Flashcards in Hypercoagulable States and CPB / Test 3/3 Deck (63)
“Hypercoagulability” can be broadly defined as a risk of ______1_______ in circumstances that would not cause thrombosis in a normal subject.
It can be either ____2____ or ___3_____.
A hereditary tendency to thrombosis, irrespective of its cause has been referred to as ?
2 factors that accelerate clot formation ?
Factor VIII & Factor V
3 factors that Inhibit clot formation ?
Protein C, Protein S, Thrombomodulin
What inhibits thrombin and other serine proteases ?
Natural Anticoagulant Antithrombin III
What inhibits Factor V and VIII ?
Cofactor for protein C ?
What does the (Natural Anticoagulant) Tissue Factor Pathway Inhibitor bind to ?
binds factor Xa and VII-tissue complex
True hypercoaguable states can only be determined after RULING OUT other causes…
Recent surgery Immobilization (stasis)
Oral contraceptive use
CRITERIA for True hypercoaguable state ?
- Recurrent thrombosis
- thrombosis in Unusual sites (cerebral veins, hepatic veins, renal veins, IVC, mesenteric veins)
- First time thrombosis at age
- Family history of thrombosis
What can make a patient PRONE to coagulability ?
-Protein C deficiency
-AT III deficiency
-Protein S deficiency
-Activated Protein C (APC) resistance
- Mutation of factor V that makes it resistant
Quantitative or Qualitative abnormalities of individual, specific coagulation factors that directly produce a pro-thrombotic state describes what state of hypercoagulability ?
Primary Hypercoagulable State
Represents a diverse group of clinical disorders that are associated with a thrombotic tendency
Secondary Hypercoagulable State
Mutations of one of the physiological antithrombotic factors which leads to a quantitative deficiency or loss of function?
that are sometimes inherited, but are more commonly ACQUIRED ?
Birth Control Pills > PE
Antithrombin/Heparin Disorder ?
Protein C/Protein S Disorders
Protein C deficiency
Protein S deficiency
Resistance to activated protein C
Prevalence of deficiencies of hemostatic factors responsible for hereditary thrombotic disease.
AT III 1%
Protein C 8%
Protein S 10%
APC Resistance 17%
Characterized by proportionate reductions in activity and antigen levels, each to about 50% of normal in heterozygous individuals, indicating synthetic abnormality of a functionally normal molecule describes what deficiency ?
Antithrombin III Deficiency Type 1
Normal or near normal antigen levels are accompanied by low activity levels, indicating a functionally defective molecule.
- Affecting heparin binding
- impaired reactive site function
- multiple abnormalities
causing both abnormal
heparin binding and
abnormal protease inhibition
Antithrombin III Deficiency
Suspected ATIII DefieciencyCPB Management & Action.
ACT still low
- Give 2 units FFP … or
- Give Thrombate
A naturally occurring anticoagulant which preserves blood fluidity and limits clot formation to the sites of vascular injury.
Rare but fatal hereditary condition (Inherited autosomal disease) manifested by massive disseminated intravascular coagulaopathy and purpura fulminans in the neonatal period?
Homozygous Protein C deficiency
Prevalence is 0.1 to 0.5% in the general population, the vast majority remain symptom free.
Inherited autosomal disease
Heterozygous Protein C deficiency
Patients with heterozygous PC deficiency are at lifelong risk for thrombosis, but the episodic nature of clinical thrombosis suggests that an _____ ______ _____ may be necessary to trigger a clinically significant thrombotic event.
acquired thrombogenic stimulus
Protein C is activated upon
the production of thrombin.
Thrombin generation promotes clot formation by
cleaving fibrinogen into fibrin
and also activates the protein C system.
Activated protein C subsequently suppresses further thrombin generation and enhances what?