hey guys it's me the coasters perfectionist when medicine makes perfect sense we continue our bleeding and coagulation playlist this is video number 96 we will talk about the coagulation factors we have how many 12 factors oh but the last ones 13 yeah but factor 6 does not exist because they later realized that factor 6 has nothing to do with calculation whatsoever so let's get started please watch my previous video on the coagulation cascade before watching this one as you know hemostasis has many steps they were talking step number 3 the coagulation the secondary hemostasis thanks to the coagulation factors here is secondary hemostasis and we're talking physiology what are the names and the numbers and the functions of the coagulation freakin factors we have discussed primary versus secondary mousses before here platelet here hydration factors play two plugs didn't result fibrin thrombus plated count reading time plates agronomy tree are the lab tests here we have PT and PTT the old test was called coagulation time or clotting time but it was not very specific because it could only tell you that there is a problem with secondary hemostasis but but it could not distinguish between extrinsic or intrinsic and that's why PT and PTT tests are way better disease symptoms superficial bleeding deep bleeding this is me who continues but this is the bleeding into joints Hema through this bleeding into muscles muscle hematoma brain hemorrhage later a bleeding bleeding after tooth extraction and even GI bleed mini Raja and epistaxis can happen in either one why do you cut manraja may know is menses or menstruation raja means flow it came from the word rayou which means river have you ever heard of rio de janeiro medicine is literally full of Rajas and Ria's we have many area many Raja Branca Raja diarrhea rhinorrhea and even freakin gonorrhea clinically speaking there is a difference between primary hemostasis and secondary hemostasis primary asymptomatic or mucocutaneous bleeding how about secondary no this is deep bleeding late rebleeding him our throat is deep muscle bleeding or muscle hematoma cranial bleeding cetera you know the story of coagulation I injured myself vasoconstriction temporary play the plug if the traumas very small platelet plug is enough but if it's big we need secondary hemostasis we need the cognition a ski to lay down the beautiful strong fibermesh world traveler imbeciles and then the cloth will contract releasing serum and then fiber lysis destroy the clot and restore the function and then regenerate the tissue step number one vasoconstriction it's a local myogenic spasm because we want to minimize the blood loss next we have primary hemostasis platelet adhesion platelet activation and secretion platelet aggregation let's start the coagulation cascade it's best to start it from down upwards ok what's the end result fibrin mesh work great so fibrin is here it came from fibrinogen because it will cause genesis a fibrin beautiful how do we go from fibrinogen to fibrin thrombin may be the protein of thrombosis literally where the thrombin come from from perot thrombin and that's why we call this factor 1 because it's closer to the end result also it's the first factor to be discovered and then we discovered a factor 2 and then factor 3 and the last one was factor 12 was up there but then we discover factor 13 which is to stabilize the fibrin from labile unstable fibrin fibers into strong stable cross-linked fibrin fibers and that's why patients with factor 13 deficiency suffer from late rebleeding because they made a fibrin mesh work and then it got dissolved because it was not stabilized that's why later rebleeding is a symptom of secondary hemostasis defect so here we have prothrombin to thrombin fibers into fibrin before it we have a cascade after it we have the fiber and stabilizing factor so here is injury vasoconstriction pull a log and I have a fibrinogen and then the mission of the coalition cascade is to take this fibrinogen and to convert it into fibrin fibers strong fibers and then the red blood cells will be stuck within the fibrin mesh work and then it's gonna be a beautiful thrombus like this full of fibrin fibers and red blood cells factor 13 will stabilize the fibers and now we have clogged the vessel and prevented blood loss hence hemo stasis there are only two ways to coagulate intrinsic and extrinsic but there are several ways to bleed several ways to bleed in loading platelet adhesion defect such as Bernard Soulier and von Willebrand disease could be platelet aggregation defects such as a GU lensman thrombus tinea ITP ParaPro taneema such as multiple myeloma freakin uremia p2i 12 inhibitors and GP to be 3a inhibitors not to mention hemophilia a hemophilia B hemophilia C factor 10 deficiency factor 12 deficiency sector 13 deficiency okay so here's five years fibrinogen thrombin and here's Perth Raman how do we go from here to here we need a pro thrombin ace an enzyme that will act when prothrombin complex Y complex because it has many members actually four members two numbers and two words what are the two numbers factor five and factor ten and what are the towards calcium and phosphate I'm sorry not just calcium ionized calcium active calcium because the non-ionized is not physiologically active you can just jam it into a bone to give it some structure but it's not functionally or physiologically active have you ever seen a patient suffering from tetany due to decreased calcium in the bone I've never seen that it's only due to decreased calcium in the blood because it's the ionized physiologically active calcium okey dokey fibrin fibrinogen thrombin prothrombin here's the proof thrombin is complex five and ten calcium and phospholipids how do we activate ten into ten a a for active we have two paths which the extrinsic pathway and the intrinsic pathway okay extrinsic pathway you have the microphone you can speak for yourself okay I am called extrinsic why because I need something from outside of the blood vessel extrinsic to me oh like such as the tissue oh yeah that will work tissue factor because when I injure myself the tissue got in contact with the blood because there is injury there is a continuation of the blood here and now the tissue factor came in contact with the blood specifically factor seven factor seven will become 7a which is active it will activate ten to 10a with five phospholipid and calcium prothrombin from hydrogen father stabilize the fiber thank you so much or I can activate factor ten using the intrinsic pathway ok intrinsic get the mic closer to your lips and speak for yourself I am intrinsic Oh so I need something from within the blood vessel such as the sub in the field of culture oh yeah that will work ok sub in basilicata will activate factor 12 then 11 and then 9 and 8 or 10 because 10 is here baby so basically it's 8 9 11 12 remember that von Willebrand factor is a carrier and a sustainer of the factor 8 we have talked about this before in my video on the von Willebrand factor as well as von Willebrand disease the most common inherited bleeding disorder in the world let's do it from scratch baby ok here is fibrin where did fibrin come from it came from fibrinogen that's why fibrinogen is factor 1 cool how do we go from fibrinogen to fibrin we need thrombin okay where did thrombin come from thrombin came from prothrombin and that's why prothrombin is factor 2 cool and then how about the prothrombin is complex oh yeah we have 2 numbers what are they 10 a 5a and then two words ionized calcium not just any calcium and membrane phospholipid how do we activate 10 from inactive to active we have two stories we have the extrinsic pathway or right and the hero here is the tissue factor also as tissue thromboplastin also known as tissue phospholipid or TPL and this tissue factor will activate factor 7 into 7a and then 7 will activate an entertaining and then you know the rest of the story don't forget to stabilize the fibrin oozing factor 13 here is a quick note the tissue factor or the tissue thromboplastin is also known as factor 3 nice tell me about the intrinsic pathway I need something from within such as the sub endothelial collagen okay 1211 skipped 10 because 10 is here and then 9 and 8 don't forget to add von Willebrand factor to help factor 8 and then we'll activate 10 into 10 a 10 and 5 calcium phospholipid prothrombin to thrombin fibrinogen into fibrin stabilize the fibrin thank you is this hard everything in the extrinsic pathway has two letters here is extrinsic cool tissue factor or thromboplastin PT prothrombin time this is the lab test what is the drug that will inhibit the extrinsic pathway mr. warfarin or coumadin or coumadin or die Coomer Oh tell me about the beloved intrinsic pathway um intrinsic sub endothelial collagen the lab test is PTT and heparin will inhibit me we have discussed the difference between intrinsic and extrinsic pathways before remember extrinsic pathway is short it has only factor 7 because it's short it's less efficient however intrinsic it's longer it's has twelve eleven nine and eight but it's more efficient the shorter pathways gets the shorter lab tests only PT and actually the normal value of PT is fifteen seconds or less however the intrinsic is longer we have four factors twelve eleven nine and eight if it's longer I need the longer name PT t or apt T what is the normal lab test for a PT t normally it should be 40 seconds or below the name is longer and the normal value is longer forty second is longer than 15 seconds beautiful do you want another mnemonic yeah how many letters are here apt T we have four letters yeah and we have four factors we have twelve eleven nine and eight or you can say eight nine eleven twelve how many letters are here PT 2 so we have factor seven and we have factor 3 which is the tissue factor let's talk about the coagulation factor of the clotting factors secondary hemostasis are they proteins fat or carbohydrates they are freaking proteins are the element or glob is the ERG lobby's are the Alpha globins beta clubs or gamblers they are beta-globulin so what are the gamma Glavine these are your antibodies or immunoglobulin says IgA IgG IgM IgD IC whatever coagulation factors they are proteins specifically plasma proteins they are globulin specifically beta club is the source they come from delivery albumin and when we come from the liver no duh number we have 12 what the last was 13 yeah but factor 6 does not exist nomenclature each factor has a name and a number the number is Roman numeral the name could denote as a function or could depict the disease such as anti he mph the a factor which is factor 8 or the patient such as Christmas disease the patient's name was Christmas and this is hemophilia B if you look at the serum protein electrophoresis here is a lots of album and that's why albumin is the main contributor for osmosis yeah because we have lots of it and when it comes to osmosis or osmotic pressure number matters and not the weight or the mass the number baby that's why album a matters way way way way way more than global and that's why sodium matters way way way way way more than glucose because there's lots of sodium the coagulation factors are here beta-globulin s-- what if you see the gamma globulin is like this it means it's probably multiple myeloma we call this the m protein or the m spike but do not say oh it's called the m spike therefore it's IgM no no no it's not IgM IgM is waldenstrom macroglobulinemia multiple myeloma is IgG or at least iga following is Arendt not to be taken seriously it's just pure satire ok Roman numerals these are their manners these are called Arabic numerals I am so happy that Arabic numerals exist ok let's say I'm preparing to file taxes and let's say I earned this amount this year just suppose ok and I want to divide them by 12 to know how much money I earn per month ok using the long division the long division is complicated by itself but can you imagine can you contemplate doing this using Roman freaking numerals like the only thing that I can help you with here is the factor 12 can you imagine doing calculus using Roman freaking numerals if I were you I would jump off the freakin balcony NASA physics do you think we're capable of doing these complex equations and calculations using Roman numerals I mean Ellen must would have never sent his rocket to space in today's world we only use Roman numerals for three things in life number 1 Kings names such as King Henry the 8th have to be right 8 so here is 8 the second thing is the Super Bowl American football which I cannot understand I'm more likely to understand the US tax code this Giganta normos thousands of pages document then I am to understand American football I mean it's can someone please explain it to me I will explain neural Anatomy for you in turn do we have a deal and the third and last thing we use Roman numerals in or brace yourself the coagulation factors also if you have Grey's Anatomy textbook from the 1920s you might have the numbers of the chapters in Roman numerals enough with the jokes let's go to science named number function factor number one fibrinogen function polymerized to make fibrin thank you to prothrombin function it's a serine protease to make thrombin vector3 tissue factor or tissue thromboplastin or tissue phospholipid TPL it's a cofactor it's gonna activate factor 7 thank you so much vector for not just any calcium ionized calcium the physiologically active calcium in the serum and this is a freaking mineral it's part of the prom bunnies complex and it helps many factors factor 5 is the labile factor or pro accelerant what does I n mean it means a protein and this is acceleration and pro exploration and it's a cofactor about factor 6 it does not exist factor 7 the stable factor the pro converting oh because it gets converted into the factor seven eight and then it converts factor ten into ten a love it it's a serine protease factor eight is entering haemophilia a factor and this is named after its disease a deficiency of factor 8 will give me haemophilia a and we also called anti hemophilic go Abhiyan it's a freaking cofactor factor 9 and to hemophilia vector also has Christmas factor this was the name of the patient who had hemophilia B and plasma from a plastic component or PTC it's a serine freakin protease how about factor 10 stored prava factor it's a serine protease factor 11 plasma thromboplastin antecedent or plasma thromboplastin component because pta is kind of funny factor 12 is Hagman factor a serine protease factor 13 the fibrin stabilizing factor that's going to stabilize the fibrin stable fibrin fibers also known as Leakey lawand factor and this is a transglutaminase or transaminase okay let's play this game fibrinogen is factor one prothrombin is factor to tissue factor or tissue thromboplastin or t PL is factor three factor four is the freakin calcium factor 5 is the labile factor factor seven is the stable factor factor eight is anti hemophilia AG factor 9 is anti hemophilia B factor eleven is anti hemophilia see how about factor 10 this is death stored per hour factor factor 12 is the Hagman factor and factor 13 is the fibrin stabilizing factor I have 50 hematology cases about bleeding and coagulation disorders on my glorious website go to medicos is perfectionist calm these are difficult now let's talk about diseases fibrinogen disease is called a fibrinogen anemia okay ma means blood fire engines fibrinogen a means no there is no fibrinogen the blood habit for thrombin hypo for thrombin II mean about factor 5 which is variable factor para hemophilia about factor 8 hemophilia a factor 9 hemophilia beat please skip 10 and go to him of in ESC this is factor 11 this is called sort primer factor and the Disco's supriya factor deficiency this is not super creative you can also call it factor 10 deficiency how about 12 the hagman factor so we have Hagman factor deficiency or Hagman trait or factor 12 deficiency fiber civilising factor we have this is called factor of 13 deficiency question of the day which of the coagulation factors is the most heat unstable factor ever let me know the answer in the comment section you'll find the answer in the next video we'll talk about the three groups of the coagulation factors we have the fibrinogen group then prothrombin group and the contact group thank you for watching you lovely people please subscribe hit the bell and click on the join button you can support me here or here go to my website to get my 50 bleeding in coagulation cases and to get my toy biotics course thank you for watching as always be safe stay happy and study hard this is medicos is perfection endless world medicine makes perfect sense