Hematology 2: Fibrinolysis and Clotting Process
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Questions and Answers

What is the product of the liver that has 5 glycosylated loops (kringles) bound to a lysine residue?

  • Plasmin
  • Fibrin clot
  • Plasminogen (correct)
  • Fibrinogen

    • What is the primary inhibitor of free plasmin?

  • Streptokinase
  • Plasminogen
  • Alpha-1 Antiplasmin (correct)
  • TAFI

    • What is the last phase of normal clotting process when the patient tries to have wound or tissue injury?

  • Clot dissolution (correct)
  • Thrombus formation
  • Fibrin clot formation
  • Fibrinolysis

    • What is the normal value of euglobulin clot lysis?

    <p>Lysis more than 2 hrs.</p> Signup and view all the answers

    What is the role of factor 13 in the clotting process?

    <p>Stabilizing the fibrin clot</p> Signup and view all the answers

    What is the result of excessive digestion of fibrin by plasmin?

    <p>Bleeding manifestation</p> Signup and view all the answers

    What is the function of TAFI?

    <p>To hydrolyze lysine residues</p> Signup and view all the answers

    What is the effect of the absence of activators in plasminogen?

    <p>Thrombus formation</p> Signup and view all the answers

    What is the principle of D-Dimer test?

    <p>Immuno Assay</p> Signup and view all the answers

    What is the role of plasmin in the clotting process?

    <p>Digesting the fibrin clot</p> Signup and view all the answers

    What is the result of Plasminogen chromogenic substrate Assay?

    <p>Intensity of yellow color is directly proportional to plasminogen coagulation</p> Signup and view all the answers

    What is the result of too much activation of plasminogen?

    <p>Bleeding manifestation</p> Signup and view all the answers

    What is the activator used in Plasminogen chromogenic substrate Assay?

    <p>Streptokinase</p> Signup and view all the answers

    What is the role of TPA (tissue plasminogen activators) in the clotting process?

    <p>Activating plasminogen</p> Signup and view all the answers

    What is the half-life of TPA?

    <p>3 minutes</p> Signup and view all the answers

    What is the primary function of PAI-1?

    <p>To inhibit plasminogen activators</p> Signup and view all the answers

    What is the normal value of TPA in the blood?

    <p>5 mg/dl</p> Signup and view all the answers

    What is the result of excessive plasminogen activation in cancer cells?

    <p>Primary fibrinolysis</p> Signup and view all the answers

    What is the main difference between primary and secondary fibrinolysis?

    <p>Primary fibrinolysis is characterized by excessive plasminogen activation, while secondary fibrinolysis is characterized by inappropriate fibrin formation</p> Signup and view all the answers

    What is the function of thrombin-thrombomodulin in fibrinolysis?

    <p>It activates TAFI</p> Signup and view all the answers

    What is the result of a deficiency in PAI-1?

    <p>Increased plasminogen activation</p> Signup and view all the answers

    What is the normal whole blood clotting time?

    <p>More than 48 hours</p> Signup and view all the answers

    Study Notes

    Tissue Plasminogen Activators (TPA)

    • Has 2 glycosylated loops
    • Half-life: 3 minutes
    • Normal value: 5 mg/dL
    • Produced by endothelial cells
    • Binds to plasminogen activator inhibitor (PAI-1)

    Urokinase Plasminogen Activator (UPA)

    • Produced by urinary epithelial cells, monocytes, and macrophages
    • Half-life: 7-15 minutes
    • Normal value: 2-4 mg/mL
    • Major activator produced by kidney

    Fibrinolysis Inhibitors

    • Alpha-2 antiplasmin: primary inhibitor of free plasmin
      • Competes with plasminogen for lysine residue binding site
      • Binds and inactivates plasmin
    • Alpha-2 macroglobulin
    • Thrombospondin
    • Plasminogen activator inhibitor 1 (PAI-1)
      • Principal inhibitor
      • Allows binding of plasminogen
      • Main activity: inhibits plasminogen activators (TPA and UPA)
      • Produced by endothelial cells, megakaryocytes, smooth muscle cells, fibroblasts, monocytes, adipocytes, and hepatocytes
    • PAI-2

    Fibrinogen and Fibrin

    • Fibrinogen: has 2 D-domains and 1 E-domain
    • Fibrin: represents the original structure of fibrinogen
    • Fibrin monomer: resulted from the action of thrombin on fibrinogen
    • D-Dimer: fragments of fibrin that are produced during fibrinolysis

    Tests for Fibrinolysis

    • Whole blood clotting time
      • Normal value: lysis more than 48 hours
      • Abnormal: lysis less than 48 hours
    • Euglobulin clot lysis
      • Euglobulin: portion of plasma with fibrinogen, plasminogen, and plasmin activators
      • Procedure: plasma + HAc (pptn) → dissolve in buffer + thrombin (to digest)
      • Normal value: lysis more than 2 hours
      • Abnormal: lysis less than 2 hours
    • Protamine sulfate test for fibrin monomer
    • Ethanol gelation test for fibrin monomer
    • D-Dimer test
      • Specific for DIC
      • Positive for D-dimer means positive in DIC
      • Principle: immunoassay (test for D-dimer)
    • Plasminogen chromogenic substrate assay
      • Principle: measures plasminogen activity
      • Result: intensity of yellow color directly proportional to plasminogen concentration
      • Normal value: 5-13.5 mg/dL

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    Description

    This quiz covers the processes of fibrinolysis and clotting in hematology, including the roles of plasmine, fibrinogen, and lysine residues.

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