1thrombosis
the inappropriate formation of clots within the vascular system
2bleeding
failure of blood to clot in response to appropriate stimulus
3vessels spasm, formation of platelet plug, development of clot (coagulation)
What are the 3 lines of defense in hemostasis?
4vessel spasm
constricts the vessel and reduces blood flow
5endothelial injury; local and humoral mechanisms
What initiates the vessel spasm in hemostasis and what causes it?
6thromboxane A
prostaglandin that promotes platelet aggregation and vasoconstriction in hemostasis
7prostacyclin
prostaglandin vasodilator and inhibitor of platelet aggregation in normal, uninjured vessels
88-12 days
What is the half-life of a platelet?
9Platelets & von Willebrand Factor & clotting factors
What are the requirements for clotting?
10the liver; vitamin K
Where are clotting factors synthesized in the body and what must be used to create them?
11thrombin III
What inactivates coagulation factors and neutralizes thrombin?
12activation of factor X
What initiates the first step of the common athway to coagulation?
13hemostasis
the orderly, stepwise process for stopping bleeding that involves vasospasm, formation of a platelet plug, and the development of a fibrin clot
14plasmin
What breaks down the fibrin mesh into fibrin degredation products that act as anticoagulants?
15thrombin
What is used in negative feedback to active anti-thrombin?
16inhibits the production of thrombin; inhibits the activation of factor X
What are the functions of anti-thrombin?
17plasminogen
What initiates fibrinolysis?
18plamin
Plasminogen is converted into what in order to dissolve the clot?
19affects vitamin K production
How does warfarin (coumadin) act as an anticoagulant?
20factors II, VII, IX, X, Prothrombin, Protein C
What clotting factors are vitamin K dependent?
21affects factor X - suppresses fibrin formation
How does heparin work as an anticoagulant?
22cannot cross the GI tract membranes
Why must heparin be given IV or SQ?
23Protein S and Protein C
Which factors are important in the inhibitory (negative feedback) control of clotting?
24PTT
What lab test is used to evaluate the heparin effect on the intrinsic pathway?
25PT/INR
What lab tests are used for warfarin on the extrinsic pathway?
26bleeding time
What lab test is used to evaluate platelet function and the ability to form a clot?
27atherosclerosis, DM, smoking, high cholesterol, pregnancy, protein S and protein C deficiencies
What are conditions that create increased platelet function?
28Factor V mutation/Leiden mutation
What is an inherited disorder that leads to a hypercoagulability state?
29bed rest, MI, cancer, BCP, hyperestrogenic states
What are acquired disorders that lead to hypercoagulability states?
30antiphospholipid syndrome
Autoantibodies that result in increased coagulation activity; results in TIAs and recurrent pregnancy loss
31> 1,000,000
What blood level of platelets is considered hypercoagulability due to thrombocytosis?
32primary
What form of thrombocytosis is due to increased proliferation of platelets related to bone marrow disorders?
33secondary
What form of thrombocytosis is due to disease states that stimulate platelet production?
34surgery, infection, cancer, chronic inflammatory conditions, myeloproliferative disorders
What are some disease states that increase hypercoagulability?
35turbulent blood flow and platelet adherence
What conditions are associated with arterial thrombi?
36stasis of blood flow with increased coagulation factors
What conditions are venous thrombi associated with?
37< 150,000
What is the platelet level that meets criteria for thrombocytopenia?
38petechiae and purpura
What are common signs of impaired platelet function?
39far below 100,000
Even though thrombocytopenia is classified at < 150,000, what level of low platelets must be seen before clinical signs show up?
40decreased platelet production, decreased platelet survival, increased sequestration of platelets in the spleen
What are 3 main reasons for thrombocytopenia?
41valproic acid, chemotherapy
What are two forms of meds that prevent the bone marrow from making enough platelets (drug induced non-immune thrombocytopenia)?
42drug induced thrombocytopenia, ITP (immune thrombocytopenic purpura), thrombotic thrombocytopenic purpura
What are 3 types of platelet defects in the body?
43Immune Thrombocytopenic Purpura (ITP)
Autoimmune production of IgG against platelet antigens; clotting factors are not involved; in children - usually follows a viral infection
44increase levels of blood lipids and cholesterol, hemodynamic stress, and DM which all predispose to vessel damage which leads to platelet adherence and eventual thrombosis
How does smoking increase the risk for arterial thrombosis?
45platelet sequestration
What is the splenic enlargement of ITP secondary to?
46petechiae
pinpoint purple or red spots from minute hemorrhages under the skin; seen almost exclusively in conditions of platelet deficiency
47purpura
the appearance of multiple purple discolorations on the skin caused by bleeding underneath the skin
48vitamin K
Fat soluble vitamin that aids in blood clotting; synthesized in the liver
49bile salts
What is required for the absorption of vitamin K into the body?
50antibiotics, impaired fat absorption
What is vitamin K deficiency caused by?
51hemophilia A, hemophilia B, and Von Willebrand disease
What are 3 examples of hereditary disorders that prevent clotting?
52hemophilia A
Factor VIII deficiency, sex-linked recessive; new mutation in 30% of new cases
53hemophilia B
factor IX deficiency
x linked recessive
54Von Willebrand Disease
bleeding disorder caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation; autosomal dominant
55platelet count usually normal; increased bleeding time
What lab values are expected with Von Willebrand disease?
56hemorrhagic telangiectasia, vitamin C deficiency, Cushing disease, senile purpura
What are 4 vascular disorders that cause bleeding?
57hemorrhagic telangiectasia
An uncommon autosomal dominant disorder characterized by thin-walled, dilated capillaries and arterioles
58scurvy
a disease caused by lack of vitamin C that results in poor collagen synthesis and failure of the endothelial cells to be cemented together properly causing a fragile wall
59cushing disease
causes vascular bleeding due to protein wasting and loss of vessel tissue support because of increased cortisol
60senile purpura
discoloration due to increasing capillary fragility caused by the aging process
61DIC (disseminated intravascular coagulation)
a consumptive process in which there is massive activation of the coagulation sequence; clot formation consumes all available coagulation proteins and platelets which then leads to severe hemorrhage
62manage primary cause, maintain volume, replace clotting components with FFP, platelets, and cryoprecipitate
What are the treatments for DIC?