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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
Q

Normal D-dimer

A

<0.50 ug/dL

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26
Q

Normal TT

A

15.4-18.0 seconds

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27
Q

Normal UFH

A

0.3-0.7 IU/mL

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28
Q

Normal EPI

A

91-172 sec

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29
Q

Normal ADP

A

50-132 sec

30
Q

Normal P2Y12

A

194-518 PRU

31
Q

Normal aspirin

32
Q

PTT Heparin therapeutic range

A

94-117 seconds

33
Q

What does increased INR indicate? How to bring it down?

A

Increased INR = blood is too thin/too anticoagulated
PT/INR is affected by Coumadin, so administer Vit K to bring it down

34
Q

What is the most commonly ordered test?

35
Q

> 55% HCT?

A

Recollect, if still high, must dilute

36
Q

What can increased fibrinogen mean? What can decreased fibrinogen mean?

A

Increased = pregnancy
Decreased = DIC

37
Q

What is the methodology of the Stago/StarMax?

A

Mechanical clot formation

38
Q

During a mixing study, when abnormal plasma is mixed with normal plasma (1:1), what indicates a factor deficiency vs an inhibitor?

A

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
Q

Why may FSP (Fibrin split products) be present?

A

Result of plasmin breaking down FBG
Increased D-dimers, Decreased FBG = DIC

40
Q

What does the TEG do?

A

Measures clot strength from the very beginning (primary hemostatis) all the way to the stabilized fibrin clot.

41
Q

When can a heparin antibody be formed and what does it cause?

A

Heparin antibody can be formed when a patient is receiving heparin therapy; can lead to HIT

42
Q

VWF is a carrier protein for _____

43
Q

Heparin is administered ________, while Coumadin/Warfarin is administered _________.

A

Intravenously, Orally

44
Q

Someone with hemophilia A has a factor ______ deficiency. This will prolong the ______.

45
Q

VWD is associated with which drug?

A

Ristocetin

46
Q

TEG stands for

A

Thromboelastograph

47
Q

VW is associated with which factor

48
Q

D-dimer is a product of?

A

Plasmin breaking down fibrin

49
Q

What type of reaction is Heparin antibody?

50
Q

When dosing heparin, what is considered?

A

Patient body weight

51
Q

When dosing Coumadin, what is considered?

A

Diet and medication

52
Q

What disease does heparin antibody correlate to? Therapy?

A

HIT (heparin induced thrombocytopenia)
Associated with anti-PF4

Take off heparin –> platelets should go back up

53
Q

Increased HCT will increase?

54
Q

When we receive specimens, what is the centrifugation time/speed?

A

Centrifuge 10 min @ 3000 rpms to create PPP (platelet poor plasma)

55
Q

What is the purpose of the INR?

A

Standardizes sensitivities of reagents being used

56
Q

What is 2 reasons why we would reject a coag specimen?

A

Clotted
Short

57
Q

What is heparin therapeutic range?

A

2-3x baseline of normal result

58
Q

Increased thrombin time can indicate?

A

DIC, high FSPs

59
Q

What does the PFA measure?

A

PLT aggregation; epinephrine and ADP

60
Q

IF epinephrine is normal and ADP is abnormal, what does this indicate?

61
Q

DIC lab results

A

Inc d-dimer
Inc PT/PTT
Dec PLTS
Dec Fibrinogen

62
Q

Mixing study results should correct within ____ seconds to be considered factor deficient

63
Q

Reagents used for PTT

A

PTT reagent, CaCl

64
Q

Reagents used for PT

65
Q

What is the role of OK buffer?

66
Q

Heparin vs Coumadin mode of delivery

A

Heparin - IV (immediate effect)
Coumadin - Oral (takes 4-5 days to see full effect)

67
Q

What reverses the affects of Coumadin?

68
Q

What is associated with an increased fibrinogen?

69
Q

What are lupus anticoagulants and what is commonly seen in those with them?

A

Phospholipid antibodies
Miscarriages

70
Q

What is Hemophilia A?

A

F VIII deficiency

71
Q

Increased UFH would lead to? (bleeding/clotting)

Coagulation (5 decks)

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