Course Code: MLS 014

Module #5 Student Activity Sheet

Section: ____________ Schedule: _____________
Class number: _______ Date: ________________
Name:
__________________________________________________

Lesson title: COAGULATION PATHWAY Materials: Module Manual, Ballpen,

Learning Targets: Paper/Notebook
At the end of the module, students will be able to:
1. Describe the flow of the coagulation References: Rodak, B.F., Keohane, E.M.,
cascade Walenga, J.M., & Smith, L.J. (2016). Rodak’s
2. Enumerate the different coagulation factors Hematology: Clinical principles and
and their functions in clotting process applications (Fifth edition). St. Louis Missouri:
Elsivier

A. LESSON PREVIEW

Good day! Let’s have a quick activity about Platelet Adhesion, Release and Aggregation.

Fill in the table with the corresponding substances/receptors involved in the process:

Term Receptor/s or substance/s involved

Platelet Adhesion

Platelet Secretion

Platelet Aggregation

B. MAIN LESSON

On primary hemostasis, a reversible plug is formed. For large injuries, a long-term response is needed, and
activation of the clotting cascade will occur. Activating this cascade will lead to the formation of fibrin
polymers which helps in the formation of an irreversible plug to arrest bleeding.

Coagulation factors/ procoagulants

- some are enzymes that circulate as zymogens (inactive form)
- some are cofactors that bind, stabilize, and enhance the activity of their respective enzymes
- when a coagulation factor becomes activated, a lowercase “a” is added after the Roman numeral.
COAGULATION FACTORS AND THEIR FUNCTIONS

Factor I (Fibrinogen): is a large globulin protein that functions to be converted into insoluble protein and then
back to soluble components.

Factor II (Prothrombin): precursor of thrombin and stimulates platelet aggregation and activates cofactor
protein C and Factor XIII.

Factor III (Tissue thromboplastin, Tissue Factor): activates factor VII when blood is exposed to tissue fluids.

Factor IV (Ionized Calcium): is an active form of calcium required for the activation of thromboplastin and for
the conversion of prothrombin to thrombin.

Factor V (Labile Factor, Proaccelerin): consumed during clotting and accelerates the transformation of
prothrombin and thrombin.

Factor VII (Proconvertin, Stable Factor): activated by tissue thromboplastin, which activates factor X.

Factor VIII (Antihemophilic Factor): VIII/vWF molecule circulates in the plasma and is composed of vWF
which is a glycoprotein responsible for binding to the endothelium and VIII:C which is the active portion
measured by clotting and is deficient in Hemophilia A.

Factor IX (Plasma Thromboplastin Component): a component of thromboplastin generating systems, also

known as Christmas Factor, and is deficient in Hemophilia B.

Factor X (Stuart-Prower): aids in the conversion of prothrombin to thrombin

Factor XI (Plasma Thromboplastin Antecedent): essential to intrinsic thromboplastin generation of the

cascade.

Factor XII (Hageman Factor): contact factor that is activated by collagen.

Factor XIII (Fibrin-stabilizing Factor): stabilizes the polymerized fibrin monomers in the initial clot in the
presence of Calcium.

High Molecular Weight Kininogen (HMWK, Fitzgeral factor): is a surface contact factor activated by
kallikrein.

Prekallikrein (PK, Fletcher Factor): is a surface contact activator, in which 755 is bound to HMWK.

CLASSIFICATION OF COAGULATION FACTORS

Fibrinogen Group: most labile, have the highest molecular weight, and are consumed during coagulation.
Factors I, V, VIII, XIII
Prothrombin Group: this group is stable and remains preserved in stored plasma
Factors: II, VII, IX, X (Vitamin K dependent Factor)
Contact Group: participates in the intrinsic pathway
Factors: XI, XII, PK, HMWK
In Vitro Coagulation Activation of Factor XII - the primary step in coagulation because it could be found in blood.

In Vivo Coagulation - requires the presence of two cell types for formation of coagulation complexes:
1. Tissue factor - extravascular
2. Platelets - intravascular

Two phases of coagulation:

1. Initiation - occurs on tissue factor-expressing cells, produces 3% - 5% of the total thrombin generated
2. Propagation - occurs on platelets, produces 95% or more of the total thrombin generated

Coagulation Regulatory Mechanisms

1. Tissue Factor Pathway Inhibitor - principal regulator of the tissue factor pathway
2. Protein C Regulatory System - revises thrombin’s function from a procoagulant enzyme to an anticoagulant
Coagulation Regulatory Proteins
1. Antithrombin - first to be identified; inhibits Factor IIa, IXa, Xa, XIa, XIIa, PK, Plasmin
2. Heparin cofactor II - inactivates thrombin
3. Protein Z-dependent protease inhibitor - potent inhibitor of Factor Xa; also inhibits Factor Xia
4. Protein C inhibitor - inhibits APC, IIa, Xa, XIa, urokinase

SUMMARY OF COAGULATION FACTORS

Factor Name Function Group Comments

I Fibrinogen Thrombin substrate Fibrinogen Is the ultimate
substrate of the
coagulation pathway.
II Prothrombin Serine protease Prothrombin
III Tissue Factor Cofactor
IV Ionic Calcium Mineral
V Labile Factor Cofactor Fibrinogen
VII Stable Factor Serine protease Prothrombin
VIII Antihemophilic Factor Cofactor Fibrinogen Is linked to a large
carrier protein, VWF.

IX Christmas Factor Serine protease Prothrombin

X Stuart-Prower Factor Serine protease Prothrombin
XI Plasma Serine protease Contact factor
Thromboplastin
Antecedent
XII Hageman Factor Serine protease Contact factor
XIII Fibrin-stabilizing Transglutaminase Fibrinogen
Factor
Prekallikrein Fletcher Factor Serine protease Contact factor
High-molecular- Fitzgerald Factor Cofactor Contact factor
weight kininogen

Check for Understanding

Fill in the table with the corresponding Factors/substances involved in the pathway:

INTRINSIC PATHWAY COMMON PATHWAY EXTRINSIC PATHWAY

C. LESSON WRAP-UP

You are done with the session! Let’s track your progress.

1. What BIG QUESTION do you still have in mind?

(Students are encouraged to read pages 648 to 660 of Rodak’s Hematology: Clinical Principles and
Applications Chapter 37.)

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