Clotting Application Exercise - Foy Flashcards

1
Q

What risk factors contribute to DVT?

A

Age, gender (female), immobility, obesity, presumably many others…

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2
Q

How should a stable venous blockage be treated?

A

Low molecular weight heparins

(Warfarin is too slow, t-PA too aggressive)

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3
Q

Name 4 conditions that can cause inappropriate clotting.

A

Factor V leiden

APLA

Prothrombin gene variation

Many, many protein or factor deficiencies (Protein S, AT…)

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4
Q

Factor V Leiden

How common is it?

What is its etiology & pathogenesis?

What is the inheritance pattern?

A

Factor V Leiden

Fairly common–it is the most common inherited thrombophilia and is seen in 5-6% of caucasians.

R506Q mutation which renders Factor V resistant to cleavage by protein C.

Autosomal dominant** (heterozygous patients experience milder symptoms).

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5
Q

What factors does antithrombin interact with?

What activates it?

A

Factors IIa and Xa. (slide 14 says factors IXa and XIa as well)

Heparin.

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6
Q

A patient presents with thrombocytopenia and schistocytes on blood smear. What is on the Ddx?

What if ADAMSTS-13 activity is reduced?

A

Microangiopathic hemolytic anemias: TTP, HUS, DIC.

Probably TTP then.

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7
Q

Recall the pentad that defines thrombotic thrombocytopenia purpura.

How is it treated?

A

MHA (with schistocytes), thrombocytopenia, mental status changes, fever, renal insufficiency.

Plasma exchange transfusion.

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8
Q

Recall Virchow’s triad.

A

Thrombosis occurs with the presence of endothelial injury, sluggish or static flow, and hypercoagulable state.

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9
Q

A patient presents with inappropriate thrombosis 7 days after an unspecified cardiac episode. Workup reveals thrombocytopenia.

What is the diagnosis? How can this be confirmed?

A

Heparin-Induced Thrombocytopenia; get ELISA for Hep:PF4 antigen

(recall the 4 “T”s: Thrombocytopenia, timing, thrombosis, no alTernate)

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10
Q

How is HIT treated?

What is its clinical presentation?

A

Direct thrombin inhibitors (eg bivalirudin)

Moderate thrombocytopenia, thromboses of both arterial and venous origin.

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