Académique Documents
Professionnel Documents
Culture Documents
Serine proteases: Factors VIIa, IXa, Xa, IIa (thrombin), XIa and XIIa
Natural anti-coagulants
• TFPI: VIIa and Xa inhibition
• Activated Protein C (APC)/protein S: VIIIa and Va inhibition
• AT-III and endogenous heparin: IXa, Xa and IIa inhibition
4) The Natural anti-coagulate TFPI causes the inhibition of what other factors?
6) The natural anti-coagulant AT-III and endogenous heparin: cause the inhibition of
what other factors?
vitamin K analog
AT-III
10) After Exogenous Heparin: binds AT-III, which in turn, inhibits what other factors?
PLASMA
Citrate
It is a measure of the time it takes to stop the flow of blood from a standardized wound.
• During the test a blood pressure cuff is placed below the elbow and inflated to 40 mmHg
• A small, superficial cut (1 mm deep x 1 cm wide) is made in the forearm.
• Blood is wicked away every 30 seconds.
• Time is noted when bleeding stops.
• Normal values range from 1-9 minutes.
18) From the test results provided, suggest a possible reason for the bleeding
problem?
Platelet Count Decreased ; Bleeding Time Increased; aPTT Normal; PT Normal;
Thrombocytopenia
19) From the test results provided, suggest a possible reason for the bleeding
problem?
20) From the test results provided, suggest a possible reason for the bleeding
problem?
Citrated plasma
Thromboplastin
Calcium
23) What is Thromboplastin derived from and what are the two important
factors in it?
from an animal brain extract that contains tissue factor III and
phospholipids.
26) Why is PT the better test to use for monitoring warfarin therapy?
Of the four vitamin K dependent clotting factors, Factor VII has the
shortest half-life
(3 to 6 hours) and is the first to decline. The PT test measures the
extrinsic pathway and is very sensitive to a decrease in Factor VII. Warfarin
is a vitamin K analog.
30) Why is aPTT the better test to use for monitoring heparin therapy?
Heparin binds to AT-III and activates it. An activated AT-III then inhibits IXa,
Xa and
thrombin. IXa is most sensitive to AT-III inhibition and is located in the
intrinsic pathway.
Thus, aPTT test is a better choice of coagulation test.
32) Explain why individuals with severe liver disease or with vitamin K
deficiency tend to be susceptible to bruising.
Vitamin K is required for the post-translational modifications of clotting
factors VII, IX, X and II.
This modification is crucial for a proper anchoring of activated clotting factors
to “adhere” to the plasma membrane of activated platelets via calcium
bridges.
When vitamin K is deficient, the levels of properly modified clotting factors
are reduced. When these four factors become activated, they are not able to
associate with the activated platelets.
Thus, coagulation is comprised, resulting in easy bruisability.
33) Why are newborn infants susceptible to hemorrhagic disease?
months.
Therapeutic range
~1.5-2.3 X upper
reference limit
TF
Ca2+
VII (7)
XIII (13)
TF
Ca2+
VIII, IX, XI, XII, XIII (8, 9, 11, 12, 13)
40) For the Following Patients propose a reason why they would have a bleeding
problem?