Factor I
Fibrinogen
Factor II
Prothrombin
Factor III
Tissue Factor
Factor IV
Ionic Calcium
Factor V
Labile factor
Factor VII
Stable factor proconvertin
Factor VIII
Antihemophilic factor
Factor IX
Christmas factor
Factor X
Stuart-Prower
Factor XI
Plasma thromboplastin
Factor XII
Hageman factor
Factor XIII
Fibrin-stabilizing factor
What factors are serine protease?
Factor II, VII, IX, X, XI, XII, Prekallikrein
What factors are cofactors
Factor III, V, VIII, HMWK
What factors are transglutaminase
XIII
What factors are in the Extrinsic pathway complex
Ca, VIIa, TF
What factors are in the Intrinsic pathway complex
Ca, PF, VIIIa
What factors are in the prothrombin complex
Ca, PF, Xa, Va
Hematology
study of blood cells (RBCs, WBCs, platelets) and the blood forming tissues in both the healthy and pathological states
Buffy coat
the white layer of WBCs and platelets that accumulate at the middle of separated non-clotted blood
Hemostasis
arrest of bleeding by spontaneous formation of hemostatic platelet plug; cellular, chemical, and fluid elements of blood in constant exchange to maintain the balance between supply and demand
Major elements of plasma
Water, Proteins, Antibodies, Lipids, CHO, electrolytes, clotting factors, enzymes, vitamins, and hormones
Serum vs Plasma
Serum is fluid obtained when coagulated blood has been centrifuged whereas plasma is obtained when its anticoagulated blood
Serum vs Plasma (in relation to Fibrinogen)
Serum does NOT contain Fibrinogen (a clotting factor) and plasma DOES (because no clot has formed)
How are platelets produced?
Endometriosis (maturation of cells in megakaryocytic lineage) occurs in the megakaryocytic lineage to produce platelets
Released from MK-III
What is the life-span of platelets?
7-10 days (very short)
What does the platelet ultrastructure including?
Peripheral zone, So gel zone, Membrane zone, and organelle zone
Discuss the constituents/functions of the peripheral zone
Glycoproteins: binding of different coag factors to platelet
Open canalicular system: allows substances contained in alpha and dense granules to be released and enable aggregation
Glycocalyx: contains blood group antigens and HLA Ags
Discuss the constituents/functions of the so gel zone
Microtubules: actin and myosin microtubules that maintain structure and shape of platelet
Actin
Microfilaments, contractile proteins
Discuss the constituents/functions of the membrane zone
Dense tubular system: stores calcium, thromboxane A2 and phospholipase C
Discuss the constituents/functions of the organelle zone
Alpha granules
Dense granules
Glycogen
Mitochondria
Golgi apparatus
Discuss adhesion vs aggregation
Adhesion: when platelets bind to elements of the vasculature when there is a breach
Aggregation: when irreversibly bind to one another
Discuss the variables in adhesion
vWF and collagen bind to their receptors on platelets to stop them from exiting (imagine using gorilla glue to stop a leak)
Fibrinogen with Ca binds to receptor and activates
Discuss the variables in Aggregation
Thromboxane A2 and ADP are released from DTS to aggregate
Fibrinogen with help of Ca facilitates
Discuss the process of platelet plug formation
There is a breech
vWF is released bc it binds to collagen and platelets have the receptor for vWF
Platelets bind via a bridge (GP-Ib) to the receptor and change in shape to increase surface area
Fibrinogen receptors are then released due to platelet activation (GPIIb/IIIa)
Alpha and dense granules are released
Alpha: releases more vWF and PDGF to help wound healing
Dense: ADP is released and Thromboxane which binds to their receptors and caused more platelets to be activated
Circulating fibrinogen from liver binds to new fibrinogen receptors and now platelets can heal to one another (now we have a plug aka aggregation)
Cyclooxygenase
enzyme that transforms arachidonic acid to prostaglandin endoperoxides; aspirin INHIBITS
Thromboxane A2
the converted version of PG endoperoxides that causes further aggregation
(can not be created without cyclooxygenase because this transforms arachidonic acid to PG endoperoxides)
Coagulation cascade model pathways
Intrinsic, extrinsic, and common
Intrinsic system
Collagen is released
XIIa is produced
XIIa combines with HMWK cofactor to turn PK into K
Xlla combines with HMWK cofactor to activate XIa
XIa with Ca activates IXa
Ixa w/ cofactor VIIIa & Ca & PF create intrinsic tenase complex
Complex activates Xa
Extrinsic system
Injury occurs
III is released
VIIa produced
Combines with TF
Vlla & TF combine with Ca to form extrinsic tenase complex
Complex activates X to Xa
Common pathway
Xa combines with Ca, PF, and factor Va to form prothrombinase complex
Complex activates II
IIa activates I (which is unstable bc its soluble)
IIa activates XIII
XIIIa combines with Ca and stabilizes soluble Ia
End with stable fibrin clot (insoluble fibrin polymer)
Cofactor
A clotting factor that acts to enhance the activation of another clotting factor
What coagulation factors function as cofactors
TF, VIII, V, and HWMK
Site of synthesis, requirement of K and function of Factor 1
found in alpha granules of platelets, polymerizes and forms fibrin, can act as acute phase reactant
Site of synthesis, requirement of K and function of Factor 2
Synthesized in liver, vitamin K dependent, acts as serine protease to cleave factor I to Ia and factor XIII to XIIIa
Site of synthesis, requirement of K and function of Factor 3
present throughout body, function is cofactor to VII
Site of synthesis, requirement of K and function of Factor 4
required for aggregation of platelets, function is as mineral allosteric activator of other factors
Site of synthesis, requirement of K and function of Factor 5
in alpha granules, function cofactor to X, serine protease involved in prothrombinase complex
Site of synthesis, requirement of K and function of Factor 7
serine protease that is used to make extrinsic tenase complex, vitamin K dependent, produced by liver
Site of synthesis, requirement of K and function of Factor 8
cofactor to factor IX, part of intrinsic tenase complex, synthesized in liver and endothelial cells
Site of synthesis, requirement of K and function of Factor 9
serine protease that is part of the intrinsic tenase complex, vitamin K dependent, synthesized in liver
Site of synthesis, requirement of K and function of Factor 10
serine protease that forms the prothrombinase complex in common pathway, vitamin K dependent, produced in liver
Site of synthesis, requirement of K and function of Factor 11
serine protease that converts factor IX to IXa, produced in liver but can be found in platelets
Site of synthesis, requirement of K and function of Factor 12
serine protease that functions to cleave PK to K and factor XI to XIa, produced in liver
Site of synthesis, requirement of K and function of Factor 13
transglutaminase (only one) that stabilizes soluble fibrin monomer with covalent bonds to insoluble fibrin polymer
What factors of vitamin K-dependent
Factor II, VII, IX, and X
Discuss role of vWF in relation to VIII
vWF and VIII circulate together as a complex in the plasma
vWF is the protective carrier for VIII (protects from degrading)
List the functions of thrombin, antithrombin, TFPI, and activated Protein C: THROMBIN
thrombin: activate V, VIII, XI, XIII; aggregate platelets, activate protein C
Function of antithrombin
a substance in the blood that limits the blood’s ability to clot (coagulation) and the primary inhibitor of thrombin
Function of TFPI
inhibit FXa, inhibit VIIa and TF
Function of protein C
inactivate Va and VIIIa to slow down coagulation
Explain the structure of fibrinogen assessing how it’s function is related to its structure
3 pairs of polypeptide chains: alpha, beta, and gamma held together by disulfide bonds
these bonds allow for a stable fibrin clot (because they are covalent)
Summarize the functionality of the vitamin K dependent factors
these factors bind VK epoxide to obtain a Ca binding region
VK epoxide is carboxylated VK hydroxyquinone with a negative charge (due to 2 carboxyl groups) that allows Ca to bind
Compare and contrast the different naturally occurring inhibitors of coagulation in relationship to their function (called anticoagulants): NITRIC OXIDE
inhibits platelet adhesion and aggregation
Hep sulfate
enhances the actions of antithrombin
TFPI
inhibits factors Xa, VIIa, and TF to slow down coagulation system
Thrombomodulin
activates protein C
EPCR
increase protein C activation rate
Compare and contrast the intrinsic pathway, common pathway, and the extrinsic pathway of coagulation in the Cascade Model of Coagulation and list factors involved in the tenase complex and prothrombinase complex
has factor HMWK, XIa, XIIa, K, and IXa, VIIIa while extrinsic pathway with TF, VIIa
both contact Ca
extrinsic pathway complex: TF, VIIA, Ca
intrinsic pathway complex: IXa, VIIa, Ca, PF
Describe the three phases of Cell-based model of coagulation and factors involved: INITIATION
VII in blood is activated by TF which forms extrinsic tenase complex and leads to activation of IX and X, leading to thrombin, leading to platelet activation via PAR1 and PAR2
Amplification
platelets are activated, vWF is released, and V, VIII, XI are activated on platelet surface
Propogation
Xa is produced and IXa-VIIIa complex and prothrombinase complex leading to massive amounts of thrombin; platelets are linked by fibrinogen through receptors GPIIb/IIIa
Discuss the process of fibrinolysis including the role of tissue plasminogen activator (TPA), plasminogen and plasmin; state regulators of fibrinolysis
the breakdown of fibrin by plasmin
regulators: plasminogen activator inhibitor-1 and TAFI (both inhibit)
TPA converts plasminogen to plasmin
Compare and contrast coagulation factors in the prothrombin group, contact group, and fibrinogen group delineating factors in each group as well as factors contained in serum, plasma, and absorbed plasma: PROTHROMBIN GROUP
II, VII, IX, and X
not present in adsorbed plasma and all except II are in serum
Fibrinogen group
I, V, VIII, XIII
all present in adsorbed plasma but not in serum
Contact group
XI, XII, PK, HMWK
present in both absorbed plasma and serum