Hemorrhage and Thrombosis

hemorrhage and thrombosIS

failure of hemostatis leads to _________ or ________________

hemorrhage

_________________: Extravascular loss of blood

thrombosis

_____________: Inappropriate formation of intravascular clots

(pulmonary) hemorrhage

What?

(pulmonary intravascular) thrombosis

what?

rhexis

Hemorrhage by "breaking forth, bursting"

diapedesis

Hemorrhage by "leaping through" or squeezing out of vessels

cause, location, severity

WHat determines what a hemorrhage looks like

petechia

If blood spots are roughly 1-2 mm they are called _____________

purpura

If blood spots are roughly 3 mm - 1 cm they are called _____________

ecchymosis

If blood spots are roughly 1-3 cm they are called _____________

petechia

what type of blood spot on this kidney?

ecchymosis

What type of blood spot on this kidney?

suffusive hemorrhage

________________Larger continuous areas of hemorrhage

hematoma

______________: focal, confined hemorrhage

hemo-

what prefix do we tend to use to describe a blood filled cavity?

until extravascular pressure matches the pressure in the vessel

How long do hematomas continue to grow?

aural hematoma

What?

hemothorax

what?

hemopericardium

What?

petechiae and ecchymoses

hemorrhage by diapedesis results in _______ and ______________

cutaneous petechiae and ecchymoses

what?

minor defects (endothelial damage); defects of primary hemostasis (platelet defects, von Wilebrand disease)

What can cause hemorrhage by dispedesis?

trauma, extensive damage by infectious damage

what can cause hemorrhage by rhexis?

endothelial cells, coagulation factors, platelets

Abnormal function of what leads to hemorrhage? (3)

Trauma, inflammation, Infectious Disease, Genetic Disorders, Nutritional Disorders

What are some causes of hemorrhage in the blood vessels?

trauma

_____________: hemorrhage due to Physical disruption of blood vessel wall

type III hypersensitivity, feline infectious peritonitis, (FIP is Type IV)

If blood vessels begin to lead rbcs due to inflammation, what type of reaction are we looking at? WHat are specific examples?

Epizootic Hemorrhagic Disease Virus,

Vasculitis and hemorrhage due to endothelial injury

what is an example of infectious disease based hemorrhage?

Why is hemorrhage caused by this?

Ehlers-Danlos Syndrome, Dermatosparaxis

fragile skin and blood vessels; more likely to break and bleed

what are some examples of hemorrhage from genetic disease?

Why does this lead to hemorrhage?

ehlers-danlos syndrome

What

dermatosporaxis

disease of collagen molecule, in which the NT domain persists instead of cleaving, that causes skin to have consistency of wet blotting paper.

Vitamin C deficiency/scurvy

what is the most notable nutritional disorder that causes hemorrhage?

ascorbic acid (vit C), proline, lysine, hydroxyproline, hydroxylysine, collagen cross-links

__________________ serves as an enzyme cofactor that is required for the hydroxylation of ________- and ____________. without __________ and _____________, there is impaired formation of the ___________ so we can't form clots.

deficient and defective collagen synthesis

What is the reason scurvy causes hemorrhage in SIMPLE terms

true

true/false: Vit C also required for synthesis of dopamine, norepinephrine, epinephrine, carnitine, for wound healing, conversion of cholesterol into bile acids, as an antioxidant, etc...

loose teeth, fragile vessels

why does scurvy lead to hemorrhage specifically around the teeth or joint capsules?

the defective collagen leads to really disorganized and messy areas like this

why does scurvy look like this?

decreased numbers, abnormal function

what two things lead to hemorrhage because of platelet issues?

thrombocytopenia

_______________________: decreased numbers of platelets

decreased production, increased destruction, increased use, (also sequestration but she didn't say that)

what leads to a thrombocytopenia?

megakaryocyte damage/destruction; radiation injury, estrogen toxicity, cytotoxic drugs, viral disease (parvo)

What causes decreased platelet production? (One general reason, 4 specific reasons, 1 SUPER specific reason)

immune mediated, drug reaction, viral diseases (equine infectious anemia)

what causes increased destruction of platelets?

diffuse endothelial damage, generalized platelet activation (DIC)

what are some examples of increased platelet use?

thrombocytopathy

______________________ = decreased function of platelets

- deficient in surface receptors, von willebrand disease

- NSAIDs (aspirin), Renal failure (uremia)

give two examples of a hereditary thrombocytopathy

and two of an acquired thrombocytopathy

hemophilia A - deficient in factor VIII

hemophilia B - deficient in factor IX

what are the X-linked hemophilia?

liver disease, vitamin K deficiency

what are some general issues that can cause decreased coagulation factor production

decreased synthesis

why can liver disease cause fewer coag factors?

moldy sweet clover, warfarin, sulfaquinoxaline

what are some vitamin K deficiency causes?

- dicumarol in _________________--

- anti-coagulant rodenticides like ______________

- _________________

DIC

whats the main example of hemorrhage due to increased use of coag factors?

disseminated intravascular coagulation

hemorrhage can occur with decreased platelets or abnormal platelet function. Decreased platelet numbers due to increased use is associated with ___________

liver issues

hemorrhage due to decreased coagulation factors is associated with ___________

bone marrow issues

decreased platelet numbers due to decreased platelet production is associated with _________________

immune mediated disease

decreased platelet numbers due to increased platelet destruction is associated with _______________

physiological

What type of thrombus is Part of normal hemostasis; rapidly resolved

pathological

what type of thrombus is persistent or inappropriate

vascular injury, altered blood flow, hypercoagulability

what are the three things in virchow's triad that lead to thrombosis?

endothelial injury/vascular injury

which corner of Virchow's triad is most important to vet med?

increased procoagulants, decreased anticoagulants

what two things are stimulated by alterations to the endothelium?

subendothelial collagen, Tissue Factor, platelet

After endothelial injury:::::: these four things happen

Exposure of________________

Release of _____________

____________ adherence and activation

Local depletion of Prostacyclin and Tissue Plasminogen Activator

stasis, turbulence

abnormal blood flow increases risk of thrombosis. What are the two abnormalities?

true

true/false: in normal laminar blood flow the Cells flow centrally in the blood vessel separated from the endothelium by a thin layer of plasma

heart failure,

vascular obstruction/dilation

if there is a stasis systemically, it's likely from ___________

if there is one locally its probably _______________

acumulation of activated coag factors, platelets contacting the endothelium

what two things do slow flow rates favor?

where vessels branch, narrowing of vessel lumens, site of venous/lymphatic valves

where is turbulence greatest/most likely?

mixes up the blood, increases coag factor interaction with other factors AND with endothelium

how does turbulence put you more at risk or a thrombosis?

true! (decrease degradation)

true/false: Hypercoagulability reflects an increase OR DECREASE in the concentration of activated hemostatic proteins

inflammation

what is the most common cause of hypercoagulability?

attached to the vessel/heart wall

key point about thrombi: they are ALWAYS _________________________

endothelial damage

arterial thrombi are usually initiated by ________________--

platelets and fibrin

arterial thrombi are primarily made of _______________________

DULL, tan/red/gray, +/- vessel occlusion, tail extends downstream, laminated appearance

The shape and appearance of arterial thrombi are due to the rapid blood flow there... describe the appearance:

lines of Zahn, arterial thrombi

______________________: Alternating layers of platelets, interspersed by fibrin intermixed with erythrocytes and leukocytes

These are more often found in [arterial/venous] thrombi

stasis

venous thrombi most often occur in areas of ____________

incorporate RBCs, platelets, fibrin, WBCs

because the blood is moving slowly or is still, thrombi in veins typically include lots more things and are composed of __________________________ (4)

gelatinous, soft, glistening, dark reed, occlusive, often extend upstream

describe the appearance of a veinous thrombi

arterial thrombi

What is this?

veinous thrombi

what is this

arterial thrombi

what is this

lines of zahn

what is this?

veinous thrombi

what is this?

arterial

arterial or veinous thrombi?

softer, NO POINT OF ATTACHMENT, no associated lesions, dark red (currant jelly) or yellow (chicken fat)

what are some characteristics of postmeortem clots?

location, ability to disrupt perfusion

significance of a thrombus is determined by its ____________ and ___________________ in a dependant tissue