The Coagulation Cascade - Deranged Physiology

This document was created by Alex Yartsev if I have used your data or images and forgot to reference you, please email me. From W illiam Hematology by Lichtman et al, especially chapter 115 by Monroe III Intrinsic pathway : the contact activation pathway Triggered by the exposure of negative charge on collagen; High molecular weight kininogen, prekallikrein and factor XII all form a complex on the collagen, and this causes the following amplification Cascade . This plays a minor role. extrinsic pathway : the tissue factor pathway This is the PRIMARY, MOST IMPORTANT pathway . Triggered by the exposure of tissue factor in the damaged blood vessel wall to the circulating factor VII. Final Common pathway The Coagulation Cascade Factor XII Factor XIIa Factor XI Factor XIa Factor IX Factor IXa Factor VIIIa Factor X Factor Xa Ca++ Ca++ Ca++ Prothrombin (Factor II) Thrombin (IIa) Fibrinogen (Factor I) Fibrin monomers (Ia) Fibrin Stabilizing Factor (XIII) Fibrin Crosslinked Polymers Fibrin Stabilizing Factor (XIIIa) Phospholipid Factor VIIa Factor X + Tissue Factor (IIIa) Factor VIIa Tissue Factor( III) Factor VII Ca++ Phospholipid Plasminogen Plasmin Fibrin Degradation Products Tissue Plasminogen Activator Factor Va Factor V Protein C Thrombin + Protein C Thrombomodulin Protein S Activated Protein C Antithrombin III Antithrombin III Antithrombin III In circulation, factor VIII is bound to

- The tissue factor activates the extrinsic pathway, which in turn activates the final common pathway; so the PT actually measures BOTH pathways. The rate of the extrinsic pathway is mainly influenced by the amount of Factor VII you have. Factor VII has a short half-life and depends on Vitamin K.

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  Pathway, Extrinsic

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