Coagulation

Question 1

Method of coag

Answer 1

endothelial damage exposes procoag factors -> haemostatic response -> plt aggregation

Question 2

What coag factors are prod by endothelial cells

Answer 2

PGI2, VWF, plasminogen activators, thrombomodulin

Question 3

platelet adhesion

Answer 3

direct = Glp1a
indirect = Glp1b and vwf

Question 4

how to platelets attach to each other

Answer 4

Glp2b and Glp3a (fibronogen R)

Question 5

what does plt adhesion cause

Answer 5

release of ADP and thromboxane A2 (-> aggregation)

Question 6

arachidonic acid -> ____ (+via)

Answer 6

-> endoperoxidases (via COX)

Question 7

what are endoperoxidases conv to

Answer 7

• > thromboxane A2 (stim agg)

- > PGI2 (inhib agg)

Question 8

aspirin vs NSAIDS

Answer 8

aspirin - irrev inhib COX

NSAIDs - rev

Question 9

actions of thrombin

Answer 9

activates F7, F8, F5, plt, F11, F13 (-> propogation)

catylises fibronogen -> fibrin

Question 10

why is vit K important in coag

Answer 10

req as co-enz for lots of liver prod factors (2,7,9,10)

Question 11

3 physiological anticoag

Answer 11

TFPI - stop F7-F7a (no initiation)
Prot c/Prot s - bind to thrombomodulin - stop 8->8a and 5->5a
antithrombin - stop prothrombin->thrombin and 10->10a

Question 12

sympto of platelet disorders

Answer 12

petechiae, purpura, sml bruises, no haemoarthrosis

Question 13

sympto of coag F disorders

Answer 13

bleeding in soft tissues (joints/muscles), large bruises

Question 14

inheritance of haemophilia

Answer 14

X linked congen def of F8 (A) or F9 (B)

Question 15

signs / sympto haemophilia

Answer 15

long APTT, normal PT, haemoarthrosis, soft tissue haematomas

Question 16

inheritance of VWD

Answer 16

T1/2 = auto dom
T3 = auto rec

Question 17

Signs sympto of VWD

Answer 17

mucocutaneous bleeding, dec plt count, inc bleeding time, inc APTT, normal PT

Question 18

types of VWD

Answer 18

T1 - patrial
T2 - qualitative
T3 - total

Question 19

causes of vit K def (5)

Answer 19

malnut
malabs
biliary obs
warfarin (most common)
antibiotics

Question 20

causes of DIC

Answer 20

activation of coag + fibrinolysis by sepsis/trauma/obstetric comp

Question 21

findings in DIC

Answer 21

long APTT/TT/PT, dec fibrinogen/platelets

Question 22

Tx for VWD

Answer 22

desmopressin

Question 23

What factors is Vit K needed for

Answer 23

2,7,9,10 (buses to south ken)

Question 24

what factor goes first in vit K def

Answer 24

7

Question 25

important DDX in vit K def

Answer 25

``` liver disease ( would -> dec plt count) scurvy ( -> corkscrew hair) ```

Question 26

most common prothrombotic disorder

Answer 26

F5 lieden

Question 27

signature of F5 lieden

Answer 27

thrombosis in weird places

Question 28

inheritance of prot c/s def

Answer 28

auto dom

Question 29

what is prot c/s associated with

Answer 29

warfarin induced skin necrosis

Question 30

how would you give heparin

Answer 30

``` unfractionated = IV LMWH = SC ```

Question 31

monitoring for heparin

Answer 31

unfrac - (variable kinetics) monitor APTT or anti-Xa | LMWH - none

Question 32

safest anticoag to use in preg

Answer 32

LMWH

Question 33

how would you give DOAC

Answer 33

oral

Question 34

monitoring for DOAC

Answer 34

none (short half life)

Question 35

DOAC in preg?

Answer 35

no - cross placenta

Question 36

3 doac that are anti X-a

Answer 36

rivaroxaban, apixaban, edoxaban

Question 37

1 doac that is anti II-a

Answer 37

dibagatran

Question 38

what falls first in warfarin

Answer 38

prot c/s - is procoag initially

Question 39

what pro-coag factor falls first in warfarin

Answer 39

7

Question 40

what factor falls lats in warfarin

Answer 40

11

Question 41

warfarin in preg?

Answer 41

never - teratogenic

Question 42

monitoring in warfarin

Answer 42

monitor INR daily (aim for 2-3) | if 5-9 - omit dose and give oral vit K