blood & Videos Flashcards
hemostasis -
a term means to stop bleeding -prevents exsanguination following injury, trauma and or surgery
zymogens
inactive enzymatic precursors of most coagulation factors
proteases
catalyst transforming inactive into an active state
extrinsic factor
7
intrinsic factor
9, 11, 12, (8)
common pathway factor
10, 2, 13
pathway for pt
extrinsic
pathway for ptt
intrinsic
what does the post op anabolic state do to coagulation factors
increases hemostatic factors for several days
factor 1
fibrinogen
factor 2
prothrombin
factor 3
thromboplastin /tissue factor
factor Iv
calcium
factor V
labile factor/proccelerin
factor VII
SPCA- serum prothrombin converting accelerator
factor VIII
anti hemophilic a factor
factor IX
christmas factor
factor X
stuart factor
factor XI
plasma thrombplastin antecedent
factor XII
hageman factor
Factor XIII
fibrin stabilizing factor
because of loss of vascular endothelial function and other prohemostatis changes, venous and arterial thromboembolic events -when does this occur
increases with age.
antiphospholipid syndrome is caused by
lupus anticoagulant (phoslipid binding antibody)
antiphospholipid syndrome- cause by lupus anticoagulant will present with
prolonged prothrombin times and partial thromboplastin times
BUT-they are hyper coagulable.
what is the most common cause of thrombocytopenia in the perioperative setting
dilutional effect following volume resuscitation
treatment for DIC
antibiotics
removed underlying problem
instituting anticoagulation
*support organs
at the center of hemostasis is the ability to generate
thrombin
thrombin plays a role in activation of additional
coagulation factors
What factor activates Factor 10?
factor 9a
the first factor in the common pathway
factor 10
factor 7 converts to 7a through
Tissue factor (factor 3)
10a acts as a protease and converts
factor 2 (prothrombin) to factor 2a (thrombin)
Thrombin converts
fibrinogen to fibrin (monomer)
Fibrin clot is eventually broken down by
fibrinolytic
plasminogen –> plasmin is the ultimate fibrinolytic and
breaks down the fibrin clot
Fibrinolytic therapy vs anticoagulation
fibrinolytics: activate plasmin to breakdown clots
anticoagulation: prevent fibrin clots from forming
Hemophilia A hallmark lab values
normal BT
Normal PLT count
In Hemophilia A, factor X can’t be activated as well. this results in
fibrin polymer meshwork to not form
Hemophilia B is a deficiency of which factor? it’s also known as?
Christmas Tree disease
Protein C inactivates
Factors Va and VIIIa (58)
Coumadin binds to
vitamin K
Protein S makes
Protein C (breaks down 5a and 8a)
*require Vit K to work
PT and PTT do not measure what factor?
XIII (13)
Heparin principally acts on
Antithrombin (AT)
Heparin makes AT do what?
“it’s on steroids”
heparin makes AT work really well
Heparin’s impact on AT inactivates
factors II, X – the common pathway
blocks coagulation
LMWH are short chained
polysaccharides
Unfractionated Heparin need to monitor
PTT
Heparin Induced Thrombocytopenia
- decreased PLT count caused by heparin
- hypercoagulability
- IgG antibodies against heparin bind to Factor IV (calcium)
- antibodies+heprin/PLT factor IV complex will activate PLT and form clots
PLT: decreased
BT: increased
PT: normal
PTT: normal
What is this disorder?
Thrombocytopenia
PLT: Normal
BT: increased
PT: normal
PTT: increased
What is this disorder?
von Willebrand Disease
PLT: normal
BT: normal
PT: normal
PTT: increased
What is this disorder?
Hemophilia A
PLT: decreased
BT: increased
PT: increased
PTT: increased
What is this disorder?
DIC
PLT: normal
BT: increased
PT: increased
PTT: increased
What is this disorder?
primary fibrinolysis
PLT: normal
BT: increased
PT: normal
PTT: normal
What is this disorder?
Aspirin or NSAIDs
PLT: normal
BT: normal
PT: increased
PTT: increased
What is this disorder?
Warfarin or Heparin
ABL =
[EBV x (Start Hct – Target Hct)] / Start Hct
Sponge (4x4) =
lap sponge =
Sponge (4x4) = 10ml
lap sponge = 100-150ml
