Hemadynamic disorders, thromboembolism and shock - Hemostasis and thrombosis

13 important questions on Hemadynamic disorders, thromboembolism and shock - Hemostasis and thrombosis

Wat zijn de Weibel Palade bodies?

Activatie van de endothelial cells zorgt voor upregulatie van de p-selectin en vWf.
In de Weibel Palade bodies zijn deze stoffen opgeslagen.

How is hemostasis achieved?

  1. Vasoconstriction. This reduces blood flow
  2. Primary hemostasis: the formation of the platelet plug
    1. von Willebrand factor (vWF) and collagen promote platelet adherence and activation.
    2. Platelets bind via glycoprotein Ib (GpIb) receptors to von Willebrand factor (VWF) on exposed ECM
    3. secretion of platelet granule contents
    4. aggregation of the platelets
  3. Secondary hemostasis: deposition of fibrin.
    1. Tissue factor binds and activates factor VII
    2. GpIIb/IIIa receptors on activated platelets form bridging crosslinks with fibrinogen, leading to platelet aggregation
    3. cascade of reactions that results in Thrombin generation
    4. Trombin polymerizes fibrinogen into fibrin
  4. Clot stabilization and resorption

Does defects in vWF result in a disorder?

Yes, von Willebrand disorder, a bleeding disorder
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Wat triggert de extrinsic pathway van coagulatie?

Extracellular damage. Leidt tot activatie tissue factor.

Leidt tot activatie VIIa. Calcium zorgt can voor activatie factor x.

How does asprin influences platelets aggregation?

Asprin inhibits cyclooxygenase, which is an enzyme needed for TXA2 synthesis. TXA2 is needed for platelets aggregation, thus asprin can cause a mild bleeding defect

What is the coagulation cascade?


a series of amplifying enzymatic reactions that lead to the deposition of an insoluble fibrin clot

What determines whether clot formation, propagation, or dissolution occurs?


balance between the anticoagulant and procoagulant activities of endothelium


normal endothelium releases a number of factors that inhibit platelet activation and aggregation. Name these


prostacyclin (PGI2), nitric oxide (NO), and adenosine diphosphatase

Name the primary abnormalities that lead to intravascular thrombosis (Virchow triad)

  1. endothelial injury
  2. stasis or turbulent blood flow
  3. hypercoagulability of the blood

How can endothelial injury lead to thrombosis?

Anti-fibrinolytic effects. Endothelial cells secrete PAI which limits fibrinolysis

What causes arterial and cardiac thrombosis and what is a contributing factor?


endothelial injury or dysfunction, as well as by forming countercurrents and local pockets of stasis
Turbulence (chaotic blood flow) is a contributing factor

Name High Risk for Thrombosis


Prolonged bed rest or immobilization
Myocardial infarction
Atrial fibrillation
Tissue injury (surgery, fracture, burn)
Cancer

What is mural thrombi?

Thrombi occurring in heart chambers or in the aortic lumen

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