FIBRINOLYSIS AND OTHER PRIMARY HEMOSTASIS TESTS
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1
Identify the final stage of coagulation that involves the dissolution of the formed clot.
Fibrinolysis.
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2
True or False: Fibrinolysis starts a few hours after fibrin polymerization and cross-linking.
True.
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3
Enumerate the two activators of fibrinolysis released in response to inflammation and coagulation.
TPA and UPA.
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4
Identify the proteins that become incorporated into the fibrin clot during clotting.
Plasminogen, plasmin, TPA, UPA, and PAI-1.
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5
Fill in the blank: In the fibrinolysis pathway, TPA and UPA activate fibrin-bound plasminogen several hours after clot formation to reestablish normal blood flow during ________.
Vascular repair.
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6
In the fibrinolysis pathway, what is the plasma zymogen produced by the liver and stored in eosinophils?
Plasminogen.
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7
Identify the serine protease that is the active form of plasminogen.
Plasmin.
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8
True or False: Free plasmin is capable of digesting plasma fibrinogen, factor V, factor VIII, and fibronectin.
True.
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9
What condition is caused by the digestion of clotting factors by free plasmin?
Primary fibrinolysis.
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10
Identify the protein that rapidly binds and inactivates any free plasmin in the circulation.
α2-antiplasmin.
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11
Identify the serine protease secreted by activated endothelium that activates plasminogen.
Tissue plasminogen activator (TPA).
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12
Fill in the blank: Circulating TPA is bound to inhibitors such as ________ and is cleared from plasma.
PAI-1.
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13
Identify the intrinsic plasminogen activator secreted by urinary tract epithelial cells, monocytes, and macrophages.
Urokinase Plasminogen Activator (UPA).
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14
True or False: UPA binds firmly to fibrin and has a major physiologic effect.
False.
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15
Identify the principal inhibitor of plasminogen activation that inhibits both TPA and UPA.
Plasminogen Activator Inhibitor 1 (PAI-1).
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16
Identify the primary inhibitor of free plasmin that is synthesized in the liver.
α2-antiplasmin.
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17
Enumerate two antifibrinolytic agents that inhibit the proteolytic activity of plasmin.
Aminocaproic acid and tranexamic acid.
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18
Identify the inhibitor synthesized in the liver that is activated by the thrombin-thrombomodulin complex.
Thrombin-Activatable Fibrinolysis Inhibitor (TAFI).
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19
True or False: The activation of TAFI and the protein C pathway by the thrombin-thrombomodulin complex are independent functions.
True.
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20
In the D-dimer test, what substance is produced when plasmin lyses fibrin?
FDP containing D-dimer.
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21
True or False: Plasmin lysis of fibrinogen produces D-dimer.
False.
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22
What does the presence of D-dimer indicate?
That a stable fibrin clot has been lysed.
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23
Interpret the following results: FDP positive and D-dimer negative.
Pathological fibrinolysis.
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24
Interpret the following results: FDP positive and D-dimer positive.
DIC.
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25
Identify the proteins that precipitate when plasma is diluted with water and acidified with 1% acetic acid.
Euglobulins.
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26
Enumerate the four components included in euglobulins.
Plasminogen, plasmin, fibrinogen, and plasminogen activators.
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27
Identify the screening test used for detecting disorders of platelet function and VWD.
Bleeding Time.
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28
Fill in the blank: In the Duke method of Bleeding Time, one should blot the drop of blood with filter paper every ________.
30 seconds.
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29
What is the normal value for the Duke method Bleeding Time?
2-4 mins.
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30
Enumerate the contents of alpha granules that participate in secondary hemostasis.
Fibrinogen, Factor V, Factor VIII, and VWF.
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31
Which granule contents act as vasoconstrictors and platelet agonists to intensify primary hemostasis?
Dense granules.
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32
Identify the organelle that probably digests vessel wall matrix components during in vivo aggregation.
Lysosomes.
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33
How many days before a bleeding time test should aspirin or aspirin-containing products be avoided?
7 days.
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34
How many hours before a bleeding time test should NSAIDs like Ibuprofen or Naproxen be discontinued?
24 hours.
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35
Identify the bleeding time method that uses a sphygmomanometer inflated to 40 mmHg.
Ivy method.
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36
In the Ivy method, where is the pressure cuff applied?
Upper forearm (above the elbow).
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37
In the Ivy method, what are the dimensions of the two skin incisions?
2-2 mm deep and 2 mm long.
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38
What is the normal value for the Ivy method?
1-7 mins.
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39
Identify the modification of the Ivy bleeding time test that used a template containing a standardized slit.
Template Bleeding Time.
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40
Who developed the Template Bleeding Time test?
C.H. Mielke, Jr. and colleagues.
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41
Enumerate two examples of commercially made devices for Template Bleeding Time.
Simplate and Surgicutt.
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42
What is the general reference range for Template Bleeding Time?
2-9 mins.
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43
Identify the capillary fragility test also known as the tourniquet test.
Rumple-Leede Test.
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44
In the Rumple-Leede test, to what pressure is the cuff inflated?
Midway systolic and diastolic.
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45
How long is the pressure maintained in the Rumple-Leede test?
5 minutes.
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46
What is the normal valuerade for the Rumple-Leede test?
Grade 1+.
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47
Identify the contractile protein important for clot retraction.
Thrombosthenin.
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48
Enumerate the four requirements for normal clot retraction.
Normal level of fibrinogen, Calcium, Normal level of functioning platelets, and ATP.
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49
Identify the clot retraction method that uses castor oil.
Hirschboeck or Castor Oil method.
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50
In the Hirschboeck method, what is the specific observation for the end point?
Extrusion of droplet-like serum or "dimpling".
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51
What is the normal value for the Hirschboeck method?
15-45 mins.
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52
Identify the clinical condition associated with dark yellow extruded serum.
Jaundice.
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53
Identify the clinical condition associated with cloudy extruded serum.
Plasma cell myeloma.
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54
Enumerate three conditions associated with milky extruded serum.
Diabetes, leukemia, or after meals.
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55
In the MacFarlane method, how much fresh venous blood is used?
5 mL.
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56
At what temperature is the tube placed in the MacFarlane method?
37°C.
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57
Provide the computation formula for the MacFarlane method %CR.
%CR = (Amt of serum left in tube / 5 mL) x 100.
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58
What is the normal value for the MacFarlane method?
44-67%.
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