Unit 13: Secondary Hemostasis

What are the 3 stages of hemostasis and the general idea of each step?

1. primary hemostasis - activated platelets form temporary plug

2. secondary hemostasis - platelet plug is reinforced by fibrin, forming secondary plug

3. fibrinolysis - plug is removed once healing is done

What is secreted by endothelial cells to inhibit platelet activation?

• prostacyclin

• nitric oxide

• heparan sulfate

• thrombomodulin

prostacyclin

What is secreted by endothelial cells to regulate vasoconstriction?

• prostacyclin

• nitric oxide

• heparan sulfate

• thrombomodulin

nitric oxide

What is secreted by endothelial cells to inhibit plasma coagulation?

• prostacyclin

• nitric oxide

• heparan sulfate

• thrombomodulin

heparan sulfate

What is secreted by endothelial cells to regulate coagulation by inactivating factors V and VIII?

• prostacyclin

• nitric oxide

• heparan sulfate

• thrombomodulin

thrombomodulin

Coagulation factors are plasma proteins produced in the:

• spleen

• thymus

• liver

• kidneys

liver

Coagulation factors circulate in the plasma in their inactive form known as:

• precursors

• proenzymes

• zymogens

• prothrombin

zymogens

What factor(s) is/are required to convert prothrombin into thrombin?

• calcium

• thrombokinase and calcium

• fibrinogen and calcium

• fibrin and calcium

thrombokinase and calcium

What factor(s) is/are required to convert fibrinogen into fibrin?

• calcium

• thrombin and calcium

• thrombin

• fibrinokinase

thrombin

The (extrinsic/intrinsic) pathway is activated when blood is in contact with exposed tissue factor (TF III) from damaged endothelium.

extrinsic pathway

The (extrinsic/intrinsic) pathway is more common and provides a more rapid response.

extrinsic pathway

What factors are involved in the extrinsic pathway?

factor III (tissue factor)

factor VII (proconvertin)

What is the factor involved in the activation of the extrinsic pathway?

• factor I

• factor II

• factor III

• factor V

factor III

What are the factors in the extrinsic pathway that activate factor X, initiating the common pathway?

• factors I and IIa

• factors III and VII

• factors III and VIIa

• factors III and XIIa

factors III and VIIa

What test is used to monitor oral anticoagulant therapy?

• Activated partial thromboplastin time (aPTT)

• Prothrombin time (PT)

• Thrombin time (TT)

• Fibrinogen assays

• All of the above

Prothrombin Time (PT)

Prothrombin time (PT) is used to monitor therapies that impact the (extrinsic/intrinsic) pathway.

extrinsic pathway

What test is reported as INR?

• Activated partial thromboplastin time (aPTT)

• Prothrombin time (PT)

• Thrombin time (TT)

• Fibrinogen assays

• All of the above

Prothrombin time (PT)

How do you calculate INR?

INR = (PT x ISI) / mean of PT

ISI = international sensitivity index

The (extrinsic/intrinsic) pathway is activated by exposure to negatively charged materials like collagen known as contact activation.

intrinsic pathway

What factors are involved in the intrinsic pathway?

factor PK (prekallikrein) - Fletcher factor

factor HMWK (high molecular Wt kininogen ) - Fitzgerald factor

factor XII (Hageman factor)

factor XI (plasma thromboplastin antecedent (PTA))

factor IX (plasma thromboplastin component (PTC))

factor VIII (antihemophilic factor/hemophilia A)

What is the factor involved in the activation of the intrinsic pathway?

• factor III

• factor V

• factor IX

• factor XII

factor XII

What factors activate factor XI in the intrinsic pathway?

• factors IXa and IV

• factors IXa and HMWK

• factors XIIa and IV

• factors XIIa and HMWK

factors XIIa and HMWK

What factors activate factor IX in the intrinsic pathway?

• factors XIIIa

• factors XIIIa and HMWK

• factors XIa

• factors XIa and HMWK

factors XIa

What are the factors in the intrinsic pathway that activate factor X, initiating the common pathway?

• factors VIIIa and PF 3

• factors IXa and VIIIa

• factors IXa, VIIIa, and PF 3

• factors XIa, XIIa, and PF 3

factors IXa, VIIIa, and PF 3

What test is used to monitor heparin therapy?

• Activated partial thromboplastin time (aPTT)

• Prothrombin time (PT)

• Thrombin time (TT)

• Fibrinogen assays

• All of the above

Activated partial thromboplastin time (aPTT)

Activated partial thromboplastin time (aPTT) is used to monitor therapies that impact the (extrinsic/intrinsic) pathway.

intrinsic pathway

Both the extrinsic and intrinsic pathways converge at what factor, staring the common pathway?

factor X

What factors are involved in the common pathway?

factor X (Stuart-Prower factor)

factor V (Proaccelerin/labile factor)

factor II (prothrombin)

factor I (fibrinogen)

factor XIII (fibrin stabilizing factor)

What factors catalyze the conversion of factor II (prothrombin) into factor IIa (thrombin)?

• factors X

• factors X and V

• factor Xa

• factors Xa and Va

factors Xa and Va

Factors IIa (thrombin) and IV (calcium) activate what factors to form a stable fibrin clot during the common pathway?

• factors V and X

• factors XII and XIII

• factors I and XIII

• factors I and X

factors I (fibrinogen) and XIII

What test is used to monitor the common pathway?

• Activated partial thromboplastin time (aPTT)

• Prothrombin time (PT)

• Thrombin time (TT)

• Fibrinogen assays

• All of the above

All of the above

What factors are part of the contact group?

• factors II, VII, IX, and X

• factors II, VII, XI, and XII

• factors IX, XI, PK, and HMWK

• factors XI, XII, PK and HMWK

factors XI, XII, PK, and HMWK

What factors are vitamin K dependent (prothrombin group)?

• factors II, VII, IX, and X

• factors II, VII, XI, and XII

• factors IX, XI, PK, and HMWK

• factors XI, XII, PK and HMWK

factors II, VII, IX, and X

What factors are consumed during clotting?

• factors I, IX, X, and XIII

• factors I, II, IX, X, and XIII

• factors I, V, VIII, and XIII

• factors I, II, V, VIII, and XIII

factors I, II, V, VIII, and XIII

What factors are part of the fibrinogen group?

• factors I, II, XI and XII

• factors I, V, VII, and XI

• factors I, V, VIII, and XIII

• factors I, II, V, VIII, and XIII

factors I, II, V, VIII, and XIII

What factors are serine proteases?

• factors II, VII, IX, X, XI, XII, and PK

• factors IIa, VIIa, IXa, Xa, XIa, XIIa, and PK

• factors II, VII, IX, XI, XIII, and PK

• factors IIa, VIIa, IXa, XIa, XIIIa, and PK

factors IIa, VIIa, IXa, Xa, XIa, XIIa, and PK

What are the coagulation factors?

I - Foolish - Fibrinogen

II - People - Prothrombin

III - Try - Tissue Factor

IV - Climbing - Calcium ++

V - Long - Labile Factor

VI

VII - Slopes - Stable Factor

VIII - After - Anti-Hemophilic Factor-A

IX - Christmas - Christmas Factor

X - Some - Stuart-Prower Factor

XI - People - Plasma Thromboplastin Antecedent (PTA)

XII - Have - Hageman Factor

XIII - Fallen - Fibrin Stabilizing Factor

What factor is known as Labile Factor?

• Prothrombin

• Proconvertin

• Antihemophilic factor

• Proaccelerin

Proaccelerin (factor V)

What factor is known as Stable Factor?

• Prothrombin

• Proconvertin

• Antihemophilic factor

• Proaccelerin

Proconvertin (factor VII)

What factor is known as Hemophilia A?

• Plasma Thromboplastin Component (PTC)

• Stuart-Prower factor

• Antihemophilic factor

• Plasma Thromboplastin Antecedent (PTA)

Antihemophilic factor (factor VIII)

What factor is known as Hemophilia B?

• Plasma Thromboplastin Component (PTC)

• Stuart-Prower factor

• Antihemophilic factor

• Plasma Thromboplastin Antecedent (PTA)

Plasma Thromboplastin Component (PTC) (factor IX)

What factor is known as Christmas Factor?

• Plasma Thromboplastin Component (PTC)

• Stuart-Prower factor

• Antihemophilic factor

• Plasma Thromboplastin Antecedent (PTA)

Plasma Thromboplastin Component (PTC) (factor IX)

What factor is known as Hemophilia C?

• Plasma Thromboplastin Component (PTC)

• Stuart-Prower factor

• Antihemophilic factor

• Plasma Thromboplastin Antecedent (PTA)

Plasma Thromboplastin Antecedent (PTA) (factor XI)