Bleeding

Question 1

What are 3 ways to increase thrombosis risk?

Answer 1

endothelial damage
stasis
hypercoagulabitily

Question 2

What are some causes of endothelial damage?

Answer 2

Artherosclerosis
Smoking 
hyperlipidemia 
obesity
HTN

Question 3

What are the causes of stasis?

Answer 3

• CHF or other heart problems
• varicose veins
• immobilization

Question 4

What are some causes of hypercoagulability?

Answer 4

• Malignancy
• Estrogen/postpardum
• thrombotic disorders
• trauma/surgery

Question 5

What are some hereditary cause of thrombotic disorders?

Answer 5

1. factor V Leiden
2. ATII def
3. Protein C def
4. Protein S def
5. Factor II gene mutation
6. Homcysteinemia

Question 6

What are some cause of acquired thrombotic disorders?

Answer 6

Anti- phospholipid antibody

Question 7

What is the most common cause of unexplained thromboses?

Answer 7

Factor V Leiden (1/2 of all unexplained)

• Point mutation in factor V
• Cant be turned off
• Genetics for Dx
• very rare in non-whites

Question 8

What kind of mutation is Factor V Leiden?

Answer 8

Point mutation and A to G

- cant be cleaved by protein C

Question 9

What is the risk of clot with V Leiden?

Answer 9

Hetero- 7x
Homo- 80x
- PTT and INR not helpful
- don’t treat unless thrombosis

Question 10

What does ATIII inhibit and what increases it efficacy?

Answer 10

2,7,9,10,11

- Heparin increases its effects

Question 11

What are the risks of clot?

Answer 11

Homo- cant live
hetero- 50% get clots

• cant do genetic testing
• heparin wont work
• ATIII concentrates required

Question 12

What does protein C do?

Answer 12

inhibits 8 and 5

• fibrinolytic by promoting tPA
• can get warfarin induced skin necrosis with C def
• Hetero 7x clotting than normal
• C and S as well as sepsis
• may need to give protein C and start on heparin

Question 13

Factor II mutation?

Answer 13

prothrombin- makes too much

• rare in non-whites
• 2-20x risk of clot

Question 14

What is homocysteinuria?

Answer 14

Rare metabolic disorder 
- def in trans-sulphuration enzyme
- increased in blood and urine
- increased thrombosis and atherosclerosis 
2x and 10x venous and arterial clots

Question 15

What is homocysteinemia?

Answer 15

Less worrisome

• caused by b12/folate def
• MTHRF gene mutation

Question 16

What is anti-phospholipid ab’s?

Answer 16

Ab’s against phospholipids

• false increase in IRN
• Thromboses
• Serious disorder

Question 17

What is the bottom line about Anti-phos ab’s?

Answer 17

Called inhibitors

• promote coag in vivo
• inhibit it in vitro
• PTT mixing study that doesnt correct

Question 18

What are the symptoms anti-phos ab’s?

Answer 18

thrombosis
spon abortions
risk of stroke
pulmonary HTN
Renal failure

Question 19

What are some of the ab’s in anti-phos against?

Answer 19

3 variants:

• anticardiolipid
• lupus anticoag
• other molecules