Page 581 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 28 ■ Disorders of Hemostasis and Thrombosis: Blood Coagulation Factors, Hypercoagulable State, and Anticoagulant Therapy 565

ARTERIAL VENOUS

THROMBOSIS THROMBOSIS

Hypercoagulability
F
O
Qualitative Activation of coagulation
S D Abnormal
O E I platelet
T fibrinogens
O I
L abnormalities
BL A Deficient
M E fibrinolysis
R
TH O Deficiency of
N Platelet
AB activation Thrombocytosis physiologic
inhibitors

F Deficient
O
clearance
W S
E O Turbulence
T I L
I
F L
D A Stasis
M O Hyperviscosity
O R Hypertension
BL O N

AB

Venous
F
O hypotonia (pregnancy)
L Trauma
S L
E Erosion
W A T I
L I L Atherosclerosis
A E
M S
R S
O VE N Deficient

AB fibrinolysis

FIGURE 28.3 Patho hysio ogy o thro bosis. Factors i icate in the athogenesis o arteria thro bosis (lef )

an venous thro bosis (right) are e icte . Exa es o isor ers ea ing to ate et activation an arteria thro -
bosis inc u e atherosc erosis, the ye o ro i erative isor ers, he arin-associate thro bocyto enia/thro bosis

syn ro e, thro botic thro bocyto enic ur ura, an certain ate et o y or his s. Exa es o isor ers ea -

ing to venous thro bosis in the category o e ciency o hysio ogic inhibitors inc u e the inherite isor ers,

actor V Lei en, rotein C an S e ciencies, an A e ciency. Many atients with thro bosis ay have ore
than one o the risk actors iste . Estrogen thera y is a risk actor or venous thro bosis; its use is associate

with activation o coagu ation. (Source: Greer JP, et a . Wintrobe’s Clinical Hematology, 13th e , Phi a e hia, PA:

Li incott Wi ia s & Wi kins, 2014.)

BOX 28.2
BOX 28.3

Thrombotic Disorders
Acquired Risk Factors for Thrombophilia

Inherite
A vancing age

■ Factor V Leiden resistance an re ate I obi ization
utations—High-Inci ence Pregnancy

■ Prothro bin gene utation—Low inci ence Hor one re ace ent thera y

■ Antithro bin e ciency—Low inci ence Ora contrace tives

■ Protein C e ciency—Low inci ence Ma ignant tu ors

■ Protein S e ciency—Low inci ence Leuke ia
Chronic inf a ation
Acquire
Surgery

■ Anti hos ho i i syn ro e—High inci ence Autoi une isor ers

■ Hy erho ocysteine ia Paroxys a nocturna he og obine ia (PNH)