Glossary of Coag intro
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- What are 3 structural levels of the vasculature?
- 1. EC lining
- What does the EC lining release that affects coag?
- 1. Prostacyclin
2. Tissue fluid
- What is prostacyclin?
What is Thromboxane?
- -PGI2/Prostacyclin inhibits plt aggregation, dilates.
-TxA2 is a potent aggregator
- where does PGI2 come from?
where does TxA2 come from?
- PGI2 - EC cells
TxA2 - vasoconstriction
- How do ADP and ADPase affect coag?
- ADP --> procoagulant
ADPase --> anticoagulant
- How do these alter coag?
- Plasmin activ = anti
Thromboplast = procoagulant
- How do ThromboMODULIN and ThromboPLASTIN compare?
- Thrombomodulin inhibits coagulation.
Thromboplastin supports coagulation.
- What is the importance of the KININ system in coag?
- Bradykinin is most important;
-Activated by Thrombin (FxII)
- What are the serine protease inhibitors?
- -Natural anticoagulants
- List the 4 serpins
- 1. AT-III
4. HC-II (heparin cofactor)
- What are 3 possible factors that make the vasculature resist coagulation?
- 1. Heparan Sulfate
2. PGI2 (prostacyclin)
3. Smooth surface/neg charge
- What 5 factors are released from injured vessel lining?
- 1. Tissue Thromboplastin
2. Plasminogen Activator tpA
- What do platelets release in their release reactions?
- 1. ADP
- What 3 things are on the SURFACE of platelets?
- 1. PGI2
2. Neg charge
3. Heparan sulfate
- What activates:
-Intrinsic pathway factors?
-Extrinsic pathway factors?
- Intrinsic: exposed collagen
Extrinsic: tissue thromboplastin
- So tissue thromboplastin is another name for:
- Tissue factor
- What's the diff between serum and plasma?
- Plasma: has coag factors
- What factors are COFACTORS?
- V, VIII-C (8a), HMWK, Protein S, PF-3
- What factor is a transamidase?
- Factor XIII
- What are the 4 serpins?
- What are the 3 natural anticoagulants?
- 1. Thrombomodulin
2. Protein c
3. Protein S
- What are the 3 groups that factors are classified into?
- 1. Vit K dependent
- What are the Vit K factors?
- 2,7,9,10, Proteins C/S
- What are the Consumables?
- 1, 5, 8, 13
- What are the signalling, contact factors?
- 11, 12, Prekallikrein, HMWK.
- Where are they produced?
-VitK dependent factors
- Vit K = liver
Consumable = liver EXCEPT Fx8
Contact = liver
- Where is Factor 8 produced?
- Endothelial cells
- Where are they found?
-VitK dependent factors
- Vit K: serum
Consumables: ONLY plasma
Contact fxs: serum AND plasma
- Where is Thrombin mostly seen?
What factors are assoc w/ it?
- -Not appreciably in serum, consumed in clotting.
-Thrombomodulin (activ ProtC)
- What is Factor VII also called?
- Stable factor - in vitro; ironically has the shortest half-life in the body.
- What does Factor 7a do?
- Complexes with Tissue factor (thromboplastin) and activats factor X
- What CAN Fx 7 activate?
- What activates fx 7?
- 12, 10, 9, or itself (7)
- What helps Fx 9a activate Fx 10?
- 8a and PF3
- What is deficiency of Fx 9 called?
- Hemophilia B
- What helps Fx 10 to activate prothrombin?
- Fx V and PF3
- What is the PURPOSE OF protein C/thrombomodulin complex?
- To keep the coagulation LOCAL
- What activates Protein C?
- Thrombomodulin/Thrombin complex
- Other than inactivating Factors V and VIII, what does APC do?
- Stimulates tPA release to break clots.
- Why are the consumables called that?
- They are eaten up when a clot forms.
- What factors are found in platelet granules?
- 1, 2, and 13.
- What's a unique characteristic of the consumables?
- APR - increase in pregnancy, inflammation, oral contraceptive use
- What are the consumables again?
- 1 (fibrinogen) 5 8 13
- What is the structure of fibrinogen?
- 2 alpha chains
2 gamma chains
2 beta chains
- What does fibrinogen do and how?
- Helps platelet aggregation b/c its in platelet granules and on their surfaces.
- what is FIBRINOGEN a substrate for?
- 1. Thrombin -> activates it
2. Plasmin -> destroys it!
- What is yielded from:
- Thrombin = fibrnopeptides a/b
Plasmin = d and e fragments
- Whats factor 5 known as, why?
- Labile factor -> storing destroys it.
- What does Factor 5 do?
- Cofactor for Xa/Ca to activate prothrombin.
- What accompanies Fx VIII?
- Von willebrand factor - linked covalently.
- What is the inheritance of:
- 8C = sexlinked recessive
vWF = autosomal dominant
- How is 8C activity measured?
How is vWF measured?
- Where are 8C and vWF produced?
- Endothelial cells
- How is vWF deficiency SCREENED for? (3 methods)
- 1. Platelet function studies
- How is VIII:C activity measured?
- With an 8C assay
- Which can females have; Hemophilia A or von Willebrand's syndrome?
- vWF -> not sex linked.
- what is vWF important for?
- Platelet adhesion
- What is the role of factor 13?
- A transamidase - stabilizes fibrin clots.
- How is Factor 13 activity detected?
- UREA test
- What symptom associated with Fx 13 defic?
- Umbilical cord oozing.
- Which kinin-contact group member is important for activating fibrinolysis?
- Factor 12 --> Hageman
- What's another name for factor 12?
- Hagemann factor, or GLASS CONTACT FACTOR
- What does Factor 12 deficiency usually cause?
- Thrombosis, even though no history of bleeding.
- What activates Fx 12?
- Making contact with a negatively charged membrane - phospholipid, glass, etc.
- What kinin is activated by Fx 12 fragments?
- BRADYKININ - potent vasodilator, factor controlling bp
- What can Fx 12/12a do?
- -Activate plasminogen
- What is the ONLY FACTOR of the contact group that causes a bleeding problem if deficient?
- Factor 11!!!! XI
- What does HMWK form?
- What is unique about PK?
- Prekallikrein; deficiency prolongs PTT, and won't immediately correct without 1-hr incubation.
- What are the miscellaneous factors?
- 3 - tissue thromboplastin (tissue factor)
4 -> calcium!
- What is the role of tissue thromboplastin?
- Cofactor of Fx VII; to activate factor 10.
- What is activated to what in the coag cascade?
- Zymogen activated to serine protease
- What are the serine proteases?
- 9-12, 7, 2, Kallikrein, Plasmin, and Protein C
- What are the cofactors?
- 5, 8, Ca, PF3, HMWK
- What's neither a serine protease or a cofactor?
What is it then?
- Factor 13; a transamidase.
- How is the intrinsic cascade started?
- -Activators activate F12
-or its bypassed-
-11 activated by collagen
- What does F12 activate?
- Fx 11, PK, and plasminogen.
- What happens in the middle phase of the intrinsic cascade?
- 11a activates 9 -> 9a, then with VIIIa/PF3/Ca activates 10. Then it activates Thrombin.
- How does Thrombin affect the middle phase after it is activated?
- Accelerates the steps before it to enhance the cascade.
- What are the 3 parts of the terminal phase of the caog cascade?
- 1. Proteolytic - fibrinogen
2. Polymerization - of fragmn
3. STabilization - via 13
- What 2 things can interfere with the terminal phase?
- 1. Dysfibrinogenemia
- What is paracoagulation?
- When fibrogen is split into FSPs; these inhibit polymerization.
- What activates Plasminogen?
- What dampens down the coagulation cascade? (2)
- 1. Protein C eventulaly destroys V and VIII
2. IIa is consumed by thrombomodulin.
- What are the 7 inhibitors of the coag cascade?
- 1. Protein C/S
7. Bloodflow (shear force)
- What is the principle of the PROTIME?
- -addition of calcium
-addition of tissue factor
-Initiates CONTACT cascade (extrinsic)
- what is the ratio of reagent to test plasma?
- What factrs does the protime measure?
- 2, 5, 7, 10
- What is the tissue factor again?
- What causes abnormal PT results?
- -Liver disease
- For the PT INR:
-What is the normal range?
-What is the therapeutic?
- Normal = 0.8 - 1.5
Therapeutic = 2-3
- What are the reagents in the PTT?
- what is the source of heparin?
- what is the therapeutic range for heparin?
- 2-2.5 x the basiline PTT
- What are 3 indications for heparin/
- 1. Pre-Sx prophylactic
2. Pulmonary embolism
- What are 3 contraindications for heparin?
- 1. Liver disease
3. ATIII deficiency
- What are sources of error in the coag tests?
- -Inappr. anticoagulant
-contaminated specimens from IV line
-Older than 2hr specimens
- What commonly causes abnormal
- PT: Coumadin, Fx VII, Liver, Vit K defic
PTT: Heparin, Fx VIII, IX, severe liver disease
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