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Intro to hemostasis, primary hemostasis, secondary hemostasis, quality assurance, fibrinolytic systems.
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Analogy of Hemostasis:
Roads =
Road Surface =
Traffic Flow =
Potholes =
Calling 311 to have pothole filled =
Construction workings patching potholes =
Asphalt pressing device =
Roads = Blood Vessels
Road Surface = Endothelium
Traffic Flow = Blood Flow
Potholes = Vascular Damage Injury
Calling 311 to have pothole filled = Chronic Signaling
Construction workings patching potholes = Platelets
Asphalt pressing device = Coag Factors
Stages of Hemostasis
Primary Hemostasis
Secondary Hemostasis
Fibrinolysis
Primary Hemostasis
Platelet plug formation at site of vascular injury
Secondary Hemostasis
Enzymatic Activation of Coagulation Factors to stabilize the platelet plug - Fibrin / Fibrinogen
Fibrinolysis
Gradual Dissolving of Clot and initiation of vascular healing
Ligands:Platelet Receptor(s)
vWF:GPb/IX/V
Collagen:GPIa/IIa;GPVI
Fibrinogen: GPIIb/IIIa
ADP:P2Y1 and P2Y12
Thrombin: PAR1 and PAR4
What are the Platelet Receptor(s) for vWF?
GP1b / IX / V
What are the Platelet Receptor(s) for Collagen?
GPIa / IIa; GPVI
What are the Platelet Receptor(s) for Fibrinogen?
GPIIb / IIIa
What are the Platelet Receptor(s) for ADP?
P2Y1 and P2Y12
What are the Platelet Receptor(s) for Thrombin?
PAR1 and PAR4
Coagulation Factors
Includes: I-XIII (except VI), HK & HMWK, and PK
Factor I Common Name
Fibrinogen
Factor II Common Name
Prothrombin
Factor III Common Name
Tissue Factor, Tissue Thromboplastin
Factor IV Common Name
Calcium
Factor V Common Name
Labile factor, Proaccelerin
Factor VII Common Name
Stable factor, Proconvertin
Factor VIII Common Name
Antihemophilic factor
Factor IX Common Name
Christmas factor, Plasma thromboplastin component
Factor X Common Name
Stuart factor, Stuart-Prower factor
Factor XI Common Name
Plasma thromboplastin antecedent
Factor XII Common Name
Hageman factor
Factor XIII Common Name
Fibrin-stabilizing factor
Factor HK, HMWK Common Name
High-Molecular-Weight Kininogen, Fitzgerald factor
Factor PK Common Name
Prekallikrein; Fletcher factor
Classification of Coagulation Factors: Functional Groupings
Substrate: Fibrinogen
Cofactor: V, VIII, & HMWK/HK
Enzymes:
Serine Proteases: IIa, VIIa, IXa, XIa, XIIa, PK
Transaminase: XIIIa
Classification of Coagulation Factors: Structural (Physical) Groupings
Contact Group: XII, XI, HMWK/HK, PK
Prothrombin Group: II, VII, IX, X, Protein C & S
Fibrinogen Group: I, V, VIII, XIII
Which Structural Group(s) are NOT consumed during clotting?
Contact group and Prothrombin group (EXCEPT FII)
Which Structural Group(s) are consumed during clotting?
Fibrinogen group and FII of the prothrombin group
Which Structural Group(s) are Vitamin K DEPENDENT?
Prothrombin group
Contact Group Factors
XII, XI, HMWK, PK
Prothrombin Group
II, VII, IX, X, Protein C & S
Fibrinogen Group Factors
I, V, VIII, XIII
Clotting Factor Mnemonic
Foolish People Try Climbing Long Slopes After Christmas Some People Have Fallen
Foolish People Try Climbing Long Slopes After Christmas Some People Have Fallen
Fibrinogen (I), Prothrombin (II), Tissue Factor (III), Calcium (IV), Labile Factor (V), Stable Factor (VII), Antihemophilic Factor (VIII), Christmas Factor (IX), Stuart-Prower Factor (X), Plasma Thromboplastin (XI), Hageman Factor (XII), Fibrin Stabilizing Factor (XIII)
“Foolish” corresponds to which clotting factor?
Fibrinogen (I)
“People” corresponds to which clotting factor?
Prothrombin (II)
“Try” corresponds to which clotting factor?
Tissue Factor (III)
“Climbing” corresponds to which clotting factor?
Calcium (IV)
“Long” corresponds to which clotting factor?
Labile (V)
“Slopes” corresponds to which clotting factor?
Stable Factor (VII)
“After” corresponds to which clotting factor?
Antihemophilic (VIII)
“Christmas” corresponds to which clotting factor?
Christmas (IX)
“Some” corresponds to which clotting factor?
Stuart-Prower (X)
“People” corresponds to which clotting factor?
Plasma Thromboplastin Antecedent (XI)
“Have” corresponds to which clotting factor?
Hageman Factor (XII)
“Fallen” corresponds to which clotting factor?
Fibrin-stabilizing (XIII)
Intrinsic, Common, and Extrinsic Memory Chart
Intrinsic: TENE = 12, 11, 9, 8
Common: $$ = 10 → 5 → 2 → 1
Extrinsic: = 3+7
Intrinsic Pathway Clotting Factors
XII, XI, IX, VIII
Common Pathway Clotting Factors
X, V, II, I
Extrinsic Pathway Clotting Factors
VII, III
Pre-Analytical Tests: Specimen Stability
PT
PTT (non-heparinized)
PTT (heparinized)
Fibrinogen
D-Dimer
Unfractionated Heparin & LMWH
Which Pre-Analytical Tests is NOT stable for only four hours? How long is it stable for?
Prothrombin Time (PT) is stable for 24 hrs
Which Pre-Analytical Test must be centrifuged? When must it be tested?
PTT (Heparinized) must be centrifuged 1 hour after collection and tested within 4 hours of collection
What temperature is required for Pre-Analytical Test Specimen Stability
Room temperature
Which Pre-Analytical Tests are stabile for four hours?
PTT (non-heparinized)
PTT (heparinized)
Fibrinogen
D-Dimer
Unfractionated Heparin & LMWH