Coagulation

____________ is a process by which the body controls bleeding and maintains blood in a fluid form

Hemostatis

Primary hemostasis is activated by small vessel damage and controls the and (Very Primary)

Vascular system and platelets

Secondary hemostasis is caused by major trauma and contains the __ and

clotting factor system and Fibrinolytic system

The __________________ controls blood loss through Vasoconstriction as well as platelet and coagulation activation

Vascular system

The vessel wall consist of fibrous tissue and exposes ___________ when injured

collagen

Collagen reacts with platelets through __________

vWF

_____________________ have procoagulant, anticoagulant, and fibrinolytic properties

Endothelial cells

The 5 phases of platelet function is the ____________________________________________ phases

Adhesion, shape change, secretion of granules, Amplification, and Aggregation

The Adhesion phase is enabled by vWF connecting to platelets through ________ after injury

GP1B

In the secretion phase of platelets, 2 types of granules are released __ and _ granules

Dense and Alpha

Dense granules consist of ____________________ and alpha granules consist of clot-activating factors

Thromboxane A2

In the amplification phase, TXA2 is used to _____________________

call more platelets

The Aggregation phase is enabled by the _____________ of 2 platelets binding together through fibrinogen

GP IIb/IIIa

Coagulation factors are classified as either _, , or _

Enzymes, Substrates, or Cofactors

Factor I is also called _______________

Fibrinogen

Fibrinogen is ____________ while fibrin is not

soluble

Fibrinogen is converted to ________ in order to create clots

fibrin

Factor II is also called ___________

Prothrombin

Prothrombin, once converted to _____________, cleaves fibrinogen and activates many substances

thrombin

Factor III is also called _________________

Tissue factor

Tissue factor activates factor ____

VII

Factor IV is _______

Ca2+ (ionized calcium)

Calcium is needed for the activation of __ and

thromboplastin and prothrombin

Factor V is also called ______________

Proaccelerin

Proaccelerin accelerates ____________ activation

prothrombin

Factor VII is also called _______________

Proconvertin

Factor VIII is also called __________________

Antihemophilic Factor

Antihemophilic Factor as well as Proconvertin activates Factor ___

Factor IX is also called ______________________________

Plasma thromboplastin component

Plasma thromboplastin component works with ___________________ to activate factor X

Antihemophilic Factor

Factor X is also called ______________________

Stuart-Prower

Stuart-Prower merges with ________________ to activate factor II

Proaccelerin

Factor XI Activates Factor ___

Factor XII combines with _________________

PK and HMWK

Factor XIII stabilizes polymerized ___________

fibrin clots

The Fibrinogen Group consists of Factors _____________________

I, V, VIII, and XIII

The Prothrombin group consists of factors ______________________ (K-Mart)

II, VII, IX, X

The Contact Group consists of Factors _, As well as ___ (First Contact)

XI and XII; PK and HMWK

The Extrinsic pathway consists of factors ____________

III and VII (3+7=X)

The Intrinsic Pathway consists of factors ___________ (X marks the spot)

XII, XI, IX, VIII (12, 11, X, 9, 8)

The Common pathway consists of factors ____________

X, V, II, I (5x2x1=X)

The ____________________ is dependant on the Intrinsic pathway

Extrinsic pathway

The ___________________ happens in circulating blood and is slower but more important than the other pathways

Intrinsic pathway

The Intrinsic Pathways Cascade reaction is best explained as:

Factor XII is activated by vessel injury, then activates factor XI with PK and HMWKs help; Factor XIa works with calcium to activate Factor IX, which combines with Factor VIII and calcium ions to activate Factor X

The ____________________ begins from damaged cells outside the circulating blood

Extrinsic Pathway

The Extrinsic pathways Cascade Reaction is best explained as:

After cell injury, they release Factor III which binds with Factor VII along with calcium ions so it can be activated (Factor VII); Factor VIIa then activates Factor X in the presence of Ca2+

The Intrinsic and Extrinsic pathways both work to ______________

activate Factor X

The Common Pathways Cascade Reaction is best explained as:

Factor Xa (From either other pathway) combines with Factor V, calcium, and PF3 to Activate Factor II (Prothrombin) to Thrombin, which cleaves Factor I to produce Fibrin strands that aggregate to form a loose Fibrin Clot, (Thrombin) Activates Factor XIII with the help of Ca2+ which in turn crosslinks and stabilizes the loose clot, and finally activates Factors V, VIII, XI to create a postitive feedback loop and amplify clot formation

The common pathway ends with the formation of a _______________

fibrin clot

Inhibitors are _________________

anticoagulants

Regulatory Inhibitors (Natural Anticoagulants) include __________________________________

Antithrombin, Protein C and S, C4b binding protein, and TFPI

Protein C and S both inactivate Factors ____________

V and VIII

C4b Binding Protein binds ____________

Protein S

TFPI inhibits _____________________________

TF-VIIa complex and Factor Xa

PT measures the _____________________ and is used to monitor oral anticoagulation with the use of Warfarin (PT is outside to prepare for War)

extrinsic pathway

_________ measures the intrinsic pathway and is used to monitor anticoagulation therapy with the use of heparin

aPTT

__________________ assess the percent activity of specific clotting factors

Factor Assays

An Abnormal PT and Normal aPTT indicates ____________ deficiency

Factor VII

An abnormal aPTT and normal PT indicates a deficiency in Factors __________________________________

XII, XI, IX, VIII (Intrinsic pathway factors)

An Abnormal aPTT and PT show deficiencys in Factors ______________

X, V, II, I (Common Pathway Factors)

A platelet count of ___ will cause bleeding in surgery

A platelet count < __ may cause spontaneous bleeding

A decreased platelet count may be caused by __________________________

aplasia or cancer/chemotherapy

An __________________ can also cause a decreased platelet count because it traps a large quantity of platelets

enlarged spleen

Samples for platelet counts must be drawn into blue top tubes with a ~ ___ blood coagulation ratio

9:1

Platelet Satellitism can falsely lower platelet count and is caused by the use of a EDTA tube instead of a ________________

Blue Top Tube

_______ can lower platelet count

Drugs

_______________________________ is a decreased platelet count as a result of immune destruction

Idiopathic thrombocytopenic purpura

Acute ITP has a unique history of ______________

viral illness

Chronic ITP can be treated with _____________________________

steroids or a splenectomy

_______________________________________________ is caused by a ADAMSTS-13, which cleaves vWF, deficiency causing excessive platelet clots

Thrombotic Thrombocytopenic Purpura

_____________________________ is caused by E. Coli and causes bloody diarrhea

Hemolytic Uremic Syndrome

vWF disease shows decreased vWF and _________________ activity

Ristocetin

_____________________ is the most important qualitative disease of platelet adhesion

vWF disease

__________________________ is a defect of platelets involving GPIb/IX complex

Bernard Soulier Syndrome

Bernard Soulier Syndrome shows ___________________ in smear

giant platelets

Glanzmann's Thrombasthenia is an abnormality in ____________

GPIIb/IIIa

______________ can cause platelet abnormalities due to its inhibition of thromboxane A2 production

Aspirin

______________________________ may cause platelet abnormalities

MM and Waldenstroms Macroglobulinemia

Platelet Function is evaluated using analyzers and _______________________

Ristocetin immunoassays

Ristocetin causes ___________________________

platelet aggregation

Plasma clotting disorders are classified as ___________________

hemophilias

PCDs are caused by mutations and impairment of the __________________ function

hemostasis systems

Hemophilia ___ is associated with a Factor VIII deficiency

Hemophilia ___ is associated with a Factor IX deficiency

The symptoms of both Hemophilia A and B is bleeding in _ and during __________

joints; circumcisions

Hemophilia A and B are tested with ______ tests, however Factor VIII/ IX reagent tests can be done for a more A/ B answer

aPTT

Hemophilia A is treated with ______________ or a human derived Factor VIII concentrate

Cryoprecipitate

Cryoprecipitate contains ________________________

Factor VIII, Fibrinogen, and vWF

Hemophilia B can be treated with Factor IX concentrates or a _______________________ (concentrate of prothrombin group)

Prothrombin complex

Factor XIII deficiency symptoms are ______________________ and birthing issues

keloid scarring

_________________________ is needed for the activation of Factors II, VII, IX, and X

Vitamin K

Vitamin K deficiency is potentially caused by ________________

liver disease

The ___________________________ dissolves fibrin clots and promotes tissue healing

Fibrinolytic system

Fibrinogen can be increased in acquired disorders such as ________________________________

acute phase reactants, hepatitis, and athereosclerosis

Fibrinogen can be decreased in acquired diseases such as ___________________________________

liver/renal disease and DIC

Fibrinogen can be decreased in inherited diseases such as _________________________________

Afibrinogenemia and Hypofibrinogenemia

Afibrinogenemia shows <__ mg/dL of fibrinogen in the plasma

Hypofibrinogenemia shows ______ mg/dL of fibrinogen in the plasma

20-100

______________________ is a qualitative disorder of fibrinogen

Dysfibrinogenemia

Thrombin is required for the initial activation of the platelet system as well as _________________ production (a platelet inhibitor)

prostacyclin

In the fibrinolytic system, thrombin converts plasminogen to ______________ (digester of fibrin and fibrinogen)

plasmin

Thrombin helps to ______________________________

repair tissues and wounds

Components of the Fibrinolytic system include _______________________________________

Plasminogen, tPA, Urokinase, Factors of the Contact group, PAI-1, and A-2 antiplasmin

____________________ converts plasminogen to plasmin

tPA

_______________________ dissolves clots

Urokinase

__________________ suppresses tPA function

PAI-1

A-2 antiplasmin prevents plasmin from binding to ______________

fibrin

________________________ is the most important inhibitor of the Fibrinolytic System

A-2 antiplasmin

________________________ are a by-product of Fibrinolysis which contains the covalent bond made by Factor XIII

D-Dimers

Laboratory tests used to measure Fibrinolysis by-products include ______________________________________________

FSP/FDP tests and D-Dimer tests

Methods for D-Dimer testing include _______________________________________---

Immune Fluorescence, Immunoturbidity, and Chemiluminescence

D-Dimer assays are useful in monitoring __________________________________________

Thrombolytic therapy and Thromboembolic episodes

_____________________ is a hyperactivity of the coagulation and/or the fibrinolytic systems

DIC

Infections, Injury, Leukemia, Newborn Hemolytic Disease, and ___________________ can cause DIC

snake bites

Symptoms of DIC is __________________, Thrombotic episodes, and microangiopathic hemolytic anemia

external bleeding

DIC can cause ________________________________________ due to its placement of microthrombi in the small vessels

microangiopathic hemolytic anemia

DIC lab results show decreased _______________________________ (abbreviations increased)

Fibrinogen and Platelets

DIC can be treated with antibiotics; surgery; transfusion of FFP, pRBCs, and platelets; as well as ________________________________________________________

Heparin mixed with antithrombin

____________________ is the formation of a blood clot in the vasculature

Thrombosis

Arterial thrombosis primarily affects _________________________

Blood cells

Venous Thrombosis primarily affects ______________________

Fibrin and RBCs

____________________________________________ all can cause thrombosis

Vascular Injury; Platelet, Coagulation, and Fibrinolytic abnormalities; and coagulation inhibitor defects/deficiencies

Antithrombin and heparin work together to neutralize factors _________________________________

II, X, IX, XI, and XII

Protein C and S work together to deactivate Factors ________________

V and VIII

________________________________________ are inherited risk factors for thrombosis

Antithrombin Deficiency, Protein C and S deficiency, APCR, and Prothrombin mutations

Factor V Leiden is the most common form of _ and most common cause of inherited ________________________

APCR; Thromboembilism

Prothrombin mutations is the second most prevalent cause of inherited _______________________________

hypercoagulability

AS/LA and HIT are the most common __________________________

acquired thrombotic disorders

AS/LA creates antibodies against proteins _________________________________________________

B2-glycoprotein and apolipoprotein

__________________ inhibits TXA2 formation