NURS 5315: Adv Patho Exam 2 Set 2
Hemostasis - ANS termination of bleeding
Two arms of hemostasis - ANS Platelet plug formation
Coagulation cascade
Platelet Plug - ANS *Primary response to bleeding
*a collection of platelets at the site of a damaged blood vessel that helps slow or stop blood loss
Platelet Structure - ANS Disc-shaped cells
1. peripheral zone: outer portion of the cell - cell membrane - made of phospholipids
2. sol-gel zone: middle layer - contains structural support for the cell
3. organelle zone - innermost layer - contains organelles
Four phases of platelet plug formation - ANS Activation: injury-->vWF, fibronectin, collagen,
thrombospondin--> collagen activates platelets--> platelets change shape to adhere to injury
Adherence: platelets attach to injured endothelium-->vWF binds to collagen and to the GP
1b/IX/V receptors on circulating platelets--> anchors platelets in place
Aggregation: platelets bind to one another
Secretion: platelet granules release contents
Platelet plug is stabilized by fibrin and XIIIa which are end products of the coagulation cascade
Normal WBC count - ANS 5,000-10,000/mm3
Normal RBC count - ANS Male: 4.7-6.1
Female: 4.2-5.4
Normal HgB - ANS Men 14-18g/100mL
Females 12-16g/100mL
Normal Hct values - ANS Male: 42-52%
Female: 37-47%
Normal MCV range - ANS 80-100 cubic micrometers
Normal platelet count - ANS 150,000-400,000/mm3
coagulation cascade - ANS Secondary Hemostasis
The series of steps beginning with the intrinsic or extrinsic pathways of coagulation and
proceeding through the formation of a fibrin clot to stabilize the platelet plug
, extrinsic pathway of coagulation - ANS initial coagulation pathway that begins with tissue
damage > Tissue Factor TF activates factor VII > results in the activation of the common
pathway
Intrinsic pathway of coagulation - ANS Happens in blood vessels when collagen fibers of the
basement membrane are exposed to blood
tissue factor - ANS protein thromboplastin, which initiates the extrinsic pathway when released
in response to tissue damage
cofactor for VIIa
Stable Factor, Proconvertin - ANS Factor VII
VIIa forms complex w/ TF to activate factor X
Stuart-Prower factor - ANS Factor X
Xa is component of prothrombinase complex which activates prothrombin
prothrombinase complex - ANS (Va, Xa, Ca++, PL), activates prothrombin (II) > thrombin
prothrombin - ANS Factor II
With prothrombinase complex converted to thrombin
Thrombin - ANS converts fibrinogen to fibrin
Fibrinogen - ANS with thrombin converts to fibrin
Fibrin - ANS Polymerizes into a fibrin clot
Fibrin-stabilizing factor (XIII) - ANS activated by thrombin
cross links fibrin to stabilize the mesh
Hageman factor (XII) - ANS first factor activated when a blood vessel or cell is injured; starts
the cascading reaction of the clotting factors, activates the conversion of plasminogen to
plasmin to dissolve clots, and activates the kinin system
antihemophilic factor (VIII) - ANS Factor VIII
component of tenase complex
Christmas factor (IX) - ANS Factor IX
activates factor X, component of tenase complex
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