disorders of clotting Flashcards

1
Q

what is cocktail purpura

A

happens in people who drink gin and tonic
tonic water has quinine which causes platelts to clump and be removed from the body
-petechiae may show up the next day

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2
Q

what is the normal PT

A

10-13 seconds

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3
Q

PT prolonged with what deficicny and what drug

A

factors II, V, VII, X and fibrinogen

warfarin or dicoumarol

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4
Q

normal PTT time

A

25-40

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5
Q

PTT prolonged in what deficiency and what drug

A

factors VIII, IX, XI, XII

heparin

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6
Q

what does Thrombin time (TT) assess for

A

deficiency or abnormalities of fibrinogen

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7
Q

most common qualitative platetelet defect

A

in pts taken aspirin or NSAIDs

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8
Q

treatment of DIC

A

correction of underlynig disorder- sepsis, bowel obstruction etc

supporive care- platelet and factor replacement

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9
Q

thrombotic thrombocytopenic purpura

add one more symptom and it gives you what

A

characterized by purpura, microangiopathic hemolytic anemia, fluctuating neurological signs, renal dysfunction and febrility anad thrombocytoenia under 50,000

add renal failure = HUS

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10
Q

helmet cells known as waring blender effect

A

TTP

-hyaline thrombi occlude capillaries of virtually every organ in the body

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11
Q

cause of acquired TTP

A

autoantibodies directed at ADAMTS13

linked to infection, malignancy, immune disorders

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12
Q

treatment for TTP

A

plasmapheresis

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13
Q

treatment for VWD

A

cryoprecipitate –>replaces vWF
DDAVP–> causes relase of vWF from endothelium
antifibrinolytic agents like aminocaproic acid

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14
Q

PT with deficiency of vitamin K dep factors

A

prolonged

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15
Q

hereditary hemorrhagic telangiectasia

A

only endothelial syndrome associated with hemostatic complications
-caused by thinning of vessel walls with telangiectatic formations, AV malformations, and aneurysmal dilations throughout the body

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16
Q

HHT inheritence and defect

A

autosomal dominant

defect in gene coding for endoglin on chrom 9

17
Q

clinical features of HHT

A

telangiectasis on tip of tongue and lip mainly
bleeding to mild or inapparent trauma
-epistaxis is the most frequent symptom

18
Q

course and treatment of HHT

A

usually benign clinical course, recurrent bleeds frequent but death rare

surgery and laser photoablation of telangiectasias of some value but care must be used in selecting site

19
Q

antithrombin III deficiency clinical presentation

A

variable from minimal symptomatology to early death from recurrent pulmonary emboli
50% of affected pts have DVT and or PE by age 30

20
Q

AT III diagnosis

A

less than 50% of normal activity of AT III levels in serum

21
Q

treatment for AT III deficiency

A

prophylactic treatment with anticoags
pts with DVT need heparin but much higher doses required
AT III replacement therapy is available for known deficient pts

22
Q

protein C and S function

A

S is cofactor for C which inactivates V, and VIII

23
Q

what do you give pts with protein C and S deficiency

A

warfarin to decrease the risk of thromboembolic disaeae

-beware that warfarin can also suppress these factors causing a hypercoagulable state

24
Q

factor V leiden and treatment

A

abnormalitiy of factor V at binding site for activated protein C

no prior DVT just moniter
prior episodes then consider lifelong anticoagulation

25
prothrombin 20210
increaed activity for prothrombin bc of mutation so it isn't deactivated risk of thrombosis is high -same treatment as factor V
26
antiphospholipid syndrome
aka anticardiolipin antibody syndrome lupus anticoagulant false postivtve VDRL antibody syndrome
27
clincial clues suggesting an inherited hypercoagulable disorder
thrombosis at young age under 50 multiple thromboses episodes thrombosis in an unusual site family history of thrombosis
28
characterized by venous and arterial thrombsois recurrent spontaneuous pregnancy loss thrombocytopenia neuropsychiatric manifestaions
antiphospholipid antibody syndrome
29
what events most common in antiphospholipid antibody syndrome how to treat
cerebrovascular events most common arterial thrombotic complication with stroke and TIA and dementia of retinal artery occlusion placental vessel thrombosis leads to pregnacny loss and fetal growth retardation -treat with warfarin
30
what causes false postitive VDRL antibody syndrome
antiphos syndrome when testing for neurosyphillis
31
associated features of APS
CT disease prolonged PTT, fails to correct with mixing valvular heart disease in some coronary artery disease
32
diagnosis; 3 test APS
prolonged PTT lack of correction in mixing neutralization of inhibitor with excess phospholipid
33
confiramtion test APS
DRVVT
34
treatment for APS | diagnosis confirmation
those with history of thromboembolic disease: lifelong anticoagulation need multiple postiive tests over 3-12 month period to make diagnosis
35
what can help reduce thromboembolism in pts with APS and SLE
hyroxychloroquine
36
most common cause of hereditary hypercoagubility are
factor V leiden and prothrombin gene mutation
37
what does a hypercoag panal include
factor v and prothrombin test and also protein C and S test won't include APS antibody and lupus anticoagulant
38
treatment of APS during pregnancy
SC heparin