Circulatory Pathology

Front 1

Antithrombogenic substances

Back 1

Prostacyclin (PGI2), nitric oxide, tissue plasminogen activator, thrombomodulin

Front 2

Steps in hemostasis

Back 2

1. Endothelial injury relases tissue factor (activates factor VII, extrinsic pathway); exposure of thrombogenic subendothelial collagen activates factor XII (intrinsic pathway), release of vWF; decreased synthesis of antithrombogenic substances; 2. Platelet adhesion to vWF through glycoprotein Ib; 3. Platelet activation with degranulation and synhesis of TXA2 and ADP (aggregators); 4. Aggregation mediated by TXA2 and ADP and fibrinogen/Gp IIb-IIIa

Front 3

Bernard Soulier syndrome

Back 3

Autosomal recessive. Deficiency of platelet GPIb. Defective platelet adhesion

Front 4

Glanzman thrombastenia

Back 4

Deficiency of Gp IIB-IIIa; defective platelet aggregation

Front 5

Immune thrombocytopenic pupura

Back 5

Antiplatelet antibodies and destruction in spleen by macrophages (bing IgG coated platelets via Fc receptor). Thrombocytopenia, prolonged bleeding time, normal PT and PTT. Petechiae, ecchymoses, menorrhagia, nosebleeds

Front 6

Thrombotic thrombocytopenic purpura

Back 6

Platelet thrombi with scant fibrin with no activation of coagulation system. Fever, thrombocytopenia, hemolytic anemia, neurologic symptoms, renal failure. Increased bleeding time, normal PT/PTT, schistocytes

Front 7

Hemolytic uremic syndrome

Back 7

Gastroenteritis with bloody diarrhea, fever, thrombocytopenia, renal failure, hemolytic anemia. Produced by verotixin-producing E. coli 0157

Front 8

Activation of coagulation system

Back 8

Intrinsic pathway (Factor XII): exposure to subendothelial collagen; Extrinsic pathway (factor VII): tissue thromboplastin by endothelium

Front 9

Kinin cascade

Back 9

Hageman factor converts prekallikrein into kallikrein. HMWK is converted to bradykinin by kallikrein

Front 10

Fibrinolytic system cascade

Back 10

Kallikrein activates plasminogen into plasmin which inhibits fibrin from coagulation cascade

Front 11

Vitamin K-dependant factors

Back 11

Factors II, VII, IX, X. Both intrinsic and extrinsic paths need vitamin k-dependant gamma carboxylation

Front 12

Prothrombin time (PT)

Back 12

Tests extrinsic and common paths. Factors V, VII, X, prothrombin and fbrinogen. Used to monitor warfarin therapy

Front 13

MOA of warfarin

Back 13

Blocks epoxide reductase (activates vitamin K). Takes 3-4 days for effect due to long half life of previously carboxylated factors which are still circulating

Front 14

Partial thromboplastin time (PTT)

Back 14

Tests intrinsic and common paths. Factors XII, XI, IX, VIII, X, V, prothrombin, fibrinogen. Used to monitor heparin

Front 15

DIC

Back 15

Thrombocytopenia, prolonged PT/PTT, decreased fibrinogen, elevated D-dimers

Front 16

Hemophilia

Back 16

Deficiency of factor VIII or IX. X-linked recessive (affects males). Bleeding at circumcision, hemarthrosis, easy bruising and hematomas. No petechiae or ecchymoses. Normal platelets and bleeding time, normal PT, prolonged PTT (intrinsic path coagulopathy)

Front 17

Increased PT and PTT

Back 17

Vitamin K deficiency, liver disease

Front 18

Von Willenbrand disease

Back 18

bleeding from mucuous membranes, prolonged bleeding time, normal PT/PTT, abnormal response to ristocetin