Pathology of Thrombosis
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Questions and Answers

What is the primary goal of hemostasis?

  • To form a blood clot in non-traumatized vessels
  • To promote endothelial injury
  • To prevent blood clotting
  • To limit bleeding from an injured vessel (correct)

    • What is the term for the formation of a blood clot within non-traumatized, intact vessels?

  • Thrombosis (correct)
  • Hemostasis
  • Infarction
  • Embolism

    • What is the result of endothelial injury in the context of thrombosis?

  • Endothelial dysfunction
  • Both A and B (correct)
  • Endothelial repair
  • Endothelial activation

    • What is the term for the 'Virchow triad'?

    <p>Abnormal formation of a solid mass from blood components</p> Signup and view all the answers

    What is the result of a thrombus breaking off and traveling to another part of the body?

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

    What is the term for the morphological changes that occur as a result of thrombosis?

    <p>Infarction morphology</p> Signup and view all the answers

    What is the most common source of pulmonary embolism?

    <p>Deep venous thrombosis</p> Signup and view all the answers

    Where do most systemic emboli come to rest?

    <p>Lower extremities</p> Signup and view all the answers

    What is the term for gas bubbles in the circulation that can cause distal ischemic injury?

    <p>Air embolism</p> Signup and view all the answers

    What is the characteristic of infarctions caused by venous thrombosis?

    <p>They are more likely to occur in organs with a single efferent vein</p> Signup and view all the answers

    What is the dominant histology of infarcts?

    <p>Ischemic coagulative necrosis</p> Signup and view all the answers

    What is the outcome of pulmonary embolism?

    <p>Clinically silent, infarction, pulmonary hypertension, or sudden death</p> Signup and view all the answers

    What is the term for the passage of an embolus through an interatrial or interventricular defect?

    <p>Paradoxical embolism</p> Signup and view all the answers

    What is the characteristic of red infarcts?

    <p>They occur with venous occlusions</p> Signup and view all the answers

    What is the outcome of fat and marrow embolism?

    <p>Ischemic injury</p> Signup and view all the answers

    What is the term for the formation of thrombi in the microcirculation?

    <p>Disseminated intravascular coagulation</p> Signup and view all the answers

    What type of blood flow contributes to the development of venous thrombi?

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

    What is the purpose of the slower-moving layer of plasma in normal blood flow?

    <p>To keep platelets and factors dispersed and inactivated</p> Signup and view all the answers

    What is the primary cause of hypercoagulability?

    <p>Alterations in coagulation factors</p> Signup and view all the answers

    What is the result of a point mutation in the prothrombin gene?

    <p>Elevated prothrombin</p> Signup and view all the answers

    What is a secondary cause of hypercoagulability?

    <p>Prolonged bed rest or immobilization</p> Signup and view all the answers

    What is an example of a condition that increases the risk of DVT?

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

    Study Notes

    Thrombosis and Embolism

    • Hypercoagulability states can lead to thrombosis and embolism, including:
      • Hyperestrogenic states (pregnancy and postpartum)
      • Oral contraceptive use
      • Sickle cell anemia
      • Smoking
    • Thrombus morphology:
      • Lines of Zahn: alternating pale platelet and fibrin layers with darker red cell-rich layers
    • Fate of the thrombus:
      • Propagation: enlargement
      • Embolization: transported elsewhere
      • Dissolution: fibrinolysis
      • Organization and recanalization: ingrowth of endothelial cells, smooth muscle cells, and fibroblasts

    Clinical Features

    • Venous thrombosis (phlebothrombosis):
      • Most common in superficial or deep veins of legs
      • Deep vein thrombosis (DVT): causes localize pain and edema; associated with stasis or hypercoagulable state
    • Arterial and cardiac thrombosis:
      • Atherosclerosis, myocardial infarction, and rheumatic heart disease can lead to thrombosis, which can embolize to brain, kidneys, and spleen
    • Disseminated intravascular coagulation (DIC):
      • Pathologic activation of coagulation cascade, leading to widespread thrombi formation in microcirculation
      • Consumptive coagulopathy: uses up platelets and coagulation factors, which can evolve into bleeding catastrophe
      • Secondary to obstetric complications, advanced malignancy, or sepsis

    Embolism

    • An embolus is a detached intravascular solid, liquid, or gaseous mass that travels through the blood to a distant site, causing tissue dysfunction or infarction
    • Emboli can travel through the bloodstream until they encounter vessels too small to permit further passage, causing partial or complete vascular occlusion

    Pulmonary Embolism

    • Originate from deep venous thromboses and are the most common form of thromboembolic lesions
    • Can occlude the main pulmonary artery, lodge at the pulmonary artery bifurcation (saddle embolus), or pass out into smaller branching arteries
    • Rarely, a venous embolus can pass through an interatrial or interventricular defect and gain access to the systemic arterial circulation (paradoxical embolism)

    Systemic Thromboembolism

    • Mostly arise from intracardiac mural thrombi
    • Most commonly involve the lower extremities (75%) or brain (10%)
    • Consequences depend on the vulnerability of the affected tissues to ischemia, the caliber of the occluded vessel, and the presence of collateral blood supply

    Fat and Marrow Embolism

    • Microscopic fat globules and hematopoietic bone marrow can be found in the pulmonary vasculature after fractures of long bones or soft tissue trauma

    Air Embolism

    • Gas bubbles within the circulation can coalesce to form frothy masses that obstruct vascular flow and cause distal ischemic injury
    • Decompression sickness: nitrogen dissolved in the blood and tissues during high-pressure breathing (e.g., scuba diving) can come out of solution during rapid decompression, causing gas bubbles to form

    Infarction

    • Ischemic necrosis caused by occlusion of either the arterial supply or venous drainage
    • Arterial thrombosis or arterial embolism underlies the vast majority of infarctions
    • Venous thrombosis most commonly leads to congestion
    • Infarcts caused by venous thrombosis are more likely in organs with a single efferent vein (e.g., testis and ovary)

    Morphology of Infarction

    • Red (hemorrhagic) or white (anemic) and may be septic or bland
    • Red infarcts: occur with venous occlusions (e.g., testicular or ovarian torsion) or in tissues with dual circulations (e.g., lung and small intestine)
    • White infarcts: occur with arterial occlusions in solid organs with end-arterial circulation (e.g., heart, spleen, and kidney)

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    Thromboembolism & Infarction PDF

    Description

    This quiz covers the causes and morphology of thrombosis, including hypercoagulability, pulmonary embolism, and the structure of thrombi. Topics include hyperestrogenic states, sickle cell anemia, and oral contraceptive use.

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