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?
- Endothelium
-
How does Tissue Factor Pathway Inhibitor work?
(mechanism) -
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?
- D-dimer
- 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
-
Damage to VESSEL WALL
Change in FLOW
BLOOD coagulability state