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Coagulation A Surgical Perspective- Exam III Flashcards

1
Q

What events occur in primary hemostasis? (3)

A

Vasoconstriction, Platelet activation, and platelet plug formation

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2
Q

What events occur in secondary hemostasis?

A

Coagulation cascade and formation of fibrin clot

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3
Q

What molecules degrades the blood clot after its done its job?

A

Plasmin

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4
Q

What event initiates hemostasis?

A

Vascular injury

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5
Q

What are the 3 phases of normal hemostasis?

A
  1. Vascular phase
  2. Platelet phase
  3. Coagulation phase
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6
Q

What causes vasoconstriction following injury to a blood vessel?

A

Vascular spasm

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7
Q

What is the first step of the platelet phase?

A

Exposed collagen binds and activates platelets

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8
Q

What is the 2nd step of the platelet phase?

A

Release of platelet factors

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9
Q

In the 3rd of the platelet phase after the release of platelet factors:

A

Attracts more platelts

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10
Q

In the final step of the platelet phase:

A

Platelet plug forms

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11
Q

The plug formed in the platelet phase is:

A

Loose and temporary

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12
Q

What molecule do platelets bind during the platelet phase?

A

Collagen

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13
Q

What pathways are involved in the coagulation phase?

A

Intrinsic, Extrinsic and common

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14
Q

The common pathway ultimately leads to:

A

Cross-linking of fibrin

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15
Q

name the pathway that involves the conversion of fibrinogen to fibrin

A

Intrinsic and extrinsic

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16
Q

What drug affects clotting?

A

Warfarin

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17
Q

What drug affects platelets?

A

Aspirin

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18
Q

What someone has issues with _____, this is a bleeding issue.

A

Platelets

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19
Q

Partial or complete dissolution of the hemostatic plug by plasmin

A

Fibrinolysis

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20
Q

What activates plasmin?

A

Thrombin

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21
Q

List factors affecting a normal hemostasis mechanism (5)

A
  1. Vessel wall integrity
  2. Adequate numbers of platelets
  3. Proper functioning of platelets
  4. Adequate levels of clotting factors
  5. Proper function of the fibrinolytic pathway
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22
Q

You can not do oral surgery if the platelet count is:

A

Less than 50k

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23
Q

What is the normal platelet range?

A

150,000-400,000

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24
Q

People with normal numbers of platelets (150-400k) can still have:

A

Issues with platelet function

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25
Q

What medications can affect platelet function?

A

Aspirin & Plavix

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26
Q

When someone has a platelet deficiency what can be an affective treatment?

A

Platelet diffusion

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27
Q

What clotting disorders should you be aware of as a clinician?

A

Hemophilia A and Hemophilia B

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28
Q

Hemophilia A deals with clotting factor:

A

8

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29
Q

Hemophilia B deals with clotting factor:

A

9

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30
Q

Platelet count is measured in a:

A

CBC

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31
Q

What are common laboratory tests to evaluate hemostasis? (3)

A

Platelet count
Bleeding Time
Coagulation profile

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32
Q

What tests make up the coagulation profile? (3)

A
  1. Prothrombin time (PT)
  2. Activated partial thromboplastin time (APTT)
  3. International normalized ratio (INR)
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33
Q

What are the advanced tests to evaluation hemostasis? (2)

A
  1. Platelet function test
  2. Clotting factor Assays (II-XII)
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34
Q

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.

A

Platelet function test

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35
Q

What measure the levels of functional activity of one or more coagulation factors?

A

Clotting factor assays (II-XII)

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36
Q

Standard range for WBC:

A

4.5-11.0

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37
Q

Standard range for RBC:

A

3.5-5.5

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38
Q

Standard range for Hgb:

A

12-15

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39
Q

Standard range for platelet count

40
Q

A platelet count of 100,000-140,000:

A

Thrombocytopenia

41
Q

An individual with a platelet count of 100-140k diagnosed with thrombocytopenia will have a bleeding time that is:

42
Q

What type of procedures can you perform on an individual with thrombocytopenia?

43
Q

An individual with a platelet count of 50,000 to 100,000

A

Mild thrombocytopenia

44
Q

An individual with mild thrombocytopenia with a platelet count of 50k-100k will experience what type of bleeding time:

A

Mild prolonged bleeding time

45
Q

What type of procedures can you do in a patient with mild thrombocytopenia? (50 - 100k platelets)

A

Simple extractions but no major surgeries?

46
Q

Platelet count of less than 50,000 is considered:

A

Severe thormbocytopenia

47
Q

What kind of procedures can be done in an individual with severe thrombocytopenia?

48
Q

Individuals with a platelet count of less than 20,000 will have:

A

Spontaneous bleeding

49
Q

How long should it take a precise Knick to stop bleeding?

A

2-9 minutes

50
Q

Normal bleeding time:

A

2-9 minutes

51
Q

Bleeding time provides an assessment of:

A

Platelet function

52
Q

A bleeding time of 9-15 minutes is indicative of:

A

Platelet dysfunction

53
Q

What test measure the effectiveness of the extrinsic pathway?

A

Prothrombin time (PT)

54
Q

The prothrombin time test measures the rate of conversion of:

A

Factor 12-12a (VII to VIIa)

55
Q

What is a normal prothrombin time

A

12-13 seconds

56
Q

What are common causes for prolonged prothrombin time? (3)

A
  1. Warfarin use
  2. vitamin K deficiency
  3. Liver disease
57
Q

What test measures the effectiveness of the intrinsic and common pathway?

A

Activated Partial Thromboplastin Time (aPTT)

58
Q

Test that measures the intrinsic clotting of blood and congenital clotting disorders?

59
Q

What is considered a more sensitive version of the PTT and is used to monitor the patietns resonse to heparin therapy?

A

Activated Partial Thromboplastin time

60
Q

What is a normal time frame for aPTT?

A

30-40 seconds

61
Q

If someone has an aPTT of more than 70 seconds this would signify:

A

Spontaneous bleeding

62
Q

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:

63
Q

What is the most commonly inherited bleeding disorder affecting platelet function?

A

Von Willebrand Disease

64
Q

What makes most of the clotting factors including the ones that are vitamin K dependent?

65
Q

Liver cirrhosis can cause a prolonged:

66
Q

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:

67
Q

What inhibits the intrinsic pathway at several points?

A

Heparin therapy

68
Q

Heparin therapy results in a:

A

Prolonged aPTT

69
Q

What inhibits the function of factors I, IX, and X, prolonging the aPTT?

A

Coumadin therapy

70
Q
  • 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:

A

Prolonged aPTT

71
Q

What does INR stand for?

A

International Normalized ratio

72
Q

The INR equation is:

A

Patient PT / mean normal PT and raised to ISI

73
Q

ISI stands for:

A

International sensitivity index

74
Q

What is the ISI value normally between?

75
Q

What is a normal INR level?

76
Q

Therapeutic INR level?

77
Q

An INR target of 2.5 (2.0-3.0) is the goal for all of the following circumstances: (7)

A

AF, Ischemic stroke, TIA, systemic embolism, Mitral stenosis, Planned cardioversion, and after open heart surgery

78
Q

We want a slightly higher INR of around 2.5 for patients with conditions that could make them:

A

Have a blood clot

79
Q
  1. Bleeding time:
  2. PT
  3. APTT
  4. INR
  5. Therapeutic INR
A
  1. 2-9 minutes
  2. 12-13 seconds
  3. 30-40 second
  4. 0.8-1.2
  5. 2-3.5
80
Q

What bleeding disorders are more common? (Congenital or acquired)

81
Q

Someone taking Ibuprofen, Aspirin, or NSAIDs can be at risk for:

A

Compromised platelet number

82
Q

What 3 bleeding disorders constitute over 90 percent of all congenital bleeding disorders?

A

Hemophilia A, Hemophilia B, and Von willebrands

83
Q

What has a higher prevalence hemophilia A or B?

A

A (1 in 10k)

84
Q

Both hemophilia A and B are inherited in a:

A

Sex-linked recessive manner

85
Q

What sex does hemophilia affect more frequently?

86
Q

What is bleeding in between the joints?

A

Hemoarthrosis

87
Q

The biggest concern is when people have ____ case of hemophilia

88
Q

Why is mild hemophilia of great concern?

A

Because typically patients aren’t aware

89
Q

What is prepared from plasma and contains fibrinogen, fibronectin, Von willebrand factor, Factor VIII, and Factor IX and is given to patient through IV

A

Cryoprecipitate

90
Q

Desmopressin can be given to a patient with:

A

Hemophilia A

91
Q

What part of hemostasis does von willebrands disease affect?

92
Q

There are 3 types of Von Willebrands disease:

Type 1 involves:
Type 2 involves:
Type 3 involves:

A

Type 1: shortage of VWF
Type 2: Flawed VWF
Type 3: Absent VWF

93
Q

What is the most common form of VWD?

94
Q

What are two causes of thrombocytopenia?

A
  1. Decreased platelet production
  2. Increased platelet destruction
95
Q

If a patient is on oral anticoagulant antiplatelet treatment are they recommended to stop use prior to a minor oral surgery procedure?

96
Q

Decision to hold an anticoagulant/ antiplatelet therapeutic drug can only be made by:

A

Physician (not dentist)

Applied Biochem (18 decks)

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