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Hemic-Lymphatic and Clin Path > Coagulation Testing > Flashcards

Coagulation Testing Flashcards

1
Q

when should you perform coagulation testing?

A

unexplained bleeding
pre-operative testing
monitoring anticoagulation

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2
Q

what is tissue factor?

A

potent coagulator, usually inside cells
release triggered by inflammation

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3
Q

what does PT test?

A

extrinsic pathway of coagulation

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4
Q

what does aPTT test?

A

intrinsic pathway of coagulation

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5
Q

what factor is in the extrinsic pathway?

A

factor VII

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6
Q

what are the commonly available coagulation tests?

A

prothrombin time (PT)
activated partial thromboplastin time (aPTT)
thrombin time
fibrinogen
platelet count
vWF assay
viscoelastic testing: thromboelastography, VCM

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7
Q

what should be avoided when collecting a sample to use for coagulation testing?

A

probing for vessel
excessive vacuum

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8
Q

when mixing citrate with blood, what is the correct ratio?

A

one part citrate
nine parts blood

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9
Q

what is mild thrombocytopenia?

A

150,000-200,000/ul

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10
Q

what is moderate thrombocytopenia?

A

100,000-150,000/ul

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11
Q

what is severe thrombocytopenia?

A

50,000-100,000/ul

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12
Q

what is profound thrombocytopenia?

A

<50,000/ul

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13
Q

what should you think about if you have platelet bleeding but a normal platelet count?

A

platelet function

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14
Q

what are some things that impact platelet function?

A

Von Willebrand’s disease
uremia
drugs

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15
Q

what can you use to test for platelet function?

A

buccal mucosal bleeding time

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16
Q

what does the extrinsic pathway start with?

A

tissue factor expression

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17
Q

why might a patient have a prolonged PT?

A

vitamin K deficiency
anticoagulant rodenticide toxicity
liver failure

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18
Q

what is factor VII dependent upon?

A

vitamin K

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19
Q

what test should you use to check for hemophilia?

A

aPTT

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20
Q

what might a prolonged aPTT mean?

A

acquired and hereditary disorders
hemophilia A and B
anticoagulation with heparin

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21
Q

what does thrombin time measure?

A

‘functional’ fibrinogen

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22
Q

what might cause hypofibrinogenemia?

A

DIC
liver failure
bleeding- consumption

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23
Q

what might a shortened PT/aPTT mean?

A

maybe hypercoagulable state

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24
Q

what are fibrinogen degradation products?

A

fibrin degradation product
D-dimer

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25
Q

what is D-dimer useful for?

A

if super high: maybe helpful
negative predictive value

26
Q

what can a thromboelastography test tell us?

A

hemostatic changes
hypercoagulability
fibrinolysis

27
Q

when might you see hyperfibrinolysis?

A

greyhounds
trauma
bleeding states (hemoperitoneum)
acute liver disease

28
Q

what are some common coagulopathies?

A

thrombocytopenia
von willebrand’s disease
anticoagulant rodenticide
DIC

29
Q

what are some less common coagulopathies?

A

dilutional
traumatic
hemophilia
drug-induced

30
Q

what tests can you use to look for von willebrand’s disease?

A

index of suspicion
vWF assay or buccal mucosal bleeding time

31
Q

what are the positives of doing a blood smear?

A

cage-side platelet count
inexpensive
rapid scan to look for clumping
immediate result
avoid delay in therapy
drive diagnostic planning
serial monitoring

32
Q

how do we treat ITP?

A

immunosuppressives
vincristine
whole blood or packed red blood cell transfusions

33
Q

should you do platelet transfusions in ITP?

A

only if bleeding out

34
Q

when should you consider the potential role of hyperfibrinolysis?

A

bleeding: spontaneous or traumatic hemoabdomen

35
Q

what does dilutional coagulopathy follow?

A

fluid resuscitation

36
Q

when is dilutional coagulopathy most significant?

A

surgical diseases

37
Q

do platelet blockers affect the platelet count?

A

no

38
Q

what are the tests for monitoring anticoagulation?

A

aPTT
anti-Xa activity

39
Q

what does anti-Xa activity test?

A

low molecular weight heparin

40
Q

what can cause hypercoagulability?

A

systemic inflammation
empiric anticoagulation

41
Q

what laboratory findings might point towards a hypercoagulable state?

A

shortened PT/aPTT
mild thrombocytopenia
fibrin(ogen) degradation products
D-dimers

42
Q

what do cytokines stimulate?

A

hypercoagulable state

43
Q

what are the endogenous anticoagulants?

A

protein C, antithrombin
decreased in inflammatory disease states

44
Q

what is the D-dimer assay specific for?

A

FDP fragment
fibrin breakdown

45
Q

fibrin formation has to have occurred for ________________ to be present

A

D-dimers

46
Q

how can sodium citrate be reversed?

A

addition of excess calcium

47
Q

what is the contact activator with activated clotting time?

A

diatomaceous earth

48
Q

what are the normal values of activated clotting time in dogs and cats?

A

dogs <120 seconds
cats <180 seconds

49
Q

what is activated clotting time used for?

A

titrate heparin in hemodialysis

50
Q

when does hypofibrinogenemia occur?

A

DIC
liver failure
bleeding

51
Q

is D-dimer or FDPs more specific for fibrinolysis?

A

D-dimer

52
Q

what test can you use for hemophilia?

A

aPTT

53
Q

what tests can you use for trauma testing coagulopathies?

A

PT
aPTT
TEG

54
Q

what tests can you use for dilutional coagulation testing?

A

PT
aPTT

55
Q

does the factor percent in hemophilia impact outcome?

A

no

56
Q

what are some common causes of unexplained bleeding?

A

anticoagulant rodenticide toxicity
ITP
trauma
heatstroke
dilution
hemangiosarcoma

57
Q

what should you do if dilutional coagulopathy is prolonged?

A

plasma transfusion

58
Q

what anticoagulants get down-regulated by cytokines?

A

protein C
antithrombin

59
Q

what does the test for fibrin degradation products measure?

A

breakdown of fibrin and fibrinogen: not specific

60
Q

what do increased values of fibrin degradation products indicate?

A

fibrinolysis has occured

61
Q

fibrin formation has to have occurred for ________________ to be present

A

D-dimers

Hemic-Lymphatic and Clin Path (33 decks)

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