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Block 3 PATH Exam - "How NOT to Make a Clot" (#19)


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3 main properties that retard clot formation in UNinjured vessels
Lamellar flow
Negative charge on endothelial cells and platelets (repulsion)
Endothelial cells shield pro-aggregatory components
What layer of the blood vessel wall is rich in pro-aggregatory components?
SUB-endothelial layer
What does PGI-2 do?
Prevents platelet aggregation
What does thromobmodulin do?
Binds thrombin and activates protein C
What does heparan sulfate do?
Catalyzes anti-thrombin inactivation of coagulation enzymes
Where is tPA released from?
How does Tissue Factor Pathway Inhibitor work?
TFPI binds Factor Xa
TFPI/Xa binds to TF/FVII

A QUATERNARY complex is formed, blocking extrinsic pathway
How is TFPI overcome (3)?
TFPI deficiency
Faulty TPFI binding to FXa

Massive expression of tissue factor
(this happens in vascular injury)
What is Factor V Leiden?
An abnormal "version" of Factor V that is resistant to Protein C
What clotting factors does Protein C degrade (2)?
Factors V, and VIII
What is Protein S?
A "co-factor" that, along w/ Protein C, attacks FV and FVIII
What are the 3 main ANTI-coagulant pathways
TFPI pathway
Protein C pathway
Anti-thrombin pathway
What coag factors does anti-thrombin affect?
Factors II, IX, XI, X
Also, Protein C
How many saccharide units of heparin are needed to activate anti-thrombin?
A minimum of 18
What is released after plasmin breaks down fibrin?
What does alpha-2 plasmin inhibitor do?
Binds and clears free plasmin
What does plasminogen activator inhibitor (PAI) do?
Binds and clears tPA
3 factors in Virchow's triad
Change in FLOW
BLOOD coagulability state

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