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Applied Biochemistry > Coagulation A Surgical Perspective (Exam III) > Flashcards

Coagulation A Surgical Perspective (Exam III) Flashcards

1
Q

What events occur in primary hemostasis (3)

A

1- vasoconstriction
2- platelet activation
3- platelet plug formation

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2
Q

What events occur in secondary hemostasis (2)

A

1- coagulation cascade
2- formation of fibrin clot

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3
Q

What molecule degrades the blood clot after it has 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 three phases of hemostasis (normal)

A

1- vascular phase
2- platelet phase
3- coagulation phase

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6
Q

What causes the vasoconstriction following injury to a blow vessel

A

Vascular spasm

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7
Q

First step of the platelet phase

A

Exposed collagen bind and activates platelets

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8
Q

What is the second step of the platelet phase

A

Release of platelet factors

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9
Q

In the third step of the platelet phase after the release of platelet factors

A

Attracts more platelets

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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 make up the coagulation phase

A

Intrinsic and 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 to fibrinogen to fibrin

A

Intrinsic and extrinsic

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16
Q

Drug that affects clotting

A

Warfarin

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17
Q

Drug that affects platelets

A

Aspirin

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18
Q

When someone has issues with ____ this results in 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 fibrinolytic pathway

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22
Q

You cannot perform oral surgery if the platelet count is:

A

Less than 50,000

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23
Q

Normal platelet range

A

150,000-400,000

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24
Q

People with a normal number 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 effective treatment

A

Platelet diffusion

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27
Q

Clotting disorders to be aware of as a clinician

A

Hemophilia A or B

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28
Q

Hemophilia A involves clotting factor

A

VIII

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29
Q

Hemophilia B involves clotting factor

A

IX

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30
Q

Platelet count is measured in a

A

CBC

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31
Q

Common laboratory tests to evaluate hemostasis

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. Internationalized normal ration (INR)
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33
Q

Advanced tests used to evaluate hemostasis (2)

A
  1. Platelet function tests
  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 taking medications following stroke or heart attack that can alter platelet function

A

Platelet function test

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35
Q

Test that measures 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 WBCs

A

4.5-11.0

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37
Q

Standard range for RBCs

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 platelet range

A

150,000-400,000

40
Q

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

A

Thrombocytopenia

41
Q

An individual with a platelet count of 100,000-140,000 diagnosed with thrombocytopenia will have a bleeding time that is

A

Normal

42
Q

What type of procedures can you perform on an individual with mild thrombocytopenia (Platelets 50,000-100,000)

A

Simple extractions, no major surgeries

43
Q

An individual with a platelet count of 50,000-100,000 is considered to have

A

Mild thrombocytopenia

44
Q

An individual with mild thrombocytopenia (platelet count 50,000-100,000) will have what kind of bleeding time

A

Mildly prolonged

45
Q

An individual with a platelet count of less than 50,000 is considered to have

A

Severe thrombocytopenia

46
Q

What type of oral surgery procedures can you perform on a patient with severe thrombocytopenia

A

You cannot

47
Q

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

A

Spontaneous bleeding

48
Q

How long should it take a precise nick to stop bleeding

A

2-9 minutes

49
Q

Normal bleeding time

A

2-9 minutes

50
Q

Bleeding time provides an assessment of

A

Platelet function

51
Q

A bleeding tie mom 9-15 minutes is indicative of

A

Platelet dysfunction

52
Q

What test measures the effectiveness of the extrinsic pathway

A

Prothrombin time (PT)

53
Q

The prothrombin time test measures the rate of conversion of

A

Factor VII-VIIa

54
Q

Normal prothrombin time

A

12-13 seconds

55
Q

What are common causes for prolonged prothrombin time (3)

A

1- warfarin use
2- vitamin K deficiency
3- liver disease

56
Q

Test that measures the effectiveness of the intrinsic and common pathway

A

Activated partial thromboplastin time (aPTT)

57
Q

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

A

Activated Partial Thromboplastin Time (aPTT)

58
Q

Considered a more sensitive version of the PTT and is used to monitor the patients response to heparin therapy

A

APTT

59
Q

Normal time frame for APTT

A

30-40 seconds

60
Q

If a patient has an aPTT of more than 70 seconds that signifies

A

Spontaneous bleeding

61
Q

Congenital deficiencies of intrinsic system clotting factors such as factors VII, IX, XI, XII including hemophilia A, and hemophilia B can cause a prolonged

A

APTT

62
Q

Most commonly inherited bleeding disorder affecting patient function

A

Von Willebrand disease

63
Q

What makes most of the clotting factors, including the vitamin K-dependent ones

A

Liver

64
Q

Liver cirrhosis can cause a prolonged

A

APTT

65
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

A

APTT

66
Q

Inhibits the intrinsic pathway at several points

A

Heparin therapy

67
Q

Heparin therapy results in a prolonged

A

APTT

68
Q

Inhibits the function of factors I, IX, and X, prolonging the APTT

A

Coumadin therapy

69
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

70
Q

INR stands for

A

International normalized ratio

71
Q

INR equation is

A

Patient PT / mean normal PT and raised to the ISI

72
Q

ISI stands for

A

International sensitivity index

73
Q

The ISI value is normally between

A

1-2

74
Q

Normal INR level

A

0.8-1.2

75
Q

Therapeutic INR level

A

2-3.5

76
Q

An INR range of 2.5 (2-3) is the goal for all of the following circumstances (7)

A

Atrial fibrillation (AF)
Transient ischemic attack (TIA)
Ischemic stroke
Systemic embolism
Mitral stenosis
Planned cardio version
After open heart surgery

77
Q

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

A

More prone to a blood clot

78
Q
  1. Bleeding time
  2. Prothrombin time
  3. APTT
  4. INR
  5. Therapeutic INR
A

1: 2-9 minutes
2: 12-13 seconds
3: 30-40 seconds
4: 0.8-1.2
5: 2-3.5

79
Q

What bleeding disorders are more common (congenital or acquired)

A

Acquired

80
Q

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

A

Compromised platelet numbers

81
Q

What three congenital bleeding disorders constitute over 90% of all bleeding congenital bleeding disorders

A

Hemophilia A
Hemophilia B
Von Willebrands disease

82
Q

What has a higher prevalence - hemophilia A or B

A

A (1 in 10,000)

83
Q

Both hemophilia A and B are inherited in a

A

Sex-linked recessive manner

84
Q

What sec does hemophilia affect more frequently

A

Males

85
Q

Bleeding in between joints

A

Hemoarthrosis

86
Q

The biggest concern is when people have ____ case of hemophilia

A

Mild

87
Q

Why is mild hemophilia of great concern

A

Because typically patients are unaware

88
Q

What is prepared from plasma and contains fibrinogen, fibronectin, Von Willebrand factor, Factor 8 and Factor 9 and is given to patients through IV

A

Cryoprecipitate

89
Q

Desmopressin could be given to a patient with

A

Hemophilia A

90
Q

What part of hemostasis does Von Willebrands disease effect

A

Primary

91
Q

There are three types of Von Willebrands Disease:

Type I involves:
Type II invovles:
Types III involves:

A

Type I - shortage of VWF
Type II - flawed VWF
Type III- absent VWF

92
Q

Most common form of VWD

A

Type I

93
Q

The two causes of thrombocytopenia

A

1- decreased platelet production
2- increased platelet destruction

94
Q

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

A

No

95
Q

The decision to hold an anticoagulant/antiplatelet therapeutic drug can only be made by

A

Physician (NOT dentist)

Applied Biochemistry (18 decks)

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