Umbilical Stump Bleeding
    Secondary: Coagulation Defects
  31. What are the Vitamin K-Dependent Procoagulant Proteins?
    • Prothrombin
    • Factor X
    • Factor VII
    • Factor IX
  32. What are the Vitamin K-Dependent Anticoagulant Proteins?
    • Protein C
    • Protein S
    • Protein Z
  33. Does the PT increase or decrease in Vitamin K Deficiencies?
    Increases
  34. What does Oral Anticoagulant Therapy decrease the risk for?
    Thrombosis
  35. What is the International Normalized Ratio (INR) for the treatment of venous thrombosis?
    2.0-3.0
  36. All of the recommended International Normalized Ratio (INR) Ranges are targeted at 2.0-3.0, with the exception of the ratios for Mechanical Heart Valves & for Treatmetn of Lupus Anticoagulant. What is the ratio for these two?
    2.5-3.5
  37. Which laboratory test is used to monitor heparin therapy?
    PTT
  38. What acquired deficiencies does a PTT detect?
    • Lupus Anticoagulant
    • DIC
  39. What acquired deficiencies does a PT detect?
    • Vitamin K Deficiency
    • Liver Disease
    • Fibrinogen Deficiencies
  40. What is heparin administered for?
    To stop active clotting
  41. What test is used to rule out thrombosis, as well as to confirm and monitor DIC?
    D-dimer
  42. If a patient presents with mucosal bleeding, what type of hemostasis is likely involved? What follow-up testing should be done?
    • Primary
    • Testing for von Willebrand Disease: vWF, vWF Multimers
    • Platelet Testing: platelet count & function tests
  43. If a patient presents with muscle or joint bleeding, what type of hemostasis is likely involved? What follow-up testing should be done?
    • Secondary
    • PT & PTT

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