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B&L Exam 2 > Case 3 > Flashcards

Case 3 Flashcards

* = dx of one of the cases

1
Q

Prothrombin Time (PT)

A
  • Extrinsic pathway

* Factors involved: V, VII, X, prothrombin, and fibrinogen

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2
Q

Partial Thromboplastin Time (PTT)

A
  • Intrinsic pathway

* Factors involved: Everything except VII and XIII

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3
Q

What causes secondary hemostasis disorders?

A

Failure to clot

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4
Q

Which disorders are secondary hemostasis disorders? (4)

A
  1. Hemophilia A
  2. Hemophilia B
  3. Vitamin K Deficiency
  4. Liver failure
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5
Q

What are some general characteristics and manifestations of platelet disorders?

A
  • PT and PTT not affected
  • Bleeding time is increased
  • Manifestations: mucosal & skin bleeding
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6
Q

Which disorders are functional platelet disorders? (3)

A
  1. Bernard-Soulier Disease
  2. Glanzmann thrombasthenia
  3. Ureamia
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7
Q

Which disorders are platelet number disorders? (4)

A
  1. Idiopathic thrombocytopenic purpura (ITP)
  2. Thrombotic thrombocytopenic purpura (TTP)
  3. Hemolytic uremic syndrome (HUS)
  4. Heparin-induced Thrombocytopenia (HIT)
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8
Q

What are some general characteristics of secondary hemostasis disorders?

A
  • Due to factor abnormalities
  • Deep tissue bleeding into muscles and joints
  • Rebleeding after surgical procedures
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9
Q

Hemophilia A*

A
  • Factor VIII deficiency
  • X-linked recessive (men affected)
  • Sx: asymptomatic, easily bruised, excessive bleeding
  • Labs: ↑ PTT, normal PT
  • Tx: Factor replacement therapy, DDADP (desmopression), EACA
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10
Q

Hemophilia B (aka Christmas Disease)

A
  • Factor IX deficiency
  • X-linked recessive (men affected)
  • Sx: asymptomatic, easily bruised, excessive bleeding
  • Labs: ↑ PTT, normal PT
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11
Q

Vitamin K Deficiency*

A
  • Activation of coagulation factors II, VII, IX, X, Protein C & S
  • Labs: ↑ PTT & PT
  • Tx: Vitamin K Supplement & treatment of coagulopathy
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12
Q

Liver failure (cirrhosis)

A

↓ coagulation factors, ↓ Vitamin K, ultrasound shows shrunken, nodular liver

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13
Q

Bernard-Soulier Disease

A
  • Defective platelet plug formation due to decreased Gp1b (adhesion affected)
  • Labs: low # of platelets but enlarged platelets
  • Tx: transfusion of normal platelets
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14
Q

Glanzmann thrombasthenia

A

• Defective platelet plug formation due to decreased GpIIb/IIIa (aggregation affected)

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15
Q

Ureamia

A

• Disrupts both adhesion and aggregation of platelets

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16
Q

Idiopathic thrombocytopenic purpura (ITP)*

A
  • Spleen makes antibodies (IgG) against platelet antigens → destruction of platelets by macrophages in spleen
  • Primary or secondary due to HIV or SLE
  • Sx: bruising, petechiae, epistaxis
  • Labs: ↓ Platelets (<20k), normal PT and PTT, ↑ megakaryocytes
  • Tx: corticosteroids, IVIG, anti-D immunoglobulin, Rituximab, Romiplostim & Eltrombopag, TPO-mimetic agents (only ones that stimulate platelet production, others prevent destruction)
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17
Q

Thrombotic thrombocytopenic purpura (TTP)

A

• Caused by genetics, medications or autoimmune
• Sx: the “pentrad” = thrombocytopenic purpura, fever, renal failure, neurological changes and microangiopathic hemolytic anemia
• Labs: normal PT and PTT, ↑ bleeding time, ↑ megakaryocytes
o Smear shows few platelets, schistocytes

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18
Q

Hemolytic uremic syndrome (HUS)

A
  • Mostly in kids after gastroenteritis w/ bloody diarrhea.

* Sx: triad = thrombocytopenic purpura, renal failure and microangiopathic hemolytic anemia

19
Q

Heparin-induced Thrombocytopenia (HIT)

A
  • Auto-immune
  • May be fatal
  • Tx: discontinue Heparin + a direct thrombin inhibitor
20
Q

Which disorders are mixed platelet and coagulation disorders? (2)

A
  1. Von Willebrand Disease

2. DIC (disseminated intravascular coagulation)

21
Q

Von Willebrand Disease

A
  • Defective platelet plug formation due to a defect in quantity or quality of von Willibrand factor (VWF) → defect in platelet plug → bleeding
  • Autosomal dominant
  • Sx: mild mucosal bleeding
  • Labs: ↑ bleeding time, ↑ PTT (due to VIII affected)
  • Tx: desmopressin
22
Q

DIC (disseminated intravascular coagulation)

A
  • Clotting factor and platelet problem
  • Causes: amniotic fluid embolism, infections, cancer, & major traumas, particularly head injuries
  • Labs: ↓ platelets, ↓ fibrinogen, ↑ bleeding time, ↑ PT, ↑ PTT, ↑ D dimer & schistocytes on smear
  • Tx: treat underlying cause, administer platelet and fresh frozen plasma as needed, & Heparin
23
Q

Which disorders are hereditary thrombosis syndromes? (4)

A
  1. Proteins C and S Deficiency
  2. Factor V Leiden Deficiency
  3. Prothrombin Gene Mutation
  4. Antithrombin III Deficiency
24
Q

Proteins C and S Deficiency

A

Results in the inability to inactivate factors V and VIII → increased risk of DVT & pulmonary embolism, cerebral venous thrombosis and warfarin-induced skin necrosis

25
Q

Factor V Leiden Deficiency

A
  • Most common risk factor for DVT and PE in caucasians
  • Labs: ↑ PTT & PT
  • Tx: Heparin then Warfarin
26
Q

Prothrombin Gene Mutation

A

Mutation in 3’ untranslated region → increase in circulating thrombin and venous clots

27
Q

Antithrombin III Deficiency

A
  • AT-III is a potent inhibitor of clotting cascade. Deficiency → increased venous clots
  • Heparin administration does nothing!
28
Q

Which drugs are thrombolytic drugs? (3)

A
  1. Tissue-type plasminogen activator, alteplase
  2. Reteplase
  3. Streptokinase
29
Q

Unfractionated heparin

A
  • Indirect thrombin inhibitor

* Mixture of highly electronegative acidic mucopolysaccharides w/ high MW

30
Q

Enoxaparin

A
  • Indirect thrombin inhibitor
  • Low MW heparin
  • SC 2x/day
31
Q

Fondaparinux

A
  • Indirect thrombin inhibitor
  • Synthetic analog of heparin
  • SC once/day
32
Q

Heparin

A
  • Indirect thrombin inhibitor
  • MOA: binds AT-III and inactivates thrombin factors IXa, Xa and XIIa
  • Short half-life
  • Use PTT to monitor
  • SE: hemorrhage, HIT, osteoporosis & fractures
33
Q

Warfarin

A
  • Oral anticoagulant
  • Use PT to monitor
  • Inhibits synthesis of Vit K dependent clotting factors II, VII, IX & X
  • SE: bleeding risk, teratogenic, tissue skin necrosis
34
Q

Tell me more about thrombolytic drugs

A
  • Clot busters
  • MOA: binds to and converts plasminogen to plasmin
  • Indications: MI, DVT, PE, ischemic stroke (t-PA)
  • Contra: active bleeding, history of intracranial bleeding, recent surgery, & HTN
  • SE: cerebral hemorrhage, severe bleeding & cholesterol embolism
35
Q

Which drugs are direct thrombin inhibitors? (4)

A
  1. Lepirudin
  2. Bivalirudin
  3. Argatroban
  4. Dabigatran
36
Q

COX Inhibitors

A
  • Antiplatelet drugs
  • MOA: inhibit TXA2 mediated platelet aggregation
  • Ex: Aspirin
37
Q

ADP Antagonists

A
  • Antiplatelet drugs
  • MOA: inhibits ADP-mediated platelet aggregation
  • Ex: Ticlopidine & Clopidogrel
38
Q

Glycoprotein IIb/IIIa Inhibitors

A
  • Antiplatelet drugs
  • MOA: inhibits binding of fibrinogen to platelet GpIIb/IIIa, preventing platelet cross-linking
  • Ex: Abciximab
39
Q

What are the 3 vaccines you need to give before a splenectomy?

A
  1. H. influenza B
  2. Pneumococci
  3. Meningococci
40
Q

What are the Vitamin K dependent clotting factors? (6)

A

II, VII, IX, X, protein C & protein S

41
Q

Deep Venous Thrombosis (DVT)*

A
  • Unilateral swelling in LE
  • Virchow’s Triad are risk factors
  • Ddx: cellulitis, superficial thrombophlebitis, chronic venous valvular insufficiency, ruptured Baker’s cyst
  • Sx: swelling & redness in leg
  • Labs: venous doppler
  • Tx: Heparin
42
Q

Virchow’s Triad

A
  1. Alteration in blood flow (ex: stasis)
  2. Vascular endothelial injury
  3. Alterations in the constituents of the blood (ex: inherited or acquired hypercoagulable state)
43
Q

What are the most common genetic risk factors for DVT? (5)

A
  1. Factor V Leiden Mutation
  2. Prothrombin Gene Mutation
  3. Protein S Deficiency
  4. Protein C Deficiency
  5. Antithrombin Deficiency

B&L Exam 2 (8 decks)

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