Clotting cascade etc Flashcards
This is a protein that catalyses plasminogen –> plasmin conversion
Tissue plasminogen activator tPA
Antidote for tissue plasminogen activator toxicity?
aminocaproic acid
This serine protease dissolves fibrin blood clots
Plasmin
Proteins that inhibit plasmin?
alpha2-macroglobulin
alpha2-antiplasmin
What effect does heparin have on antithrombin?
Heparin increases AT binding of factor II and X
Produced by activated platelets and has prothrombotic effects by increasing expression of GPIIb/IIIa on platelets
Thromboxane A2
This enzyme is important for platelet aggregation and is irreversibly inhibited by aspirin.
Cyclooxygenase
It works by irreversibly inactivating Factor Va and VIII. It is activated itself by thrombomodulin.
Protein C
What is the other name for Prostaglandin-endoperoxide synthase 2?
Cyclooxygenase-2
BM - increased megakaryocytes on a background of fluctuating history of easy bruising, epistaxis and menorrhagia.
Immune thrombocytopenic purpura
Which components of the coagulation cascade are dependent on Vitamin K?
Factors II, VII, IX and X
Protein C, S and Z
Vascular endothelium or subendothelium … which one synthesises tissue factor, vWF, prostacyclin, plasminogen activator, antithrombin III and thrombomodulin?
Endothelium
Pain, tenderness, indurated cord along a palpable superficial vein. Skin is warm and erythematous.
Superficial venous thrombosis
Peripheral oedema, tachycardia, supine hypotensive syndrome.
IVC syndrome
Shortness of breath
Facial and arm swelling
Distended veins in the upper chest/arms
SVC syndrome (obstruction)
Past medical history of DVT
Brownish discolouration of skin
Ulcer
Worsens after walking or standing for a long time
Post-thrombotic syndrome
Antithrombin potentiator
Administered IV
Can be reversed quickly
Unfractionated heparin
Potentiates antithrombin III
Usually subcut.
Risk of osteoporosis/hyperkalaemia
Dalteparin (LMWH)
This is used to monitor warfarin therapy
INR (the patient’s PT divided by a normal PT)
This prodrug goes on to inhibit P2Y receptors found on platelets - inhibiting their function
Primary prevention of stroke in aspirin allergic patients
Used in acute MI along with aspirin
Clopidogrel
In patients with metallic heart valves, this drug is the most effective anticoagulant
Warfarin
In patients with cancer and acute venous thromboembolism, the most effective drug at reducing the risk of recurrent VTE is __?
Dalteparin (LMWH)
This drug when given alone initially increases the clotting risk
Warfarin
Side effects include cutaneous necrosis
Warfarin
The drug most likely to cause thrombocytopaenia with paradoxical thrombosis
Unfractionated heparin (UFH)
Heparin mechanism of action?
Activates Antithrombin III –> inactivates Thrombin and FXa
When is streptokinase contraindicated?
Contra-indicated if recent sore throat, if ever used before, or in the presence of proliferative retinopathy.
Peripheral cytopenia
Greater than 20% blast cells in bone marrow
AML
Macrocytic anaemia
Megakaryocyte hyperplasia with nuclear hypolobation
Moderate thrombocytosis
5q syndrome
Pelger-Huet anomaly
Hyposegmented neutrophils
A myelodysplastic syndrome with a marrow blast percentage of 5 to 19%
Refractory anaemia with excess of blasts
A myelodysplastic syndrome in which two of the three blood cell types are abnormal and less than 1% of peripheral cells are blasts
Refractory cytopenia with multilineage dysplasia
A myelodysplastic syndrome with low red cells and ringed sideroblasts
Refractory anaemia with ringed sideroblasts
Imatinib used for what?
Treatment of CML - it’s a tyrosine kinase inhibitor
Two conditions in which you might see dacrocytes (teardrop cell)
Beta thalassemia major
Myelofibrosis
Patient with CLL
Biopsy shows anaplastic, large cell lymphoma
Richter’s syndrome
CLL or hairy cell leukaemia –> diffuse large B cell lymphoma (a type of NHL)
Patient with ALL has bone marrow infiltration of blasts or lymphocytes?
Blasts
The commonest adult leukaemia
CLL
‘C’ for common!
Neutrophil alkaline phosphatase is low
CML
Neutrophil alkaline phosphatase is raised
myeloproliferative disorders
Infections
