Coagulation A Surgical Perspective- Exam III Flashcards
1
Q
What events occur in primary hemostasis? (3)
A
Vasoconstriction, Platelet activation, and platelet plug formation
2
Q
What events occur in secondary hemostasis?
A
Coagulation cascade and formation of fibrin clot
3
Q
What molecules degrades the blood clot after its done its job?
A
Plasmin
4
Q
What event initiates hemostasis?
A
Vascular injury
5
Q
What are the 3 phases of normal hemostasis?
A
- Vascular phase
- Platelet phase
- Coagulation phase
6
Q
What causes vasoconstriction following injury to a blood vessel?
A
Vascular spasm
7
Q
What is the first step of the platelet phase?
A
Exposed collagen binds and activates platelets
8
Q
What is the 2nd step of the platelet phase?
A
Release of platelet factors
9
Q
In the 3rd of the platelet phase after the release of platelet factors:
A
Attracts more platelts
10
Q
In the final step of the platelet phase:
A
Platelet plug forms
11
Q
The plug formed in the platelet phase is:
A
Loose and temporary
12
Q
What molecule do platelets bind during the platelet phase?
A
Collagen
13
Q
What pathways are involved in the coagulation phase?
A
Intrinsic, Extrinsic and common
14
Q
The common pathway ultimately leads to:
A
Cross-linking of fibrin
15
Q
name the pathway that involves the conversion of fibrinogen to fibrin
A
Intrinsic and extrinsic
16
Q
What drug affects clotting?
A
Warfarin
17
Q
What drug affects platelets?
A
Aspirin
18
Q
What someone has issues with _____, this is a bleeding issue.
A
Platelets
19
Q
Partial or complete dissolution of the hemostatic plug by plasmin
A
Fibrinolysis
20
Q
What activates plasmin?
A
Thrombin
21
Q
List factors affecting a normal hemostasis mechanism (5)
A
- Vessel wall integrity
- Adequate numbers of platelets
- Proper functioning of platelets
- Adequate levels of clotting factors
- Proper function of the fibrinolytic pathway
22
Q
You can not do oral surgery if the platelet count is:
A
Less than 50k
23
Q
What is the normal platelet range?
A
150,000-400,000
24
Q
People with normal numbers of platelets (150-400k) can still have:
A
Issues with platelet function
25
What medications can affect platelet function?
Aspirin & Plavix
26
When someone has a platelet deficiency what can be an affective treatment?
Platelet diffusion
27
What clotting disorders should you be aware of as a clinician?
Hemophilia A and Hemophilia B
28
Hemophilia A deals with clotting factor:
8
29
Hemophilia B deals with clotting factor:
9
30
Platelet count is measured in a:
CBC
31
What are common laboratory tests to evaluate hemostasis? (3)
Platelet count
Bleeding Time
Coagulation profile
32
What tests make up the coagulation profile? (3)
1. Prothrombin time (PT)
2. Activated partial thromboplastin time (APTT)
3. International normalized ratio (INR)
33
What are the advanced tests to evaluation hemostasis? (2)
1. Platelet function test
2. Clotting factor Assays (II-XII)
34
A test that may be recommended for those who bruise easily, have excessive bleeding, or take medications after a stroke or heart attach that can alter platelet function.
Platelet function test
35
What measure the levels of functional activity of one or more coagulation factors?
Clotting factor assays (II-XII)
36
Standard range for WBC:
4.5-11.0
37
Standard range for RBC:
3.5-5.5
38
Standard range for Hgb:
12-15
39
Standard range for platelet count
150-400k
40
A platelet count of 100,000-140,000:
Thrombocytopenia
41
An individual with a platelet count of 100-140k diagnosed with thrombocytopenia will have a bleeding time that is:
Normal
42
What type of procedures can you perform on an individual with thrombocytopenia?
ALL
43
An individual with a platelet count of 50,000 to 100,000
Mild thrombocytopenia
44
An individual with mild thrombocytopenia with a platelet count of 50k-100k will experience what type of bleeding time:
Mild prolonged bleeding time
45
What type of procedures can you do in a patient with mild thrombocytopenia? (50 - 100k platelets)
Simple extractions but no major surgeries?
46
Platelet count of less than 50,000 is considered:
Severe thormbocytopenia
47
What kind of procedures can be done in an individual with severe thrombocytopenia?
None
48
Individuals with a platelet count of less than 20,000 will have:
Spontaneous bleeding
49
How long should it take a precise Knick to stop bleeding?
2-9 minutes
50
Normal bleeding time:
2-9 minutes
51
Bleeding time provides an assessment of:
Platelet function
52
A bleeding time of 9-15 minutes is indicative of:
Platelet dysfunction
53
What test measure the effectiveness of the extrinsic pathway?
Prothrombin time (PT)
54
The prothrombin time test measures the rate of conversion of:
Factor 12-12a (VII to VIIa)
55
What is a normal prothrombin time
12-13 seconds
56
What are common causes for prolonged prothrombin time? (3)
1. Warfarin use
2. vitamin K deficiency
3. Liver disease
57
What test measures the effectiveness of the intrinsic and common pathway?
Activated Partial Thromboplastin Time (aPTT)
58
Test that measures the intrinsic clotting of blood and congenital clotting disorders?
APTT
59
What is considered a more sensitive version of the PTT and is used to monitor the patietns resonse to heparin therapy?
Activated Partial Thromboplastin time
60
What is a normal time frame for aPTT?
30-40 seconds
61
If someone has an aPTT of more than 70 seconds this would signify:
Spontaneous bleeding
62
Congenital deficiencies of intrinsic system clotting factors such as factors VIII, IX, XI, and XII, including hemophilia A, and hemophilia B can cause a prolonged:
APTT
63
What is the most commonly inherited bleeding disorder affecting platelet function?
Von Willebrand Disease
64
What makes most of the clotting factors including the ones that are vitamin K dependent?
The liver
65
Liver cirrhosis can cause a prolonged:
APTT
66
The synthesis of some clotting factors requires vitamin K, so vitamin K deficiency results in an inadequate quantity of intrinsic system and common pathway clotting factors resulting in a prolonged:
APTT
67
What inhibits the intrinsic pathway at several points?
Heparin therapy
68
Heparin therapy results in a:
Prolonged aPTT
69
What inhibits the function of factors I, IX, and X, prolonging the aPTT?
Coumadin therapy
70
- Congenital deficiencies of intrinsic clotting factors (8,9,11,12)
- Von willebrand disease
- Liver cirrhosis
- Vitamin K deficiency
- Heparin therapy
- Coumadin therapy
People affected by any of these will have a:
Prolonged aPTT
71
What does INR stand for?
International Normalized ratio
72
The INR equation is:
Patient PT / mean normal PT and raised to ISI
73
ISI stands for:
International sensitivity index
74
What is the ISI value normally between?
1.0-2.0
75
What is a normal INR level?
0.8-1.2
76
Therapeutic INR level?
2-3.5
77
An INR target of 2.5 (2.0-3.0) is the goal for all of the following circumstances: (7)
AF, Ischemic stroke, TIA, systemic embolism, Mitral stenosis, Planned cardioversion, and after open heart surgery
78
We want a slightly higher INR of around 2.5 for patients with conditions that could make them:
Have a blood clot
79
1. Bleeding time:
2. PT
3. APTT
4. INR
5. Therapeutic INR
1. 2-9 minutes
2. 12-13 seconds
3. 30-40 second
4. 0.8-1.2
5. 2-3.5
80
What bleeding disorders are more common? (Congenital or acquired)
Acquired
81
Someone taking Ibuprofen, Aspirin, or NSAIDs can be at risk for:
Compromised platelet number
82
What 3 bleeding disorders constitute over 90 percent of all congenital bleeding disorders?
Hemophilia A, Hemophilia B, and Von willebrands
83
What has a higher prevalence hemophilia A or B?
A (1 in 10k)
84
Both hemophilia A and B are inherited in a:
Sex-linked recessive manner
85
What sex does hemophilia affect more frequently?
Males
86
What is bleeding in between the joints?
Hemoarthrosis
87
The biggest concern is when people have ____ case of hemophilia
Mild
88
Why is mild hemophilia of great concern?
Because typically patients aren’t aware
89
What is prepared from plasma and contains fibrinogen, fibronectin, Von willebrand factor, Factor VIII, and Factor IX and is given to patient through IV
Cryoprecipitate
90
Desmopressin can be given to a patient with:
Hemophilia A
91
What part of hemostasis does von willebrands disease affect?
Primary
92
There are 3 types of Von Willebrands disease:
Type 1 involves:
Type 2 involves:
Type 3 involves:
Type 1: shortage of VWF
Type 2: Flawed VWF
Type 3: Absent VWF
93
What is the most common form of VWD?
Type 1
94
What are two causes of thrombocytopenia?
1. Decreased platelet production
2. Increased platelet destruction
95
If a patient is on oral anticoagulant antiplatelet treatment are they recommended to stop use prior to a minor oral surgery procedure?
NO
96
Decision to hold an anticoagulant/ antiplatelet therapeutic drug can only be made by:
Physician (not dentist)
