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CP Boards > Coagulation > Flashcards

Coagulation Flashcards

1
Q

Platelet aggregometry

Basic principles

Molecular targets

A

More light passes through when aggregated

Ristocetin - reliant on GP1b + vWF

All others (ADP, collagen, thromboxane A2, epinephrine (weakest) - GP 2b/3a

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2
Q

vWD Type 2B - platelet agg results

A

No agg with ristocetin

Rest normal

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3
Q

Glanzmann’s thrombasthenia
- Defect
- platelet agg results
- CBC

A

Glanzmann’s thrombasthenia
- Reduced GP 2b/3a
- No agg with ADP, collagen, TXA2, epinephrine. Reduced with ristocetin
- Normal platelets

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4
Q

Bernard Soulier
- Defect
- platelet agg results
- CBC

A

Bernard Soulier
- Reduced GP1b
- No agg with ristocetin
- Thrombocytopenia, Large platelet with pseudonucleus

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5
Q

4 T’s of HIT - HIT Type 1

A

degree of Thrombocytopenia - > 100

Timing - within 2 days of starting

Thrombosis - no risk

(oTher causes)

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6
Q

4 T’s of HIT - HIT Type 2

A

degree of Thrombocytopenia - < 100 ()also schistocytes)

Timing - 4-10 days of starting

Thrombosis - yes

(oTher causes)

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7
Q

vWD - Inheritance

A

Autosomal dominant EXCEPT 2N and 3

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8
Q

Hemophilia - inheritance

A

A and B are X-linked recessive
C is autosomal w partial dominance

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9
Q

Factor with shortest half life?

A

Factor 7

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10
Q

Platelet alpha vs dense granules

A

Alpha granules = large proteins (PDGF, vWF, PF4, fibrinogen)

Dense granules = small molecules (ADP, Ca2+, serotonin, histamine)

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11
Q

UFH vs LMWH
- Targets
- Clearance
- Dosing
- Monitoring

A
  • UFH-AT3 mostly target thrombin (F2) and 10a, vs LMWH-AT3 mostly 10a
  • UFH hepatically cleared, LWMH renally cleared
  • UFH given IV, LWMH given IM
  • UFH monitored by PTT, LWMH not routinely monitored
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12
Q

Protein C and S targets

A

Factor 5 and 8

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13
Q

Antithrombin targets

A

Factor 2 (thrombin) and factor 10a

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14
Q

Thrombin time vs Reptilase time
- Assay
- What it measures
- Diseases

A

Thrombin time
- Exogenous thrombin + platelet poor plasma
- Measures common pathway + fibrinogen to fibrin
- Elevated with paraprotein, amyloid, heparin, dysfibrinogenemia

Reptilase time
- Venom + PPP
- Measures only fibrinogen to fibrin
- Elevated with dysfibrinogenemia

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15
Q

Platelet storage disorders
- Defect
- platelet agg results
- CBC

A

Platelet storage disorders
- Defic in dense or alpha granules
- No second wave of agg
- Normal morphology

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16
Q

Defect:
Gray platelet
Quebec
Wiskott-Aldrich
Chediak-Higashi
Hermansky-Pudlak

A

Gray platelet - no alpha granules (large gray plt)

Quebec - no alpha granules

Wiskott-Aldrich - no dense granules

Chediak-Hiashi - no dense grnaules

Hermansky-Pudlak - no dense granules (swiss cheese plt)

17
Q

NSAIDs - platelet agg results

A

No second wave to ADP and epi

No response at all to collagen or arachidonic acid

18
Q

Ristocetin vWF : vWF antigen - high vs low

A

High Rcof:vWF Ag - vWD 2A

Low Rcof:vWF Ag - vWD 2M

19
Q

vWD 2M

A

Defective GP1b binding, but no loss in large multimers

20
Q

Factor 12 defic -symptoms, labs

A

Factor 12 defic
- No bleeding but increased risk of thrombosis
- Increased PTT, low prekallikrein, low HMWF

21
Q

Factor 13 defic - symptoms, labs

A

Factor 13 defic
- Initially clot well but then delayed bleeding when clot breaks down
- Normal PT, PTT. Clot stability test - 5M urea

22
Q

Vitamin K factors

A

2, 7, 9 10, C and S

23
Q

TTP vs HUS
- Clinical
- Labs
- Treatment

A
  • Clinical:
    TTP = more neuro, microthrombi in other organs
  • Labs:
    TTP = big vWF multimers, cant cleave
    HUS = normal vWF cleavage
  • Treatment:
    TTP = FFP + steroids + IVIG + splenectomy
    HUS = supportive + antibiotics
24
Q

Activated Protein C Resistance Assay

A

Add protein C to specimen
- No APCR ten increase PTT > 2:1
- APCR then increase PTT < 2:1

25
Q

Liver disease and clotting factors

A

All factors except:
- Factor 8 by endothelium
vWF by endothelium and megakaryocytes

  • Factor 5 and 7 most sensitive
26
Q

Fonaparinux - mechanism

A

Fondaparinux - binds AT III, which inhibits Factor 10 (“parin” like he”parin”)

27
Q

Aspirin - mechanism

A

Aspirin - COX1/2 inhibitor, decreases thromboxane A2 and inhibits platelets

28
Q

Abciximab - mechanism

A

Abciximab - anti-GP2b/3a

29
Q

Rivaroxaban - mechanism

A

Rivaroxaban - direct Factor 10 inhibitor

30
Q

Dipyridamole - mechanism

A

Dipyridamole - platelet agg inhibitor; block adenosine uptake and increases intracellular cAMP

31
Q

Ticlodipine/Clodipogrel - Mechanism

A

Ticlodipine - block ADP receptor, prevents GP2b/3a conformational change and fibrin cross linking

32
Q
A

CP Boards (8 decks)

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