Page 587 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 28 ■ Disorders of Hemostasis and Thrombosis: Blood Coagulation Factors, Hypercoagulable State, and Anticoagulant Therapy 571

PAI-1
Plasminogen

tPA
uPA

α AP
2
α M
2

Plasmin
Endothelial cells

Xa/Va Fibrin D-Dimer
FDPs

Prothrombin Thrombin

Fibrinogen

Thrombomodulin

TAFIa
aPC

Protein C TAFI

FIGURE 28.4 Fibrino ysis. T ro bin, generate ro rothro bin by the action o the Xa/Va rothro binase
co ex, activates en othe ia ce s to ro uce as inogen activators. T ese, in turn, c eave as inogen to or

as in, which egra es brin ( or e by the action o thro bin on brinogen) to d- i er rag ents an other

brinogen egra ation ro ucts. Inhibitors o brino ysis (in ia on s) inc u e PAI-1, which inhibits the actions

o tPA an uPA, an a 2AP, β 2M, an AFI, which inhibit as in. T ro bin, when boun to thro bo o u in
on the sur ace o en othe ia ce s, activates AFI to its active or an ro uces activate rotein C, an i ortant

vita in K– e en ent rotein with anticoagu ant an anti-inf a atory ro erties. α 2AP, a ha-2-anti as in

(a ha-2- as in inhibitor); a 2M, a ha-2- acrog obu in; tPA, tissue-ty e as inogen activator; uPA, urine-

ty e as inogen activator; PAI-1, as inogen activator inhibitor ty e-1; FDPs, brin egra ation ro ucts; Xa,
activate actor X; Va, activate actor V; aPC, activate rotein C; AFI, thro bin-activatab e brino ysis inhibitor;

AFIa, activate AFI. (Source: Sha ner DH, Nicho s DG. Rogers’ extbook o Pediatric Intensive Care, Phi a e hia,

PA: Li incott Wi ia s & Wi kins, 2015.)

FIGURE 28.5 Fibrino ysis. (Fro Buck in BA, Baysinger CL, Ga b ing D. A Practical Approach to Obstetric

Anesthesia, 2n e , Phi a e hia, PA: Li incott Wi ia s & Wi kins, 2016.)