Coagulation Flashcards
What is the 3 step in maintaining hemostasis during an injury?
Which of the following is considered primary vs secondary hemostasis?
- vascular spasm
- platelet plug formation (primary hemostasis)
- blood coagulation (secondary hemostasis)
If a patient presents with petechiae, ecchymoses and bleeds from minor cuts what type of defect does he have?
platelet/vascular defect
If a patient presents with hemarthroses or hematomas, what type of defect does he have?
coagulation defect
What is the 3 steps in the platelet plug formation?
Which of the following steps is reversible?
- Adhesion
- activation (reversible)
- aggregation
What substance is important in platelet aggregation?
fibrinogen
Normal values for the following:
RBC Hgb Hct WBC Plts -Thrombocytopenia/mild/severe
RBC = 4-5.5 x 10^6 Hgb = 12-15 g/dL Hct = 36-45% WBC = 5-10x10^3 Plts = 150-400x10^3 Thrombocytopenia = <150,000 Mild = 50-100,000 Severe = <50,000
When measuring bleeding time what is the normal value and what signifies a prolonged bleeding time?
- Normal value 3-10 minutes
- > 10 minutes = prolonged
Bleeding time is only prolonged due to what 3 things
- low platelet count
- vWD
- bad test
What medication is a COX inhibitor and works by inhibiting platelet activation?
Aspirin
What are 3 P2Y12 inhibitors that work by inhibiting platelet activation?
- Plavix
- Effient
- Brilinta
What are the 3 GPIIb/IIIa inhibitors that works by inhibiting platelet aggregation?
- Abciximab
- Integrillin
- Tirofiban
What medication is a PDE5 inhibitor that works to inhibit platelet aggregation?
aarenox
What are the 4 vitamin K dependent factors?
II, VII, IX, X
What 3 factors are NOT produced in the liver?
III, IV, VIII
What are the names of the following factors?
II
IIa
I
Ia
II - prothrombin
IIa - thrombin
I - fibrinogen
Ia - fibrin
What factors make up the intrinsic pathway?
XII, XI, IX, VIII, X
12, 11, 9, 8, 10
What factor make up the extrinsic pathway?
VII
What factors make up the common pathway?
X, II, I
Fondaparinux, Eliquis, Xaralto are what type of medications?
Factor Xa inhibitors
Lovenox, Fragmin (LMWH) or Heparin are what type of medications?
Factor Xa inhibitor
Angiomax or Argatroban are what type of medications?
Antithrombin (IIa) agents
Coumadin (Warfarin) is what type of medication?
Vitamin K Antagonist
Deficiency in the following 4 substances makes you hypercoagulable.
- Protein C
- Protein S
- AT
- Factor XIIa
What 2 proteins are important in inhibiting Factor VIII and Factor V?
- Protein C
- Protein S
What substance breaks down fibrin?
What is the product of this break down depending on if a fibrin clot has been formed already or not?
Plasmin
- if fibrin clot formed = D-dimer
- if just fibrin = fibrin split products (FSP)
What is thrombin time used for?
evaluate the part of the hemostatic process where soluble fibrinogen is changed into fibrin threads
What is the normal value for PT?
11-15 seconds
What is normal value for INR? Therapeutic range? Therapeutic range for mechanical valve? What is ideal for surgery? What INR has an unacceptable high risk of bleeding?
Normal = <1.0 Therapeutic = 2-3 Mechanical valve = 2.5-3.5 Surgery = <1.5 High risk of bleeding = >5
What is the normal value for PTT?
25-40 seconds
If you add a patient’s plasma with a normal pooled plasma and the PT/PTT comes out NORMAL what does this mean?
Factor deficiency
If you add a patient’s plasma with a normal pooled plasma and the PT/PTT comes out PROLONGED what does this mean?
Factor inhibitor issue
If you add a patient’s plasma with a factor specific deficient plasma and the PT/PTT comes out PROLONGED what does this mean?
Factor deficiency
*of the known Factor missing in sample
If you add a patient’s plasma with a factor specific deficient plasma and the PT/PTT comes out NORMAL what does this mean?
Factor normal
*Factor missing in sample
80-85% of patients with Hemophilia have deficiency of which factor?
Which lab test is affected?
a. platelet count
b. bleeding time
c. PT/INR
d. PTT
- Factor VIII
d. PTT
Hemophilia B (Christmas Disease) accounts for 10-15% of all hemophiliacs. It is a result of a deficiency in what factor?
Which lab test is affected?
a. platelet count
b. bleeding time
c. PT/INR
d. PTT
- Factor IX
d. PTT
If a patient is on coumadin which lab results will be affected?
a. platelet count
b. bleeding time
c. PT/INR
d. PTT
c. PT/INR
d. PTT
What is the MOA of action of Lovenox (LMWH)? Which lab test is affected?
a. platelet count
b. bleeding time
c. PT/INR
d. PTT
-activates antithrombin III which blocks thrombin (Factor IIa)
a. PT/INR
d. PTT
If a patient has liver disease which lab test is affected?
a. platelet count
b. bleeding time
c. PT/INR
d. PTT
c. PT/INR
d. PTT
If a patient had DIC what lab test is affected?
a. platelet count
b. bleeding time
c. PT/INR
d. PTT
All of them
For DIC what special test should you do to look for low fibrinogen levels?
TT time
Platelet adheres to the damaged area through which specific receptors?
GPIIb/IIIa, GPIb, GPIa/GPIIa
If you would like to monitor therapy for coumadin or heparin what pathway should you measure?
- coumadin = extrinsic pathway
- heparin = intrinsic pathway
This condition is characterized by pathological activation of coagulation blood clotting mechanisms that happens in response to disease leading to the formation of small blood clots inside the blood vessels.
Disseminated Intravascular Coagulation (DIC)
