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Coagulation Cascade
Coagulation Cascade
Common pathway
∑ Activated Factor 10 causes the conversion of prothrombin to thrombin
∑ Thrombin hydrolyses fibrinogen peptide bonds to form fibrin and also activates factor 8 to form links
between fibrin molecules
Fibrinolysis
Plasminogen is converted to plasmin to facilitate clot resorption
Abnormal coagulation
1 Question 1 of 172
Which of the following statements relating to abnormal coagulation is false?
1
E. Massive transfusion is associated with reduced levels of factor 5 and 8
In haemophilia A the APTT is prolonged and there is reduced levels of factor 8:C. The bleeding time and PT are
normal. Cholestatic jaundice prevents the absorption of the fat soluble vitamin K. Massive transfusion (>10u blood or
equivalent to the blood volume of a person) puts the patient at risk of thrombocytopaenia, factor 5 and 8 deficiency.
2 Question 2 of 172
Which of the following is least likely to cause a prolonged prothrombin time?
A. Cholestatic jaundice
D. Liver disease
Vitamin K deficiency results from cholestatic jaundice and prolonged antibiotic therapy. Acquired factor 12 deficiency
causes prolonged APTT.
3 Question 3 of 172
A 43 year old lady is admitted with cholestasis secondary to a stone impacted at the level of the ampulla of vater.
Which of the following tests is most likely to be predictive of bleeding diathesis at the time of ERCP in this particular
case?
A. Bleeding time
B. Prothrombin time
C. APTT
D. Platelet count
E. Factor I levels
Jaundice will impair the production of vitamin K dependent clotting factors. This is most accurately tested by
measuring the prothrombin time. APTT can be affected by vitamin K deficiency (due to factor 9 deficiency), however
this occurs to a lesser extent and is normally associated with severe liver disease. The bleeding time is a measure of
platelet function.
A. Vitamin K deficiency
B. von Willebrand's disease
C. Acquired haemophilia
D. Haemophilia B
E. Protein C deficiency
F. Disseminated intravascular coagulation
G. Factor V Leiden
H. Excess heparin
I. Warfarin overdose
2
What is the most likely diagnosis for the scenario given?
1. A 33 year old female is admitted for varicose vein surgery. She is fit and well. After the procedure she is
persistently bleeding. She is known to have menorrhagia. Investigations show a prolonged bleeding time and
increased APTT. She has a normal PT and platelet count.
2. A 70 year old coal miner presents with 3 weeks of haematuria and bruising. He is normally fit and well. He is
on no medications. His results reveal:
3. A 33 year old female is attends the day unit for elective varicose vein surgery. She has ly had recurrent
pulmonary embolic events. After the procedure she is persistently bleeding.
A combination of thromboembolism and bleeding in a young woman should raise the possibility of
antiphospholipid syndrome. Other features may include foetal loss, venous and arterial thrombosis and
thrombocytopenia. Protein C is not associated with a prolonged APTT.
5 Question 2 of 312
Which of the following is not associated with thrombosis?
D. Thrombocytopenia
All the other options either act directly to promote thrombosis e.g. endothelial cell damage or via changes in
consistency or flow of blood.
6 Question 37 of 172
Which of the following statements related to the coagulation cascade is true?
C. The activation of factor 8 is the point when the intrinsic and the extrinsic pathways
meet
D. Tissue factor released by damaged tissue initiates the extrinsic pathway
The extrinsic pathway is the main path of coagulation. Heparin inhibits the activation of factors 2,9,10,11. The
activation of factor 10 is when both pathways meet. Thrombin converts fibrinogen to fibrin. During fibrinolysis
plasminogen is converted to plasmin to break down fibrin.
3
7 Question 38 of 172
Which of the following statements about blood clotting is untrue?
Although aprotinin reduces fibrinolysis and thus bleeding, it is associated with increased risk of death and was
withdrawn in 2007. Protein C is dependent upon vitamin K and this may paradoxically increase the risk of thrombosis
during the early phases of warfarin treatment.