4.2 Secondary Hemostasis and Related Disorders

Question 1

What is the goal of secondary hemostasis?

Answer 1

Stabilize the platelet plug via coagulation cascade

Question 2

What is the cross linking molecule between platelets?

Answer 2

Fibrinogen

Question 3

What is the end product of the coagulation cascade?

Answer 3

Thrombin

Question 4

Where are the Factors of coagulation produced?

Answer 4

Liver

Question 5

What are disorders of secondary hemostasis often caused by?

Answer 5

Abnormalities in the Factors

Question 6

What are some of the clinical features of secondary hemostasis diseases?

Answer 6

Deep tissue bleeding into muscle and joints VS the skin and mucosa of primary hemostasis disorders

Question 7

What is the PT/INR used to measure?

Answer 7

Extrinsic Pathway

Question 8

What is the PTT (APTT) used to measure?

Answer 8

Intrinsic Pathway

Question 9

What are the factors involved in the intrinsic pathway?

Answer 9

XII
XI
IX
VIII

Question 10

What are the factors involved in the extrinsic pathway?

Answer 10

VII

Question 11

What is the deficiency in Hemophilia A?

Answer 11

Deficiency in Factor VIII

Question 12

What happens to the PT and APTT in Hemophilia A?

Answer 12

APTT will go up

PT will remain normal

Question 13

What is the deficiency in Hemophilia B (Christmas Disease)?

Answer 13

Factor IX deficiency

Question 14

What is the most common coagulation factor inhibitor (Ab against Factors)?

Answer 14

Anti-Factor VIII

Question 15

How can coagulation factor inhibitor VIII be distinguished from Hemophilia A?

Answer 15

Mixing of blood with normal blood will lead to correction in Hemophilia A but NOT if there is a coagulation factor inhibitor against Factor VIII as the Ab will just bind VIII from the normal blood.

Question 16

What is the most common inherited coagulation disorder?

Answer 16

von Willebrand Disease

Question 17

What is the dysfunction in von Willebrand disease?

Answer 17

Deficient vWF (either quality or quantity)

Question 18

What are the clinical presentations of von Willebrand disease?

Answer 18

Skin and mucosal bleeding with increased bleeding time.

Increased PTT but normal PT

Question 19

What is a lab test that will be abnormal in von Willebrand disease?

Answer 19

Ristocetin Test

Question 20

What happens with Vitamin K deficiency?

Answer 20

Without it, Factor II, VII, IX and X cannot be gamma-carboxylated so they won’t function properly

Question 21

Why does liver failure lead to hemostatic problems?

Answer 21

1. Decreased production of coagulation factors

2. Decreased activation of Vitamin K by epoxide reductase

Question 22

What is used to measure liver failure effect on hemostasis?

Answer 22

PT/INR