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Pass Program > Chapter 8: The Clotting Cycle & Bleeding disorders > Flashcards

Chapter 8: The Clotting Cycle & Bleeding disorders Flashcards

1
Q

MCC of venous clots

A

stasis

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2
Q

MCC of arterial clots?

A

endothelial injury (exposure of BM)

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3
Q

MCC of genetic venous clots

A

Factor V Leiden defect

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4
Q

What is the normal PLT count?

A

150,000–350,000

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5
Q

All cells have MHC 1 on surface except which cells?

A

RBCs and PLTs (so they can set off immune system)

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6
Q

What is thrombocythemia?

A

When PLT count is 2 standard deviations above normal

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7
Q

What could cause secondary throbocytosis?

A

anemia, neoplasm, autoimmune disease, inflammation, infection

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8
Q

What could cause secondary thrombocytosis?

A

anemia, neoplasm, autoimmune disease, inflammation, infection

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9
Q

What is thrombotic thrombocytopenia purpura?

A

thrombotic microangiopathy due to vWF-esterase deficiency (ADAM TS 13); similar to DIC

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10
Q

What is microangiopathic Hemolytic Anemia (MAHA)?

A

When blood vessels have micro thrombus and causes passing RBCs to lyse

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11
Q

MCC of thrombocytopenia?

A

1)virus 2)drugs

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12
Q

What is immune thrombocytopenia?

A

When antibodies are made against PLTs; also called idiopathic thrombocytopenia purpura, immune thrombocytopenia purpura, and autoimmune thrombocytopenia purpura

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13
Q

What kinds of infection could cause thrombocytopenia?

A

Parvovirus B19; Hep C, Hep E

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14
Q

Do we transfuse for destructive process of PLTs?

A

NO, it will just be destroyed even more. Correct underlying problem or steroids

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15
Q

Which meds can cause thrombocytopenia?

A

AZT, benzene, chloramphenicol, vinblastine

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16
Q

What is heparin induced thrombocytopenia?

A

IgG attacks heparin after it forms a complex with Platelet Factor 4, usually occurs 3-10 days after initiating heparin therapy (HIT 2)

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17
Q

What is the difference between HIT 1 and HIT 2?

A

HIT 1 occurs due to PLT clumping within 48 hours (spleen removing PLTs); HIT 2 occurs 3-10 days after and involves IgG.

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18
Q

What is responsible for the “lucid” interval in epidural hematoma?

A

vasoconstriction

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19
Q

What are the 3 steps of Platelet plug?

A

1.platelet adhesion to injured vessel
2.platelet degranulation
3.platelet aggregation

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20
Q

What starts the platelet adhesion process?

A

endothelial injury exposes sub endothelial collagen, vWF binds to collagen, PLTs bind to vWF

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21
Q

What do platelets give off in degranulation?

A

Thromboxane A2, ADP and Ca

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22
Q

What does ADP do?

A

exposes GpIIb/IIIa so it can bind fibrinogen and provides energy for clumping process

23
Q

What starts the platelet adhesion process?

A

endothelial injury exposes sub endothelial collagen, vWF binds to collagen, PLTs bind to vWF via GpIb

24
Q

What is Bernard-Soullier syndrome?

A

defective GpIb (platelets don’t aggregate, prolonged bleeding)

25
Q

What is Glanzmann thrombasthenia?

A

defective GpIIb/IIIa; platelets don’t aggregate, prolonged bleeding)

26
Q

What does Prostaglandin I-1 do?

A

inhibits platelet aggregation; vasodilation

27
Q

What does Prostaglandin E2 do?

A

vasodilation; decreases gastric secretion; increases gastric mucous secretion

28
Q

What does prostaglandin F2a do?

A

bronchoconstriction, vasoconstriction, uterus contraction

29
Q

What does TXA2 do?

A

platelet aggregation (aspirin irreversible inhibitor)

30
Q

Which test is used to detect vWF or Bernard-Soullier?

A

ristocetin (add ristocetin to blood, no clumping)

31
Q

What can you use to stop moderate bleeding in vWF, Bernard-Soullier, Glanzmann?

A

cryoprecipitate

32
Q

What do you use for severe bleeding?

A

fresh frozen plasma (FFP)

33
Q

Name a few ADP receptor blockers:

A

Clopidogrel, Ticagrelor, prasugrel

34
Q

When are aspirin and clopidogrel used together?

A

In cardiac stenting; aspirin and clopidogrel for first 30 days; after that just aspirin

35
Q

What do you use cilostazol for?

A

TTP first 2 weeks (inhibits TXA2 while increasing prostaglandin)

36
Q

Name a GpIIb/IIIa inhibitor

A

abciximab

37
Q

What is an irreversible TXA2 inhibitor?

A

aspirin

38
Q

compartment syndrome 5 P’s

A

1.Pain out of proportion
2.Pallor
3.Paresthesia
4.Poikilothermia
5.Paralysis

39
Q

What is Hemophilia A?

A

deficiency of Factor VIII

40
Q

What lab is high in Hemophilia A?

A

PTT

41
Q

What is Hemophilia B?

A

deficiency of Factor IX

42
Q

What lab is high in Hemo B?

A

PTT

43
Q

What do you do for mild bleeding of Hemophilia A?

A

DDAVP

44
Q

What do you do for severe bleeding in Hemophilia A?

A

administer Factor VIII

45
Q

What do you do for all bleeding Hemophilia B?

A

FFP

46
Q

To stop passive hemorrhage (massive):

A

tranexamic acid
activated factor VII
activated prothrombin concentrate
activated fibrinogen complex concentrate

47
Q

Direct thrombin inhibitors

A

argatroban, dabigatran

48
Q

factor X inhibitors

A

rivaroxaban, apixaban

49
Q

In which autoimmune disease is vWF blocked and intrinsic pathway stimulated (easy to clot)?

A

SLE, anticardiolipin

50
Q

What is reflex sympathetic dysfunction from carpal tunnel syndrome?

A

severe autonomic discharge due to pain caused by NE (Tx: NE blocker phentolamine)

51
Q

What is the earliest sign of Factor XIII defeciency?

A

recurrent umbilical stump bleeding

52
Q

Skin necrosis upon administering warfarin

A

stop warfarin and give direct Factor X inhibitor

53
Q

Why is there a two day bridge between heparin and warfarin?

A

because factor VII has a half-life of 2 days, hep blocks next thrombolytic after prot. C and antithrombin III

54
Q

What should INR be for warfarin?

A

2-3 unless for metallic heart valves 2.5-3.5

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