Blood and Hemostasis

Question 1

role of factor 5

Answer 1

cofactor for 10—>2

Question 2

role of factor 9

Answer 2

9a activates 10

Question 3

low iron, high transferrin, low ferritin, low rtcs

Answer 3

iron deficiency

Question 4

anemia compensation for rtc

Answer 4

rtc * hgb(patient) / hgb(control). if cells are nucleated this is worse (even less mature) so divide corrected rtc by 2.

Question 5

most common cause of b12 deficiency

Answer 5

pernicious anemia = autoimmune destruction of parietal cells

Question 6

why is clotting present in hemolytic anemia

Answer 6

1) stop the bleed; 2) high free hemoglobin

Question 7

role of factor 2

Answer 7

2a activates conversion of fibrinogen to fibrin, which actively forms clots

Question 8

factor 8 deficiency

Answer 8

hemophilia A

Question 9

DIC

Answer 9

disseminated intravascular coagulation, too much coagulation, uses up the platelets, causes clot AND bleeding

Question 10

low iron, low transferrin, high ferritin

Answer 10

chronic disease (sequestration by macrophages); total iron levels are normal so body doesn’t think to take in more (via transferrin), but being extensively stored in macrophages so high ferritin

Question 11

factor 9 deficiency

Answer 11

hemophilia B

Question 12

high aPPT

Answer 12

activated partial prothrombin time, bleeding, factor 8, 9, 11, 12 problems, heparin

Question 13

peripheral smear most important for which anemias

Answer 13

hemolytic (includes sickle cell, fragmented d/t turbulence or valvulopathies, etc)
Thalassemia alpha vs beta (hgbH precipitates vs no) + target cells

Question 14

normal to high iron, normal to high transferrin, normal to high ferritin

Answer 14

thalassemia (poor hgb synthesis); may try to correct for bad hemoglobin with more iron (ineffectively), but this isn’t the problem so end up storing it

Question 15

high PT and aPPT

Answer 15

factor 2, 5, 10 problems, vitamin k antagonists, heparin, liver disease, DIC, fibrinogen deficiency …

Question 16

low iron, high transferrin, low ferritin, high rtcs

Answer 16

hemolytic anemia

Question 17

role of protein c

Answer 17

APC inhibits 8 and 5, acting as an anticoagulant

Question 18

expected lab results in hemolytic anemia aside from standard blood ones

Answer 18

high bilirubin (degradation product), high haptoglobin (salvage protein), high co2, high free hemoglobin (leads to clotting)

Question 19

mcv in b12 and b9 deficiency?

Answer 19

high, can’t mature

Question 20

role of protein s

Answer 20

cofactor for APC, anticoagulant

Question 21

is alpha or beta thalassemia worse

Answer 21

alpha; it is present in fetal hemoglobin in addition to adult; often fatal in utero (now have in utero blood transfusions so less so)

Question 22

b12 or b9 deficiency more common

Answer 22

b9

Question 23

abnormal thrombocyte level

Answer 23

<150,000

clinical relevance (bleeding) kicks in well below that usually

Question 24

most common cause of b9 deficiency

Answer 24

pregnancy

Question 25

normal aPPT and PT with clinical symptoms

Answer 25

problem outside normal pathway e.g. factor 13, VWF

Question 26

high prothrombin time

Answer 26

PT, bleeding, factor 7 problems, vitamin k antagonists

Question 27

role of VWF

Answer 27

makes platelets more sticky

Question 28

normal to low iron, normal to low transferrin, normal to low ferritin, low rtc

Answer 28

megaloblastic anemia: b12 or b9 deficiency, chemo, myelodysplastic syndrome

Question 29

role of vitamin k

Answer 29

cofactor for 2, 7, 9, 10, proteins C and S

Question 30

role of factor 8

Answer 30

cofactor for 9—->10

Question 31

role of factor 10

Answer 31

10a activates 2

Question 32

role of plasminogen

Answer 32

—>plasmin breaks down fibrin

Question 33

normal reticulocytes

Answer 33

CORRECTED FOR ANEMIA = 0.5-1.5

Question 34

role of AT3

Answer 34

anti thrombin iii, inactivates 9, 10, 2, 7, mostly 2, anticoagulant

Question 35

role of factor 7

Answer 35

7a activate 10

Question 36

what are b12 and b9 needed for

Answer 36

dna synthesis; b12 = methionine synthesis; b9 = purine synthesis. b12 also need for kreb’s cycle, homocysteine recycling