Hematology 5 Hemostasis and Hypercoagulable States

Lecture Outline
I.

Hemostasis
A. Platelet plug
B. Coagulation cascade
1. Final common pathway
2. Tissue factor pathway
3. Contact activation pathway
C. Termination of clotting
D. Fibrinolysis and clot removal
II. Hypercoagulable States
A. Virchows triad
B. Inherited hypercoagulability
1. Factor V Leiden
2. Prothrombin G20210A mutation
3. Antithrombin deficiency
4. Protein C deficiency
5. Protein S deficiency
C. Acquired hypercoagulability
1. Hyperhomocysteinemia
2. Antiphospholipid syndrome

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Hemostasis
1. What are the four basic stages of hemostasis?

2. What is tissue factor, and where is it found?

3. What is the name of primary pathway for initiating coagulation (formerly known as the extrinsic pathway)?

4. What is the name of the secondary pathway for initiating coagulation (formerly known as the intrinsic
pathway)?

5. What are the two main enzymes in the antithrombotic pathway, which inactivate the coagulation cascade?

6. How does the anticoagulant heparin work?

Quick Review
7. What does bleeding time measure?

8. What does the prothrombin time (PT) measure?

9. What does the partial thromboplastin time (PTT) measure?

10. What lab test is used to monitor anticoagulation with heparin?

11. What lab test is used to monitor anticoagulation with warfarin?

12. What lab test is used to monitor anticoagulation with enoxaparin?

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Hypercoagulable States
13. What is Virchows triad?

14. How does the Factor V Leiden cause a hypercoagulable state?

15. In what ethnic groups are Factor V Leiden and the Prothrombin G20210A mutation more commonly found?

16. What is the treatment for patients with a history of thrombosis and an inherited hypercoagulable disorder?

17. What acquired conditions predispose to thrombosis?

18. What vitamin deficiencies cause hyperhomocysteinemia?

19. What lab and clinical findings are caused by lupus anticoagulants?

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End of Session Quiz

1. A previously healthy 26-year-old man presents with a DVT and PE. He has not been immobilized recently, and
he has no history of prior thrombosis. He reports that his grandmother and an uncle both had a history of
blood clots. The next morning on rounds, your attending suggests that you work him up for a
hypercoagulable state. What tests should you order?

2. Which coagulation factors are inhibited by warfarin?

3. What is the treatment for an overdose of warfarin? Of heparin?

4. What are the actions of thrombin?

5. What are the actions of antithrombin?

6. What are the actions of protein C?

7. What are the actions of fibrin?

8. What are the actions of plasmin?

9. What is the most common inherited hypercoagulable disorder?

10. Because of the increased risk of thrombosis, in whom are oral contraceptives absolutely contraindicated?

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