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Coagulation Factors and Disorders

Prolonged APTT with normal PT and TT Deficiency of Factor XII, XI, IX, VIII
Prolonged PT with normal APTT and TT Factor VII deficiency
Prolongation of APTT and PT with normal TT Factor X, V or II deficiency, patients receiving Warfarin or with liver disease
Prolongation of APTT, PT and TT Heparin therapy (activated antithrombin III) or a complex deficiency state (DIC, abnormal fibrinogen, fibrinogen deficiency)
Dense platelet granules contain... Calcium and ADP
Alpha granules Secondary mediators of coagulation
Primary platelet activation Platelet monolayer attached to vWF or collagen on the subendothelial layer
Secondary platelet activation Release of calcium, ADP and synthesis of thromboxane A2 to activate surrounding platelets. Cross-linking with fibrinogen
Von Willebrand's Factor Large multimeric protein found in the subendothelium, made by the endothelium. Carrier for FVIII in the blood
Desmopressin Releases vWF from endothelial cells for the treatment of vWF deficiency
Factor V and VIII Clotting cofactors
Coagulation cascade: Initiation Release of TF, binds FVII in blood, activates FX which causes the production of a small amount of thrombin
Coagulation cascade: Amplification Positive feedback by thrombin activates extrinsic pathway
Coagulation cascade: Clot Formation Large amounts of thrombin are present, fibrinogen is broken down to fibrin monomers.
Antithrombin III Directly inactivates thrombin and FX
Tissue plasminogen activator Released when a clot is formed, or conditions that promote clotting (stasis, hypoxia). Converts plasminogen to plasmin
Mucocutaneous bleeding vWF deficiency, platelet dysfunction
Haemarthrosis Haemophilia
Purpura Thrombocytopenia
Bleeding into hair follicles, gingival bleeding Scurvy
Telangiectasia Vascular abnormality (hereditary haemorrhagic telangiectasia)
Venous thrombosis Fibrin based (surgery, trauma, pregnancy, cancer)
Arterial thrombosis Platelet based (smoking, diabetes, hyperlipidaemia, obesity)
Venous stasis eczema Complication of deep vein thrombosis and varicose veins
Normal prothrombin time 12-13 seconds
Normal INR 1
Normal INR on patient on warfarin 2-3.5
Mildly prolonged APTT vWF deficiency (FVIII low)
50:50 plasma mix does not correct APTT Clotting factor inhibitor
Binding site of unfractionated heparin Thrombin and Xa
Binding site of LMWH Factor Xa
Factors that decrease effectiveness of warfarin High intake of green leafy vegetables, administration of vitamin K
Factors that inctrase effectiveness of warfarin Poor diet, antibiotics (roxithromycin), NSAIDs, liver disease or congestion
Dabigatron Thrombin inhibitor
Haemophilia A X-linked recessive deficiency of Factor VIII
Haemophilia B X-linked recessive deficiency of Factor IX
Severe haemophilia <1% of normal factor levels
Mild haemophilia >5% of normal factor levels
Moderate/severe haemophilia 3-5% of normal factor levels
Treatment of mild haemophilia A Desmopressin
vWF Disease Autosomal dominant inheritance (not complete penetrance) in 1% of population.
Delayed bleeding Clotting factor deficiency (haemophilia), chronic liver disease, warfarin or heparin therapy
Immediate bleeding Platelet problem - thrombocytopenia, vWF deficiency, NSAID, corticosteroid use (vascular fragility)
Transexamic acid Anti-fibrinolytic drug that stabilises clots. Used for dental surgery in high risk patients, menorrhagia in vWF disease, trauma
Clotting factors made in the liver I, II, V, VII, IX, X, XII
Thrombocytopenia in liver disease Toxic effect of alochol on megakaryocytes
Pulmonary embolism Dyspnoea, pleuritic chest pain
Decreased platelet count with deficiency of all clotting factors Disseminated intravascular coagulopathy
D-dimers Breakdown products of fibrin, marker of fibrin formation in vivo and its subsequent breakdown by plasmin
Risk of spontaneous coagulation INR>5
Created by: Epoot