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Q4 Clin Lab II thyroid, rheum, coag, LFT, body fluids > Coagulophathies > Flashcards

Coagulophathies Flashcards

1
Q

Coagulopathy categories?

A

Clotting
Platelet
Hypercoag

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2
Q

Clotting disorders? (2)

A 
Hemophilia A (factor 8)
Hemo B (factor 9)
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3
Q

Petechiae?

A

< 2mm
Focal SQ bleed
Don’t blanch

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4
Q

Purpura?

A

2-10mm
Palpable
Don’t blanch

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5
Q

Ecchymoses?

A

> 1cm

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6
Q

Initial labs for bleeding disorder? (4)

A

CBC w/ platelet count
Periphial smear
PT/INR, aPTT
+/- bleed time

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7
Q

Platelets levels:

thrombocytopenia?

prolonged bleed from injury?

spontaneous bleed?

A

< 100k

40k

<20k

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8
Q

Bleed time measures?

Screens for?

Prolonged if?

A

Time for hemostasis

Microvasculature and platelet fxn

Platelet disorder

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9
Q

Hemostatic response to vessel injury?

A

1st vasospasm
2nd platelet aggregation
3rd coag cascade

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10
Q

Extrinsic Pathway includes what Factors?

Requires what for activation?

What test measure Extrinsic path?

What med interrupts Extrinsic path?

A

Factor VII

Tissue Factor

PT (also measures Common)

Warfarin

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11
Q

Intrinsic Pathway includes what Factors?

Requires what for activation?

What test measures Intrinsic path?

What med interrupts Intrinsic path?

A

VIII, IX, XI, XII

Injury

PTT (also measures Common)

Heparin

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12
Q

Common Pathway includes what Factors?

What test measures Common path?

What med interrupts Common path?

A

I (fibrinogen), II (prothromin), V, X

PTT and PT

Lovanox

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13
Q

Prothrombin Time (PT) monitors what Path?

What meds?

What conditions? (2)

A

Extrinsic path

Warfarin

Liver fxn/damage
DIC

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14
Q 
Partial Thromboplastin Time (PTT) or
Activate Partial (aPTT) monitor what Path?

What meds?

What conditions? (5)

A

Intrinsic

Unfractionated Heparin (NOT LMWH)

Hemophilia, vW, liver damage, Vit K def, DIC

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15
Q

International Normalized Ratio (INR) monitors what?

A

Same as PT but more specific measures dependent on condition

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16
Q

INR target ranges:

DVT prophy?

DVT (acute), VTE, AFib?

Heart valves?

A

1.5 - 2

2 -3

2.5 - 3.5

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17
Q

PTT mixing study tests what?

A

Coag factor deficiency vs inhibitor problem

Mix pt blood w/ blood w/ normal factors,
If corrects, then pt missing factors
If not, pt has inhibitor problem

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18
Q

Thrombin Time (TT) tests what?

A

Fibrinogen

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19
Q

Clotting Disorders are?

A

Congenital or acquired

Excess or repetitive bleed at UNUSUAL sites w/ normal activity

U joints, mm, GI, GU

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20
Q

Hemophilia A/B details?

A 
A = VIII (most common)
B = IX (Christmas)

X-linked recessive
M&raquo_space; F

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21
Q

Hemophilia A/B presentation?

A

Asympt until 1st bleed U by 2yo

Severe pain in weight-bearing joints

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22
Q

Hemo A tests?

A 
Platelet count = N
PT = N
aPTT = long but corrects w/ PTT mix study
Factor VIII assay
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23
Q

Platelet Disorders: Low

Questions? (5)

A 
Sustained ↓?
Recent infection?
Meds that ↓ platelets?
Bleed/Not bleed OFP to platelets?
Evidence of:
-platelet consumption synd?
-other autoimm?
-chronic liver dz?
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24
Q

Platelet Disorders: High

Questions? (6)

A 
Cause of significant inflamm?
Current infection?
Peripheral smear abnormal?
Fe def anemia?
Inapprop clotting/bleeding?
Signs of:
-essential thrombocytosis?
-CA
25
Q

Platelet Disorders: Dysfxn

Caused by? (2)

A

Congenital (rare)

Acquired (drugs/EtOH, uremia, myelopro dz)

26
Q

Platelet Disorders: Dysfxn Lab tests?

A

Count = N
Morphology = N
Bleed Time = long

27
Q

Platelet Disorders: Splenic Sequestration?

A 
Hyper/Megaly = cytopenia
Ectomy = cytosis
28
Q

Idiopathic Thrombocytopenic Purpura (ITP) result of? (3)

Acute?

Chronic?

A

Platelet destruction
↓ prodxn
Sequestration

A = U kids post URI,
Heparin (most C inpt cause)

C = a/w autoimm, HIV, 20-50yo

29
Q

ITP presentation? (3)

A

Petechia, purpura, bullae on skin/muc memb
Epistaxis, oral bleeding
Subarachnoid/Intracranial hemorrhage

30
Q

ITP labs? (2)

A 
Coag studies = N
Platelet count = ↓↓
31
Q

ITP tx? (4)

A

No NSAIDs/ASA
Prednisone
IV IG
Platelet transfusion

32
Q

DIC (Disseminated Intravascular Coag) is?

a/w?

A

Widespread coag ->
massive platelet, fibrin, factor consumption ->
uncontrolled bleeding

underlying systemic illness

33
Q

Illness a/w DIC? (4)

A

Sepsis
Trauma
CA
Preggo complications

MOST ?????
Malaria
Osteomyelitis
Sepsis
Trauma
34
Q

DIC presentation?

A

Variable onset
Multi organ systems
Hemorr

35
Q

DIC labs? (6)

A 
Platelets = ↓
Fibrinogen = ↓
Fibrinolysis = ↑
PT/PTT = ↑
D-dimer = ↑
Smear = schistocytes
36
Q

DIC tx? (4)

A 
Transfusion w/:
Cryoprecipitate (fibrinogen replacement)
FFP (coag factors)
Platelets
PRBCs
37
Q

Thrombotic Thrompocytopenia Purpura (TTP) is?

Caused by? (4)

A

Rare, U fatal
Microangiopathic hemolytic anemia + thrombocytopenia ->
endothelial injury/small vessel thrombi

E. coli O157:H7
CA
Preggo
Drugs

38
Q

TTP common in who?

A

20-50yo
F>M
+HIV

39
Q

TTP presentation? (6)

A 
Toxic
Abd pain
HA
Mental ∆s
Pallor, petechiae
Jaundice
40
Q

Hemolytic Uremic Synd is?

Presentation?

Labs? (4)

Tx?

A

U from e. coli O157:H7

Abd pain w/ bloody D days prior
Like TTP less CNS, more renal

Hemolytic anemia
Thrombocytopenia
Schistocytes
Renal fail

Adults: plasmapheresis
Kids: IV hydration w/ e-

41
Q

TTP-HUS labs?

A 
Microangiopathic hemolytic anemia
Thrombocytopenia
Smear = Schistocytes
Coag = N (diff from DIC)
Renal insuff
42
Q

TTP-HUS tx? (4)

A

Steroids
Plasmapheresis (plasma exchange)
Rituximab if refractory
High mortality

43
Q

SUMMARY: TTP triad?

A

Hemolytic anemia
Thrombocytopenia
Neuro deficits
(ADAMTS13 mutation)

44
Q

SUMMARY: HUS triad?

A

Hemolytic anemia
Thrombocytopenia
Renal insuff

45
Q

Von Willebrand’s Dz epidemiology?

A

Auto dominant
M=F
Most C coag

46
Q

vWF causes?

Type I?

A

↓ Factor VIII ANTIGEN -> deficient or defective vWF

Most C
Acquired (bone marrow CA, valproic acid, SLE)
↓ Factor VIII

47
Q

vWF presentation? (4)

A

Bleed (nose, vag, GI)
Hemarthrosis/Soft tissue bleed less likely
Bleed ↑ w/ ASA
Bleed ↓ E2/preggo

48
Q

vWF labs?

A

Bleed time = long (N in hemophilia)
INR = N
vWF = low

49
Q

vWF tx?

A

Desmopressin (releases stores vWF from endo cells)
Factor VIII infustion
Humate-P (VIII and vWF)

50
Q

Hypercoag States: Congenital?

A

U auto-dominant

Deficiencies in:
Antithombin (III)
Prot C or S

Mutations in:
Factor V (Leiden)
Prothrombin (II)

51
Q

Antithrombin III deficiency epidemiology?

Causes what?

What med acts on III?

A

Congenital or acquired (DIC, HUS)

Thromboembolic dz
Lack of III means no inhibition of coag cascade

Heparin (↑ effects of III)

52
Q

Antithrombin III Deficiency presentation?

Labs?

Tx? (2)

A

FHx of DVT, PE
U 20-30yo
U asympt
Acute thrombosis or embolism

III = low

IV heparin
Long-term Warfarin

53
Q

Protein C Deficiency epidemiology?

Causes what?

Presentation?

A

Auto dominant
Prot C is Vit-K dependent

DVTs
Lack of C means no fibrinolysis ∴ no clot lysis

FHx
Spontaneous or provoked DVT

54
Q

Protein C Deficiency labs?

Tx? (3)

A

Prot C = low

IV heparin
Long-term Warfarin
No oral contraceptives or hormone replacement

55
Q

Protein S Deficiency epidemiology?

Causes what?

Presentation?

A

Auto domin or
Acquired (liver dz, vit K def)

VTE, thromboembol
Lack of S means no Prot C activation

VTE U <40yo
Spontaneous abortion

56
Q

Protein S Deficiency labs?

Tx?

A

Prot S antigen = low

Same as Prot C
+ prophy w/ preggos

57
Q

Factor V Leiden Mutation epidemiology?

Causes what?

A

Hereditary thrombophilia

Resists activated Prot C ->
venous thrombosis, thromboembolism

58
Q

Factor V Leiden Mutation labs:

aPTT

PTT

A

aPTT = screen for activated Prot C (APC) resistance

PTT = measure w/ APC and w/o APC,

If resistance +, PTTs will be equal
If resistance -, PTT longer w/ APC
If abnormal, test for mutation

59
Q

Factor V Leiden Mutation tx?

Q4 Clin Lab II thyroid, rheum, coag, LFT, body fluids (14 decks)

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