Blood bank, coagulation final

Factor I

fibrinogen

Fibrinogen needs what factor to make a stable clot

factor XIII

Factor II

Prothrombin

Factor IIa

thrombin

Factor II activates

I, XIII, XI, protein C, plts,

Factor II modifies

V to Vm

VIII to VIIIm

Factor II is dependent on

Vitamin K

Factor III

tissue factor (thromboplastin)

Factor IV

Calcium

Factor V

Labile Factor

Factor VII

Proconvertin, Stable Factor

Factor VII activates

Factor X and IX

Factor VII is dependent on

Vitamin K

what factor is the first facor affected by lack of vitamin K

Factor VII

Factor VIII

antihemophilic factor

Deficiency in factor VIII leads to

Hemophilia A

is factor VIII sex linked

yes on the x chromosome

vWF

von Willebrand factor

is vWF sex linked

no, autosomal

deficiency in vWF lead to increased

bleeding time

Factor IX

Christmas factor

deficiency in factor IX leads to

Hemophilia B / Christmas disease

is factor IX sex linked

yes on X chromosome

Factor X

Stuart-Prower factor

Factor XI

Plasma thromboplastin antecedent (PTA)

deficiency in factor XI leads to

Hemophilia C / Rosenthal syndrome

Is factor XI sex linked

no, autosomal

Factor XII

Hageman factor (glass contact factor)

Factor XIII

Fibrin-stabilizing factor (FSF)

5M urea test

tests for Factor XIII, if XIII present, clot wont dissolve

Prekallikrein

Fletcher factor, pre-K

High Molecular Weight Kininogen (HMWK)

Fitzgerald factor

what 2 factors form a complex that helps activate XII

PK and HMWK

what factors are not found in serum or aged plasma

V and VIII (labile factors)

What factors are vitamin K dependent?

II, VII, IX, X

What factors are sex linked?

Factor VIII , IX,

Contact group factors

XI, XII, PK, HMWK

prothrombin group

II, VII, IX, X, protein C, protein S

all of the prothrombin factors are in serum except

II

is the contact group absorbed by BaSO4

no

fibrinogen group

I, V, VIII, XIII

is the contact group consumed in coagulation

no they are present in the serum

Is vitamin K needed for the contact group

No

is the prothrombin group absorbed by BaSO4

yes

Is vitamin K needed for the prothrombin group

Yes

is the fibrinogen group consumed in coagulation

yes, its not present in serum

Is vitamin K needed for the fibrinogen group

No

what factors diminish at room temperature and are not present in aged plasma

factor V and VIII

fibrinolysis

the final step in hemostasis, the breakdown and removal of a clot

plasmin

fibrin-digesting enzyme

PAI-1

Plasminogen activator inhibitor-1

Where is PAI-1 stored?

plts and epithelial cells

TPA binds with

PAI-1

alpha2-antiplasmin

inactivates plasmin by binding to free plasmin

TAFI

Thrombin activatable fibrinolysis inhibitor

What does TAFI do?

Prevents binding of TPA to plasminogen preventing the formation of plasmin

TFPI

tissue factor pathway inhibitor

what does TFPA do?

inhibits factor VIIa making it short lived

Protein C

initiated by IIa and inactivates Va and VIIIa

protein C deficiency causes _____

clots and recurrent venous emboli

Protein S

cofactor for protein C, synthesized in the liver

SEPIN

Serine protease Inhibitors

1. antithrombin

2. heparin cofactor

3. Alpha1 antitrysin

4. alpha2 macroglobulin

5. ZPI

Antithrombin III

requires heparin which is found in vessels naturally, inactivates thrombin

heparin cofactor

requires heparin and alpha1 antitypsin and alpha2 macroglobulin, inhibits IX, X, XI, XII

ZPI

- protein z-dependent protease inhibitor

- inhibits Xa and XIa

Platelet function in hemostasis

- Cause capillary homeostasis by adhering to the inner surface of a vessel and sticking to each other to create a temp. mechanical plug

Prothrombin Time (PT)

11-12.5 seconds

what pathway is PT

extrinsic

what factors are in the extrinsic pathway

III, VII

aPTT (activated partial thromboplastin time)

normal = 60 - 70 seconds; if on heparin therapy goal is 1.5 - 2.5 times norm

aPTT tests what pathway

intrinsic

Factors of intrinsic pathway

XII, XI, IX, VIII

factors in common pathway

X, V, II, I

FDPs

fibrinogen or fibrin monomer degradation products formed when plasmin cleaves fibrinogen or fibrin monomers into protein fragments; formerly called fibrin split products

D-dimer test

is a global marker of coagulation activation and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is used for the diagnosis of DVT Useful as an adjunct to noninvasive testing, a negative D-dimer test can exclude a DVT without an ultrasound.

Hemostasis

stoppage of bleeding

primary hemostasis

Formation of platelet plug

secondary hemostasis

fibrin clot formation

serine proteases

synthesized as inactive zymogens, cleaves peptide bonds in proteins, includes factors II, VII, IX, X, XI, XII, PK

serine protease cofactors

binds with serine proteases to activate them, includes factors III, V, VIII, HMWK

labile factors

V and VIII ( not found in serum )

Hemophlilia A

factor VIII def.

sex linked

1:10,000

causes recurrent bleeding in joints, deep muscle and soft tissue

treated with cryo or FFP

prolonged PTT

ACQUIRED hemophilia A may be the result of which of the following conditions?

postpartum

immunological problems

aging

Von Willebrand Disease

synthesized in epithelial cells and megakaryocytes

stored in plts

helps bind plts to collegen

carrier of VIII

autosomal dominant disease

cutaneous and mucosal bleeding

increased bleeding time

increase PTT

most prevalent def ( 1:10)

Hemophilia B (Christmas disease)

Factor IX deficiency

sex linked

treated with FFP

indistinguishable from hemophilia A

increased PTT

substitution studies will correct

Hemophilia C

Factor XI deficiency

Plasma thromboplastin anticedant def

autosomal ( increased in ashkenazi jewish pop)

treated with FFP

hemophila B is increased where

India

Liver failure

nearly all factors are produced in the liver, especially vit. K dependant

Increased PT

whats the first factor to drop in liver failure

VII

Renal disease

decreased plts count

decreased plt adhesion

shouldnt take aspirin

substitution studies/ mixing studies

mixing pt sample with fresh normal plasma to see if it corrects testing, also helps distinguish what pathway is affected

def in intrensic pathway results

PTT increased

PT normal

def in extrensic pathway results

PTT normal

PT increased

def in common pathway results

PTT increased

PT increased

aged plasma is missing what factors

V or VIII

serum is missing what factors

I, V, VIII, XIII

BaSO4 absorbed plasma is missing what factors

II, VII, IX, X

Russell's viper venom

activates X directly ( common pathway )

increased in def of factor X, V, II, I

venous thrombosis

The formation of blood clots within a vein

typically in the legs

fragments can migrate to heart and lungs

____ % of PE is caused by DVT

95