287b acquired coag

Question 1

qualitative platelet defect causes?

Answer 1

immune mediated
toxins - uremia from renal disease
medications -ASA, penicillins
myelodysplastic syndrome (MDS)

Question 2

what does vit k dep N-terminal glutamic acid carboxylation allow?

Answer 2

binding Ca to bring to phospholipids

Question 3

Causes of Vit Deficiencies?

Answer 3

severe malnutritions

antibiotics

malabsorption (requires bile b/c fat soluble) - biliary cirrhosis, cholestasis, celiac sprue

Question 4

liver cirrhosis - portal htn effect on spleen?

Answer 4

splenomegaly –> platelet sequestration

Question 5

what coag factor has the shortest t 1/2 and goes down first with liver disease? what test reflects this?

Answer 5

F VII

PT

Question 6

when should you treat coagulopathy in liver disease?

Answer 6

only when symptomatic (i.e. bleeding)

Question 7

pathologic inhibitors of coagulation?

Answer 7

antibodies against factors from…

idiopathic

acquired IgG to F VIII –> mucosal bleeding + easy bruising; elevated PTT; mixing doesn’t fix PTT; Bethesda assay quantifies

cancer

Question 8

what does thrombin act on to activate coagulation?

Answer 8

Va
XIII
VIII
XI

Question 9

acquired F VIII treatment?

Answer 9

bleeding - DDAVP (low titer) or Prothrombin complex concentration (high tighter)

eradication of antibody - steroids, rituximab (binds CD 20 on B cells)

Question 10

Antiphospholipid syndrome (APLS)

Answer 10

AB –> anionic PL –> thrombosis, livedo reticularis (lacy rash), pregnancy complications

LAC (lupus anticoagulant), anticardiolipin, Beta 2

causing thrombosis (veins and arteries) despite high PTT

Question 10

Antiphospholipid syndrome (APLS)

Answer 10

AB –> anionic PL –> thrombosis, livedo reticularis (lacy rash)

LAC (lupus anticoagulant), anticardiolipin, Beta 2

causing thrombosis (veins and arteries) despite high PTT