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101 Cards in this Set
- Front
- Back
Which coagulation factors have common names?
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I-IV (one through four)
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What is the Common Designation for Factor I?
(active and inactive) |
Fibrinogen (inactive)
Fibrin (active) |
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What is the Common Designation for Factor II?
(active and inactive) |
Prothrombin to Thrombin
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What is the Common Designation for Factor III?
(active and inactive) |
Tissue Factor aka Thromboplastin
it is always in active form |
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What is the Common Designation for Factor Iv?
(active and inactive) |
Calcium
it is always in active form |
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What coagulation factors are always in active form?
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III & IV
Tissue Factor and Calcium |
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How are tissue factors V-XIII designated as active or not?
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If they are active their roman numeral will be followed by the letter "a"
Example V will become Va The exception is "VI" it is ommitted |
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Which coagulation factors are stored in the α-granules of platelets?
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Factors V and VIII
5 & 8 the cofactors (except TF) that need activated also the ones that are circulating |
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Which of the factors are Serine proteases (zymogens)?
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II, VII, IX, X, XI, XII
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Which of the factors are Cofactor proteins?
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III, V, VIII
358 |
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What factor is Fibrin?
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I
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Which factors are Transglutaminase
(zymogens)? |
XIII
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Where are the The majority of the coagulation proteins are synthesized?
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the liver they float freely except for III which is a transmembrane protein on endothelial cells.
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Which cofactors need cleaved to function? Which do not?
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V, VIII do
III does not (its tissue factor and membrane bound) |
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Which coagulation facors have unique vitamin-K dependent carboxylation of glutamate residues? (AKA GLA residues)
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(VII, IX, X, and II, and Proteins C and S)
7,9,10,2 |
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What are the GLA residues
(vitamin-K dependent) zymogens? |
VII, IX,X,II
7,9,10,2 |
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What are the Non-GLA residue
zymogens? |
XI - 11
XII -12 XIII-13 |
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What are the three circulating cofactors?
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V
VIII Protein S |
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What is the Cell membrane co factor?
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III (Tissue Factor; Thromboplastin)
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What is the structural coagulation factor?
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Fibrinogen, Fibrin
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What is the Coagulation Function of Factor VII?
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Serine protease (Initiation Complex)
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What is the Coagulation Function of Factor IX?
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Serine protease (Tenase Complex)
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What is the Coagulation Function of Factor X?
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Serine protease (Prothrombinase Complex)
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What is the Coagulation Function of Factor II?
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Thrombin/prothrombin
Serine protease. Feeds forward to activate XI, V, and VIII (11,5,8) |
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What is the Coagulation Function of Factor XI?
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Serine protease (Intrinsic Pathway)
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What is the Coagulation Function of Factor XII? What is it's Common name?
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Serine protease (Intrinsic Pathway)
Hageman Factor |
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What is the Coagulation Function of Factor XIII?
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Transglutaminase (does not have proteolytic activity)
Cofactor for factor 9 and is stabilized by vWf |
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What is the Coagulation Function of Factor V?
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Cofactor for Factor Xa.
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What is the Coagulation Function of Factor VIII?
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Cofactor for Factor IXa. Stabilized by vWF.
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What is the Coagulation Function of Protein S?
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Cofactor for Activated Protein C
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What is the Coagulation Function of Cofactor III?
What it its common name? |
Cofactor for Factor VII.
Tissue Factor; Thromboplastin |
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What is the Coagulation Function of Cofactor I?
What it its common name? |
Forms meshwork around platelet plug
Fibrinogen, Fibrin |
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What are the three ENDOGENOUS
INHIBITORS? (antocoagulants) |
Antithrombin III
TFPI Activated Protein C |
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What is the function of Antithrombin III?
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Inhibits thrombin, IXa and Xa (bound to heparan sulfate on endothelial cells)
2,9,10 |
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What is the function of TFPI?
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Inhibits VIIa and Xa in complex with TF on subendothelial cells
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What is the function of Activated Protein C?
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Degrades Va and VIIIa on platelet membranes
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What are the two NATURAL
FIBRINOLYTICS? |
a2-antiplasmin
PAI |
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What is the function of PAI?
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Inhibits plasminogen activation
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What is the function of a2-antiplasmin?
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Neutralizes free plasmin in circulation
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What are the 4 THERAPEUTIC
ANTICOAGULANTS that we learned about? |
Heparin
Warfarin (Coumadin) Streptokinase t-PA |
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How does Heparin work?
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Activates Antithrombin III; neutralizes
circulating coagulation factors |
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How does Warfarin work?
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Inhibits modification of GLA residues on VII, IX, X, and II
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How does Streptokinase work?
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Bacterial protein that activates plasminogen to form plasmin
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How does theraputic t-PA work?
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Its Tissue plasminogen activator (tPA)
It does the same as the "natural" form Activates fibrin-bound plasminogen to form plasmin (to degrade fibrin clot) |
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Trans Fatty Acids have what metabolic effect?
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Increase LDL
Decrease HDL Increase coronary heart risk |
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Saturated Fatty Acids have what metabolic effect?
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Increase LDL
Little effect on HDL Increase CHD, may increase risk of prostate and colon cancer |
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MUFAs have what metabolic effect?
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Decrease LDL
Decrease HDL Decrease incidence of CHD |
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Omega 6 PUFAs have what metabolic effect?
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Decrease LDL
Decrease HDL Provide arachadonic acid fro prostoglanding and leukotriene synthesis Decrease rish for CHD |
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Omega 3 PUFAs have what metabolic effect?
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Little effect on LDL or HDL
Decrease CHD Decrease risk f sudden cardica death suppress cardiac arrythemias reduce TAGs Decrease tendency for thrombosis lower blood pressure |
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What constitutes macrocytic anemia
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MCV greater than 100fL
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Macrocytic anemias are typically,
Hypo, hyper or normochromic? |
Normochromic
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Megaloblastic anemia have what distinguishing characteristics?
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Caused by a deficiency in vitamin b12 or folate with a MCV usually between 110 & 130 as characteristic.
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What meagaloblastic anemia has impared DNA sysnthesis?
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Megaloblastic
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Is DNA sysntesis impared in nonmegaloblastic anemia?
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No
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Non-Megaloblastic anemia have what distinguishing characteristics?
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MCV of 100-110
no impared DNA synthesis alcoholism, liver disease, and hyperthyroidism can cause |
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What are the two categories of macrocytic anemia
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megaloblastic and non-meagaloblastic
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Morphology of megaloblastic anemias in blood smear?
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• Oval macrocytes
• Large hypersegmented neutrophils (at least 5 lobes in nuclei) • Marked anisocytosis and poikilocytosis (high RDW) • Presence of Howell-Jolly bodies (nuclear remnants) • Low reticulocyte count (normal to low CR) • Thrombocytopenia and leukopenia |
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Morphology of megaloblastic anemias in bone smear?
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• Megaloblastic changes in all cell-lines, indicating nuclear/cytoplasmic asynchrony
(i.e.cytoplasm matures, nuclei do not) : • all stages of red cell development (erythroid cells) • Large megakaryocytes (platelet precursors) with hyperploid nuclei • Giant granulocyte precursors • Decreased number of precursor cells in all cell-lines: • Decreased number of erythroid cells indicate insufficient and ineffective erythropoiesis, which results in anemia • Decreased number of granulocyte and platelet precursors result in leukopenia and thrombocytopenia. |
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Megaloblastic anemias are characterized as hypoproliferative or hyperproliverative anemias?
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hypoproliferative
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Insufficient erythropoiesis would have what lab result?
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(low CR)
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Ineffective erythropoiesis would have what lab result?
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(elevated IBIL)
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Vitamin B 12 (aka cobalamin) functions as a cofactor for two enzymes?
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homocysteine methyltransferase and methylmalonyl-CoA mutase.
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Impaired activity of homocysteine methyltransferase results in accumulation of what products?
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Accumulation of N5-methyl-tetrahydrofolate (N5-methyl-THF)
Known as the folate trap |
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What is the significance of individuals with vitamin B 12 deficiency? Why is providing folate problematic?
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they exhibit a functional folate deficiency: As the bioavailable folate becomes trapped as N
5-methyl-THF, DNA synthesis is then compromised in a manner similar to that of an individual with folate deficiency. Giving folate will relieve megaloblastic anemia, but not fix neuropathy from insufficeint B12 needed for methylmalonyl CoA mutase reactions that make succinyl co-a. |
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What do the levels of serum methylmalonic acid and serum
homocysteine tell you? |
Increased homocysteine indicates either a folate of B12 deficiency.
However only Methylmalonic acid levels will be elevated in vitamin b12 deficiency. It is the "determining" test. |
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What is the role of the following protein in B12 absorption?
R-binder: |
mouth to stomach
In the stomach Pepsin hydrolzes b12 proteins and free b12 binds to r biner. low pH prevents binding of b12 to intrinsic factor |
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What is the role of the following protein in B12 absorption? Intrinsic factor (IF):
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stomach to duodenum
in neutral pH of duodenum degrades R-Binder so b12 can bind to intrinsic factor |
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What is the role of the following protein in B12 absorption? Intrinsic factor receptor:
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duodenum to circulatory system
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What is the role of the following protein in B12 absorption? Transcobalamin II:
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used in circulatory system
released by ileal cells into portal blood |
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What do the type 1 antibodies of pernicious anemia do?
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BLOCK formation og intrinsic factoer b12 complex
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What do the type 2 antibodies of pernicious anemia do?
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BINDING antibodies that prevent IF-B12 from binding to ileal receptors
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What do Cardiac-Specific Troponins (cTn) tell you?
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cTn are specific for cardiac tissue
Positive troponin levels are considered virtually diagnostic of MI. and are not normally detectable in the circulation. Following an MI, cTn begin to leak into the serum, where levels rise in 2-4 hours and peak at 48 hours. Elevated levels persist for 7-10 days. |
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What do Creatine Kinase Isoenzyme MB (CK-MB) tell you?
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CK-MB is not normally found
in circulation, but it is elevated when any muscle (skeletal or cardiac) is injured. |
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Prothrombin time (PT) tests what factors and pathways?
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Extrinsic System
7,10 & 5 (VII, X, V), prothrombin and fibrinogen; it is also used to monitor oral anticoagulant therapy (Coumadin = warfari |
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Activated partial thromboplastin time (PTT or aPTT) tests what factors and pathways?
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the intrinsic pathway (factors XII, XI, IX, VIII, prothrombin and fibrinogen);
it is also used to monitor heparin therapy. |
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Which lab test monitors heparin therapy
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aPTT
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What lab test moitors warfarin therapy?
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PT
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what does the bleeding test look at?
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platelt function and vWF
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What are the overlapping factors/common pathway?
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5, 10, prothrombin and fibrinogen
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What is the inhibitor of the intiation complex?
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Tissue Factor Pathway Inhibitor
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What is the inhibitor of the Tenase complex?
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Antithrombin (ATIII) (binds 10)
and Activated Protein C (degrades 5) |
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Waht is the inhibitor of the prothrombin complex?
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Antithrombin (ATIII)
and Activated Protein C |
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What is the inhibitor of thrombin?
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ATIII and thrombomodulin
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What Laboratory reagents are
needed for reaction to occur in a PT test? |
Tissue factor
Phospholipid Ca 2+ |
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What Laboratory reagents are
needed for reaction to occur in a aPPT test? |
Negatively charged surface
Phospholipid Ca 2+ |
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What clotting factors are required to get a normal PT test?
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Extrinsic 7
Common 1,2,5,10 |
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What clotting factors are required to get a normal aPPT test?
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Intrinsic 8,9,11.12
Common 1,2,5,10 |
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Hemophilia A: Deficiency of factor
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8
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Hemophilila B: Deficiency of factor
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9
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What does factor 13 do?
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it is the transglutaminase enzyme which crosslinks fibrin.
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What is the Mechanism of Action of Aspirin?
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Inhibits platelet
aggregation (inhibition of COX leading to decreased synthesis of platelet agonist Thromboxane A2) |
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What is the Mechanism of Action of Unfractionated Heparin?
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It Activates antithrombin III which binds Thrombin, 9 & 10
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What is the Mechanism of Action of Warfarin ?
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Inhibits vitamin K epoxide
reductase; prevents -carboxyglutamate formation and 7.9.10 & 2 in that order |
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What will cause a prolonged PT test
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prob with factor 7
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what will cause a prolonged bleeding time and aPPT test?
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Von Villebrand disease
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what will cause a prolonged aPPT?
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def of factors 9,11,8 or 12
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what can cause a prolonged PT and aPPT?
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liver diesase
def. vitamin k heparin or warfarin def in common fibrin, thrombin, 5 or 10 |
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What factors promote plasminogen to plasmin?
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urokinase
tPA streptokinase |
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what factors inhibit clot dissolution?
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alpha antiplasmin binds to free plasmin
PAI (plasmionogen activarot inhibitor) blocks the natural urokinase and t-PA promotors |
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What does factor 7 turn on?
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10 & 9
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What does factor 10 turn on?
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2 (thrombin) which can turn on 5,8,11,and 13
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