Coagulation

Question 1

factors in the intrinsic pathway (PTT, test system)

Answer 1

XII
XI
IX
VIII

Question 2

factors in the extrinsic pathway (PT)

Answer 2

tissue factor
VII

Question 3

factors in the common pathway

Answer 3

X
V
prothrombin
fibrinogen
XIII

Question 4

converts XII to XIIa

Answer 4

kallikrein

Question 5

regulates thrombin

Answer 5

thrombomodulin
ATIII

Question 6

converts fibrinogen to fibrin

Answer 6

thrombin

Question 7

stabilizes fibrin clot by crosslinking D molecules

Answer 7

XIII

Question 8

fibrin degradation product
sign of pathologic clotting

Answer 8

D-dimer

Question 9

↑ FDP

Answer 9

fibrin degradation products
sign of pathologic clotting

Question 10

function of plasminogen

Answer 10

plasminogen → plasmin
fibrinolysis

Question 11

convert plasminogen → plasmin

Answer 11

TPA
UPA

Question 12

normal PT

Answer 12

12-15 s

Question 13

normal PTT

Answer 13

25-35 s

Question 14

normal bleeding time

Answer 14

< 10 min

Question 15

PFA only involves ———– hemostasis

Answer 15

primary
platelet plug
no factors involved

Question 16

explain primary hemostasis

Answer 16

vessel break → collagen exposure, TF released
GPIB on plt + vWF + exposed collagen
GPIIB on plt + fibrinogen + GPIIB (aggregation)

Question 17

Bernard-Soulier

Answer 17

GPIB deficiency
platelet function problem

Question 18

Glanzmann’s thrombasthenia

Answer 18

GPIIB deficiency
platelet function problem

Question 19

abnormal PFA + ↑ PTT

Answer 19

vonWillebrand disease
↓ wWF, ↓ VIII

Question 20

vWD panel

Answer 20

vWF Ag test (quantitative)
ristocetin cofactor assay (functional)

Question 21

for PFA, patient must be off aspirin for…

Answer 21

7 days

Question 22

VIII deficiency

Answer 22

hemophilia A

Question 23

IX deficiency

Answer 23

hemophilia B

Question 24

XI deficiency

Answer 24

hemophilia C

Question 25

thrombolytic drug converts plasminogen → plasmin

Answer 25

streptokinase

Question 26

drug therapy that can give coag results like a multi-factor deficiency

Answer 26

thrombolytic agents

Question 27

factor deficiency that causes clotting, not bleeding

Answer 27

XII

Question 28

distinguish coag factor inhibitor from deficiency

Answer 28

mixing study corrects — deficiency does not correct — inhibitor

Question 29

distinguish which factor deficiency a patient has

Answer 29

single factor assays pt plasma + plasmas each deficient in one factor remains abnormal — deficiency of that factor

Question 30

coag problem causing superficial bleeding vs deep bleeding

Answer 30

superficial — plt problem deeper — hemophilia

Question 31

Christmas disease

Answer 31

hemophilia B IX deficiency

Question 32

normal fibrinogen

Answer 32

200-400

Question 33

why is pregnancy a risk factor for DIC?

Answer 33

placenta can release large amounds of TF

Question 34

triggers of DIC

Answer 34

sepsis pregnancy venoms APML trauma, burns acute hemolytic trxn

Question 35

malnutrition effect on coag pathway

Answer 35

↓ vitamin K ↓ functional prothrombin group factors (prothrombin, VII, IX, X)

Question 36

first factor that ↓ in liver disease or vitamin K def.

Answer 36

VII shortest half life PT affected first

Question 37

how can ↓ GI flora cause ↑ PT?

Answer 37

vitamin K deficiency

Question 38

function of coumadin

Answer 38

inhibits vitamin K - dependent factors

Question 39

function of heparin

Answer 39

enhances the effects of ATIII

Question 40

PIVKAs

Answer 40

proteins affected by vitamin K deficiency prothrombin, VII, IX, X

Question 41

coag pathway inhibitors that are vitamin K-dependent

Answer 41

proteins C & S

Question 42

functions of proteins C & S

Answer 42

inhibit factor V S is cofactor for C

Question 43

V not susceptible to protein C clotting tendency

Answer 43

factor V leiden mutation

Question 44

too much thrombin clotting tendency

Answer 44

prothrombin mutation

Question 45

buildup of homocysteine clotting tendency

Answer 45

MTHFR mutation

Question 46

normal INR

Answer 46

usually 2-3

Question 47

sodium citrate tube ratio

Answer 47

9:1

Question 48

bridge for multiple coag factors, tenase, PL surface

Answer 48

Ca

Question 49

activates plts inhibited by aspirin

Answer 49

arachidonic acid system

Question 50

test for XIII deficiency based on clot stability

Answer 50

5M urea test

Question 51

tests fibrinogen → fibrin step used to detect heparin contamination

Answer 51

thrombin time

Question 52

tests fibrinogen → fibrin step not affected by heparin contamination

Answer 52

reptilase time

Question 53

PTT prolonged bleeding tendency time & temp dependent hemophiliacs

Answer 53

factor VIII inhibitor (Ab)

Question 54

PTT prolonged clotting tendency anti-phospholipid

Answer 54

lupus anticoagulant

Question 55

PTT with ↓ phospholipid, prolonged by LAC PTT with ↑ phospholipid, more normal with LAC | Lupus anticoagulant

Answer 55

DRVVT StaClot test