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Coagulation Rotation Final Flashcards

1
Q

List the factors involved in the intrinsic pathway.

A

PK, HMWK, Kall, XII, XI, IX, VIII

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2
Q

List the factors involved in the extrinsic pathway.

A

VII, III

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3
Q

List the factors involved in the common pathway.

A

X, V, II, I

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4
Q

State the purpose and function of Neoplastine.

A
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5
Q

State the contents and purpose of the activated PTT reagent.

A
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6
Q

What factors are measured by the PTT?

A

Intrinsic/Common pathway
I, II, V, VIII, IX, X, XI, XII

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7
Q

What factors are measured by the PT?

A

Extrinsic/Common pathway
I, II, V, VII, X

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8
Q

What is the action of Heparin and what test is used to monitor Heparin therapy? This means, what factors are affected by heparin?

A

Heparin interacts with/activates antithrombin which binds a pentasaccharide structure.
PTT
I, II, V, VIII, IX, X, XI, XII

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9
Q

What is the action of Coumadin and what test is used to monitor Coumadin therapy? This means, what factors are affected by heparin?

A

Coumadin is a Vitamin K antagonist
PT/INR
I, II, V, VII, X

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10
Q

What neutralizes the effects of Coumadin?

A

Vitamin K

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11
Q

What neutralizes the effects of Heparin?

A

Protamine

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12
Q

What protein accelerates the effects of heparin?

A
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13
Q

List 2 reasons a coagulation specimen may be rejected.

A

Short sample (Not 9:1 ratio)
Clotted

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14
Q

What effects will an increased hematocrit have on PT/PTT?

A

Falsely prolonged

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15
Q

How does sodium citrate work as an anticoagulant?

A

Chelates calcium; calcium is essential for clotting

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16
Q

What is the proper blood to anticoagulant ratio?

A

9:1

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17
Q

Critical INR

A

> 5.0

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18
Q

Critical PTT

A

> 200 seconds

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19
Q

Critical FBG

A

<100 mg/dL

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20
Q

Critical UFH

A

> 1.0 IU/mL

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21
Q

Normal PT range

A

11.7-14.5 seconds

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22
Q

Normal INR

A

0.9-1.1

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23
Q

Normal PTT

A

22.8-34.2 seconds

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24
Q

Normal fibrinogen

A

191-524 mg/dL

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25
Normal D-dimer
<0.50 ug/dL
26
Normal TT
15.4-18.0 seconds
27
Normal UFH
0.3-0.7 IU/mL
28
Normal EPI
91-172 sec
29
Normal ADP
50-132 sec
30
Normal P2Y12
194-518 PRU
31
Normal aspirin
>550 ARU
32
PTT Heparin therapeutic range
94-117 seconds
33
What does increased INR indicate? How to bring it down?
Increased INR = blood is too thin/too anticoagulated PT/INR is affected by Coumadin, so administer Vit K to bring it down
34
What is the most commonly ordered test?
PT/INR
35
>55% HCT?
Recollect, if still high, must dilute
36
What can increased fibrinogen mean? What can decreased fibrinogen mean?
Increased = pregnancy Decreased = DIC
37
What is the methodology of the Stago/StarMax?
Mechanical clot formation
38
During a mixing study, when abnormal plasma is mixed with normal plasma (1:1), what indicates a factor deficiency vs an inhibitor?
If PT/PTT corrects with normal plasma --> factor deficiency Normal correction is within 5 seconds If PT/PTT does not correct --> inhibitor may be present
39
Why may FSP (Fibrin split products) be present?
Result of plasmin breaking down FBG Increased D-dimers, Decreased FBG = DIC
40
What does the TEG do?
Measures clot strength from the very beginning (primary hemostatis) all the way to the stabilized fibrin clot.
41
When can a heparin antibody be formed and what does it cause?
Heparin antibody can be formed when a patient is receiving heparin therapy; can lead to HIT
42
VWF is a carrier protein for _____
F VIII
43
Heparin is administered ________, while Coumadin/Warfarin is administered _________.
Intravenously, Orally
44
Someone with hemophilia A has a factor ______ deficiency. This will prolong the ______.
VIII; PTT
45
VWD is associated with which drug?
Ristocetin
46
TEG stands for
Thromboelastograph
47
VW is associated with which factor
VIII
48
D-dimer is a product of?
Plasmin breaking down fibrin
49
What type of reaction is Heparin antibody?
ELISA
50
When dosing heparin, what is considered?
Patient body weight
51
When dosing Coumadin, what is considered?
Diet and medication
52
What disease does heparin antibody correlate to? Therapy?
HIT (heparin induced thrombocytopenia) Associated with anti-PF4 Take off heparin --> platelets should go back up
53
Increased HCT will increase?
PTT
54
When we receive specimens, what is the centrifugation time/speed?
Centrifuge 10 min @ 3000 rpms to create PPP (platelet poor plasma)
55
What is the purpose of the INR?
Standardizes sensitivities of reagents being used
56
What is 2 reasons why we would reject a coag specimen?
Clotted Short
57
What is heparin therapeutic range?
2-3x baseline of normal result
58
Increased thrombin time can indicate?
DIC, high FSPs
59
What does the PFA measure?
PLT aggregation; epinephrine and ADP
60
IF epinephrine is normal and ADP is abnormal, what does this indicate?
Aspirin
61
DIC lab results
Inc d-dimer Inc PT/PTT Dec PLTS Dec Fibrinogen
62
Mixing study results should correct within ____ seconds to be considered factor deficient
5
63
Reagents used for PTT
PTT reagent, CaCl
64
Reagents used for PT
Neos
65
What is the role of OK buffer?
Dilutes
66
Heparin vs Coumadin mode of delivery
Heparin - IV (immediate effect) Coumadin - Oral (takes 4-5 days to see full effect)
67
What reverses the affects of Coumadin?
Vitamin K
68
What is associated with an increased fibrinogen?
Pregnancy
69
What are lupus anticoagulants and what is commonly seen in those with them?
Phospholipid antibodies Miscarriages
70
What is Hemophilia A?
F VIII deficiency
71
Increased UFH would lead to? (bleeding/clotting)
Bleeding

Coagulation (5 decks)

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