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MLT 104 Hematology > Coagulation // Unit 5 > Flashcards

Coagulation // Unit 5 Flashcards

1
Q

What composes hemostasis?

A

vascular system
platelet
coagulation
fibrinolysis

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2
Q

What are the systems involved in hemostasis?

A

primary & secondary

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3
Q

What is the primary system activated by?

A

Small vessel damage (controls vasoconstriction/platelet function)

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4
Q

What is the secondary system activated by?

A

major trauma, surgery or hemorrhage

controls coagulation proteins & enzymatic rxns

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5
Q

What is coagulation?

A

a series of proteins that go through a series of enzymatic rxns to form fibrin

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6
Q

What is the life span of PLTs?

A

7-10 days

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7
Q

What is the cell that drops off PLTs at the site of injury?

A

megakaryocyte through endomitosis

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8
Q

What are the 3 phases of PLT function?

A

adhesion
amplification
aggregation

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9
Q

In the adhesion phase, what are the PLTs adhering to? What is required?

A

collagen, vMF & Gp1b

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10
Q

What makes up the vessel wall?

A

collagen
elastic fibers
smooth muscles

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11
Q

What occurs during amplification?

A

more PLTs are recruited to aggregate

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12
Q

What enforces aggregation of PLTs?

A

Thromboxane A2

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13
Q

What coagulation factor isn’t produced in the liver?

A

VIII

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14
Q

What factors make up the extrinsic pathway? Does is have a faster or slower response?

A

III & VII

faster

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15
Q

What factors make up the intrinsic pathway?

A

XII, XI, IX, VIII

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16
Q

Hemophilia A is a factor ___ deficiency?

A

VIII

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17
Q

What factor is a substrate for thrombin & a precursor of fibrin?

A

Factor I, fibrinogen

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18
Q

What factor is the fibrin stabilizing factor?

A

Factor XIII

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19
Q

What factor activates factor VII?

A

Factor III

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20
Q

Hemophilia B is a factor ____ deficiency?

A

IX

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21
Q

Deficiency of factor ___ may cause prolonged aPTT

A

XII

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22
Q

What factor accelerates the transformation of prothrombin to thrombin?

A

factor V

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23
Q

What are the contact factors?

A

HMWK
Pre-K
XII
XI

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24
Q

What pathway forms the fibrin clot?

A

the common pathway

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25
Q

What do PT & aPTT measure?

A

PT- extrinsic pathway

aPTT- intrinsic pathway

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26
Q

What type of bleeding is seen in a decreased PLT count?

A

gingival bleeding
epistaxis
extensive bruising
petechiae

27
Q

What causes an altered distribution of platelets?

A

enlarged spleen

28
Q

What coagulation process is vitamin K dependent?

A

Prothrombin group

29
Q

Which drugs can cause thrombocytopenia?

A

quinines
NSAIDs
Sulfonamides
Diuretics

30
Q

Where can closed bleeding occur?

A 
soft tissue
genitourinary
gastrointestinal
bleeding in muscles
bleeding in bones, joints & skull
31
Q

What is unique about the factor VIII molecule?

A

largest protein in the coagulation complex
not exclusively synthesized by the liver
forms complex w/ vMF for transportation
genetically controlled by X-chromosome

32
Q

What are some symptoms of an individual with Hemophilia A & B?

A 
bleeding in...
GI tract
kidneys
gums
muscles
joints
umbilical cord
circumcisional
hemarthrosis
33
Q

What are the lab results of a person with Hemophilia A & B?

A

normal bleeding time
normal PT
increased APTT

34
Q

How was Hemophilia A treated back in the day? What was the issue with this?

A

whole blood transfusion

80-90% of pts contracted HIV

35
Q

What is the issue with treating Hemophilia A & B?

A

patients run the risk of developing inhibitors or antibodies to their infusion products

36
Q

In clotting factor disorders in both bleeding and no bleeding, what are the factors?

A

bleeding- XIII, X, VII, V, II

no bleeding- contact activation factors (XI, XII, HMWK, Pre-K)

37
Q

Describe Factor XIII clotting disorder

A

normal PT & PTT
tested with 5M urea test
issues/bleeding w/ pregnancy

38
Q

Describe factor II, V, VII & X clotting disorders

A

prolonged PT & APTT
rare autosomal recessive
treated with prothrombin complex concentrates

39
Q

What are causes of Vitamin K deficiency?

A

antibiotic therapy
nutritional deficit
biliary obstruction
malabsorption syndrome

40
Q

If Vitamin K is depleted, what will show in lab results?

A

Increased PT & APTT

41
Q

What is the role of fibrinogen in the coagulation & fibrinolytic system?

A

gets converted to fibrin (fibrinopeptides A & B) by thrombin and is the onset of a solid clot & is broken down by the fibrinolytic system

42
Q

Name some acquired disorders of fibrinogen…

A 
minor increases:
inflammation
pregnancy
stress
diabetes
oral contraceptives

major increases:
hepatitis
atherosclerosis

decreases:
acute liver disease
acute renal disease
DIC

43
Q

Name the 3 types of inherited fibrinogen disorders & their values

A

afibrinogenemia <10
hypofibrinogenemia 20-100
dysfibrinogenemia (qualitative)

44
Q

Describe Afibrinogenemia

A

autosomal recessive
increased PT, PTT, TT & reptilase time
long bleeding time
abnormal PLT aggregation

45
Q

Describe hypofibrinogenemia

A

heterozygous form of afibrinogenemia
autosomal recessive
mild spontaneous bleeding
severe postop bleeding

46
Q

Describe dysfibrinogenemia

A

autosomal dominant
inherited homo or hetero
most lab findings are abnormal
inc PT, PTT, TT & RT

47
Q

What is the role of thrombin in the coagulation system?

A

PLT release reaction
PLT aggregation
activation of factor V & VIII
activation of Protein C

48
Q

What is the role of thrombin in the fibrinolytic system?

A

negative feedback by converting plasminogen to plasmin which breaks down fibrin

49
Q

When is thrombin & tPA generated?

A

during injury to endothelial cells

50
Q

What are the activators of the fibrinolytic system?

A 
tPA
factor XIIa
kallikrein
HMWK
Urokinase
51
Q

What are products or fibrinolysis called? What are their labels?

A 
fibrin splint/degradation products
X
Y
D
E
D-dimers
52
Q

Which inhibitor prevents plasmin from binding to fibrin & is the most important inhibitor of the fibrinolytic system?

A

alpha-2 antiplasmin

53
Q

What are events that can trigger DIC?

A 
infections
tissue injury
malignancy
heat stroke
GI disorders
OB complications
snake bites
54
Q

What may develop in patients with DIC?

A

microangiopathic hemolytic anemia due to microthrombi

55
Q

Describe the two types of thrombosis…

A

arterial thrombi- PLTs. RBCs & WBCs

venous thrombi- fibrin & WBCs

56
Q

What factors does antithrombin neutralize?

A

mostly IIa

IXa, Xa, XIa, XIIa

57
Q

What are the inherited risk factors for thrombosis?

A 
AT deficiency
Protein C deficiency
Protein S deficiency
Factor V Lieden
Prothrombin Mutation
58
Q

What are the two forms of protein S & their %’s?

A

free 40%

C4b bound 60%

59
Q

What are the differences between the two types of type II qualitative protein S disorders?

A

IIa - reduced free protein with normal total protein

IIb - both free & total protein are normal

60
Q

What are the most common acquired risk factors for thrombosis?

A

LA/Antiphospholipid syndrome

HIT

61
Q

What are the specimen requirements for coagulation testing?

A

3.2% sodium citrate
9:1 dilution
spin @ 3000 rpm for 5 min
Hct >60% need to be drawn differently

62
Q

Which drug inhibits the formation of thromboxane A2?

A

aspirin, antiplatelet drug

63
Q

What is special about coumadin?

A

long term anticoagulant

inhibits vitamin K dependent coagulation factors (II, VII, IX, X)

MLT 104 Hematology (3 decks)

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