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Ch 1-21 > 7 > Flashcards

7 Flashcards

1
Q

2 stages of hemostasis

A
  1. primary hemostasis–platelet plug2. secondary hemostasis–proteolytic clotting cascade; fibrin clot/mature thrombus
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2
Q

platelet characteristics

A

anucleatemegakaryocyte precursorlife span 6-8 days

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3
Q

prostaglandin responsible for platelet aggregation/activation

A

thromboxane (TxA2)made from AA–>cox 1 pathway

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4
Q

platelet MOA after endothelial injury

A
  1. adhere to exposed endothelial collagen via vWF2. activation which leads to granular release (TXA2, ADP) and conformational change exposing binding domains for fibrinogen3. recruitment4. aggregation
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5
Q

cascade model of coagulation INTRINSIC

A

XII converts XI activeXI with VIII, PL, Ca activate IXCOMMONIX activates X X with V, PL, Ca activate THROMBINthrombin converts fibrinogen to fibrinaPTT

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6
Q

cascade model of coagulation

A

TF +PL, Ca activate VIICOMMONVII activates XX with V, PL, Ca activate THROMBINthrombin converts fibrinogen to fibrinPT

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7
Q

clotting number of thrombin

A

II

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8
Q

theory behind cell based model of coagulation

A
  1. TF is primary physiologic activator/initiator2. coagulation is localized to and controlled by cell surfacesinitiation, amplification, propagation
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9
Q

normal inhibitors of platelet reactivity

A

Prostacyclin (PGI2)NOectoadenosine diphosphatase

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10
Q

Three natural anticoagulant pathways

A

antithrombin IIIactivated protein CTF inhibitor

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11
Q

MOA of antithrombin III

A

AT III binds and inactivates factor 10 of the common pathwayalso neutralizes other clotting factors, antiinflammatoryactivity of AT III is increased with the presence of heparin

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12
Q

MOA of activated protein C

A

activated protein C inhibits VII, Vdecreases thrombin formationenhances fibrinolysis

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13
Q

MOA TF inhibitor

A

inhibits TF of extrinsic pathway

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14
Q

fibrinolysis

A

dissolution of fibrin clotmain proteolytic enzyme = plasminogen –>plasmindegrades fibrin to FDP, FSPother enzyme: tissue type and urokinase type plasminogen activators

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15
Q

how is fibrinolysis controlled

A

plasminogen activator inhibitorsalpha antiplasminthrombin activator fibrinolysis inhibitor

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16
Q

cause of pseudothrombocytopenia

A

falsely low due to platelet aggregation and mis countingreported in 71% of feline blood samples

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17
Q

estimate of average platelet count on blood smear

A

platelets/HPF x 15,000

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18
Q

BMBT

A

buccal mucosal bleeding time–tests platelet fx/primary hemostasisN dog 1.7-4.2 minN cat 1.4-2.4 mininter/intraoperative variability up to 2 min

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19
Q

BMBT is prolonged with what diseases

A

thrombocytopeniathrombocytopathia (vWF disease)vasculopathy

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20
Q

what % of coagulation factors must be decr to have prolonged PT/aPTT

A

25-30% decreased prior to prolongation

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21
Q

vitamin K dependent coagulation factors

A

2, 7, 9, 107 has the shortest half life

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22
Q

what coagulation test to examine for bit K deficient animals

A

PT7 because of very short half life 4-6 hr

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23
Q

PT tests…

A

extrinsic + common pathwayTF, 7less sensitive to heparin affects than aPTT

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24
Q

aPTT tests…

A

intrinsic + common12, 11, 9

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25
activated clotting times ACT
whole blood + diatomaceous earth (contact factor for XII)tests INTRINSIC and common pathN dog < 110 sN cat < 75 sless sensitive than aPTT
26
FDP/FSP
degradation products of fibrin/fibrinogenmarkers of fibrinolysisusually cleared via livercan lead to dysfx in platelets/inhibit coagulationMay be a marker DIC
27
D dimers
indicate activation of thrombin and plasminspecific for activation of coagulation and fibrinolysissensitive marker for DIC, thromboembolism with excellent negative predictive valueNOT specific
28
fibrinogen deficiency in relation to thrombin clot time
TCT is prolonged and clot formation decreased with 1. hypofibrinogenemia2. dysfibrinogenemia3. presence of factors inhibiting fibrin polymerization (heparin, FDPs)
29
list coagulation testing
platelet number and blood smear reviewPT/PTTBMBTACTFDPs/FSPsDDimersFibrinogenTEG
30
Thromboelastography
TEG evaluations clot initiation, formation, propagation to fibrinolysisstrength and stability of clotdynamics of its formation and breakdown
31
TEG parameters
R reaction time (time of latency until start of clot form)K clotting time (time to clot formation)alpha how fast clot is formedMA max amplitude (overall strength of clot)LY60 (fibrinolysis)
32
which TEG variable measures secondary hemostasis
R reaction time (time of latency until start of clot form)
33
Which TEG variable measures clot kinetics
K clotting time (time to clot formation)
34
predictive value of TEG to ID bleeding
TEG correctly ID bleeding with PPV 89% NPV 9*%
35
disorders of primary hemostasis
thrombocytopenia (SPUD)thombopathia (acquired, inherited-vWF)vasculopathy (acquired, inherited-ehler-danlos)pg 101
36
acute coagulopathy of trauma
tissue injury, shock, massive fluid resuscitation (>blood volume within 24 hr)hemodilutionhypothermiaacidemiashock
37
what is the first factor to be decreased with hemodilution
fibrinogen
38
which fluid demonstrates the most pronounced hemodilution effect
hetastarchdecreases fibrinogen, vWF, VIII
39
clinical signs of patients with primary hemostatic disorder
ecchymosisspontaneous bleeding from mucosal surfacespetechia (more with thrombocytopenia rather than pathia)
40
clinical signs of patients with secondary hemostatic disorder
hematomasbleeding into body cavity
41
indications for use of cryoppt
vWF disease VIII deficiencyhypofibrinogenemia/dysfibrinogenemia
42
list platelet containing blood products
fresh whole blood**platelet rich plasmaplatelet concentrate
43
T/FDesmopressin is effective for all types of vWF
FALSEonly effective for type I vWF were there is not a complete absence of vWF
44
treatment of hemophiliac patients
recombinant factor VIIpromotes extrinsic/common pathway especially important for hemophilia A (8) and B (9) deficiencies of the intrinsic pathwayDOSE CANNOT BE REPEATED--Ab develop
45
most common primary hemostatic disorder
thrombocytopeniaSPUD (immune mediated destruction is most common cause in dogs)may not have spontaneous bleeding until < 50,000
46
condition of non pathologic thrombocytopenia
Cavalier King Charles Spaniel
47
most common congenital bleeding disorder
vWF deficiency (ELISA definitive dx 50% cut off)1. all multimers present but reduced concentration--DOBIES2. loss of hi moleculecular weight multimers--GSP GWP3. absence all multimers--sheltie, bay retrievers
48
most common inherited coagulopathy in cats
deficiency in factor 12does not result in bleeding usuallyprolongation aPTT
49
% of dogs and cats with hepatobiliary disease that have some sort of hemostatic abnormality
dog 93%cat 82%spontaneous bleeding occurs in < 2%
50
T/Fvit K trial therapy is advantageous in patients with cholestatic/liver disease
TRUEliver responsible for vit K metabolismdysfunction leads to malabsorption of vit K which leads to decr clotting factors 2, 7, 9, 10may see prolongations of PT (due to factor 7)
51
what is Virchow's triad in thromboembolic discussion
thrombotic tendency depends on 3 major risk factors1. endothelial injury2. blood stasis3. hypercoagulability
52
a study of dogs with THR show what % of thromboembolism
82%
53
what is oligemia in terms of diagnosing pulmonary thromboembolic disease
oligemia increased radiolucency on VD/DV thoracic filmscorresponds to hypovascular area of lung regions distal to PTE
54
Diagnostics for PTE patient
D DimersTEGRadiographs (nonspecific; oligemia)ABGCardiac eval/Echo (right hypokinesis)DEFINITIVE DX: selective pulmonary angiography
55
most common abnormalities in ABG of PTE patient
not pathognomonic (in descending order)1. increased Aa gradient2. hypoxemia3. hypocapnia4. decrease oxygen response
56
management of thromboembolic disease
1. anti platelet drugs (aspirin, clopidogrel)2. anticoagulants (heparin--unfrac, LMW and warfarin)
57
drug protocol for hyperadrenocorticoid dogs undergoing adrenalectomy
unfrac heparin in plasma at induction followed by 35 U/kg SQ q8hr tapered over 4 days
58
drug used for prophy tx of emboli in renal transplants in dogs
low molecular wt heparin enoxaparin before sx0/5 w drug had TE5/10 dogs without drugs had TE
59
diagnosis of DIC
3 or more of the following:thrombocytopeniaPT/aPTT prolongationincr FDPs/ D Dimershypofibrinogenemiadecreased antithrombin III activityRBC fragmentation
60
most dogs with DIC are hyper or hypo coagulable?
HYPER only 22% hypocoagulable
61
MOA of clopidogrel
blocks ADP binding to receptor on platelet (P2Y12)prevents activation/recruitment/aggregation
62
what is the target aPTT when treating for thromboembolic disease
aPTT 1.5-2.0 times normal

Ch 1-21 (19 decks)

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