DISORDERS OF SECONDARY HEMOSTAS Flashcards
is a severe form of bleeding that requires immediate intervention and transfusion
hemorrhage
what are the inherited disorders of coagulation: intrinsic pathway disorders
prekallikrein (fletcher factor deficiency)
high molecular weight kininogen (fitzgerald factor) deficiency
factor XI deficiency (hemophilia C; rosenthal syndrome)
Factor VIII;C deficiency (hemophilia A; classic hemophilia)
Factor IX deficiency (hemophilia B; christmas disease)
von willebrand’s disease
what are the inherited disorders of coagulation: extrinsic and common pathway disorders
factor VII (proconvertin; stable factor) deficiency
factor X (stuart-power factor) deficiency
Factor V deficiency (owren’s disease; labile factor deficiency
Factor II (Prothrombin) Deficiency
Fibrinogen (factor I) deficiency
Factor XIII (fibrin stabilizing factor) deficiency
acquired disorders of coagulation
hepatic disease
vitamin K deficiency
therapeutic anticoagulation
circulating anticoagulant (inhibitory) substance
massive transfusion effects
disseminated intravascular coagulation
pre-kallikrein (fletcher factor) deficiency is believed to be transmitted as _____ trait
autosomal recessive trait
laboratory findings of prekallikrein (fletcher factor) deficiency is similar to what factor deficiency
factor XII deficiency
laboratory findings of prekallikrein is similar to factor XII deficiency except for
APTT result as it is shortened if the plasma is incubated with a surface activating substance
what is the surface activating substance being talk about in shortened APTT result of incubated plasma
kaolin
refers to the absence of HMWK in poor contact-phase reactions, a deficiency of kinin formation (active forms derived from kininogen), and defective fibrinolysis reaction
High Molecular Weight Kininogen (Fitzgerald
Factor) Deficiency
active form derived from kininogen
kinin
lab findings in High Molecular Weight Kininogen (Fitzgerald
Factor) Deficiency
APTT results typically are prolonged
other tests are within normal limits
factor XI deficiency is what type of hemophilia
hemophilia C
hemophilia C, what is the general name
rosenthal syndrome
factor XI deficiency is originally describe on what year
1953
factor XI deficiency
what is the mode of inheritance
autosomal dominant
describe the bleeding of factor XI deficiency
mild to moderate bleeding
TX of factor XI deficiency( Hemophilia C; Rosenthal Syndrome
fresh plasma infusions
this deficiency represents the first inherited disorder of the intrinsic cascade to which a clinical bleeding syndrome is attributed
factor XI deficiency (Rosenthal syndrome; hemophilia C)
this deficiency is very prevalent in jewish population
Factor XI Deficiency (Hemophilia C; Rosenthal Syndrome)
clinical findings of patients with factor XI Deficiency (Hemophilia C; Rosenthal Syndrome))
- patients present mild bleeding tendencies which usually respond to therapy
- most patients are symptomatically “silent” until stressed by trauma or surgery
- clinical syndromes may include episodes of epistaxis, hematuria, and menorrhagia
laboratory findings of Factor XI Deficiency (Hemophilia C; Rosenthal Syndrome)
prolonged APTT which is corrected by aged serum
one stage PT and bleeding time are not affected
prolonged aptt in factor XI deficiency is corrected using
aged serum
therapy for Factor XI Deficiency (Hemophilia C;
Rosenthal Syndrome)
no specific blood component exist to treat factor XI deficiency
factor VIII:C deficiency (hemophilia A; classic hemophilia )
is first scientifically described on what year
1803
factor VIII:C deficiency ; hemophilia A; classic hemophilia
what is the disease called
royal disease
mode of inheritance of factor VIII:C deficiency hemophilia A; classic hemophilia
sex-linked (X chromosome)
mother to son
the entire molecule as it circulates in the plasma. Composed of VIII:C and VIII:vWF portions noncovalently bound
VIII/vWF
portion of molecule responsible for binding to endothelium and supporting normal platelet adhesion and function. Tested by bleeding time
VIII:vWF
portions of molecule acting in intrinsic system as cofactor to factor Ixa (with Ca++) in the conversion of factor X to Xa. Tested by PTT
VIII:C
antigenic property of procoagulant portion as measured by immunologic monoclonal antibody techniques
VIIC:Ag
Factor VIII-related antigen, which is a property of the large vWF portion of
the molecule and measured by immunologic techniques of Laurell rocket or
immunoradiometric assay.
VIIIR:Ag
Ristocetin cofactor activity, which is factor VIII related activity required for
aggregation of human platelets with ristocetin in in vivo aggregation studies
VIIIR:RCo
Bleeding diathesis arises from decreased or defective factor VIII:C.
Hemophilia A
Joints of the knee, elbow, ankle and shoulder are the most vulnerable
parts of the patient
Hemophilia A
Repeated hemarthroses can cripple and deform the patient.
Hemophilia A
✓Tragically, 70% of hemophiliacs treated before 1984 are ___ and
have died from ___
HIV positive and
have died from AIDS
lab findings of hemophilia A
prolonged APTT but corrected by adsorbed plasma but not with aged serum
level so of factor VIII:C differ in the daughters of
carrier females (maternal carrier) and the daughters
of hemophiliacs (paternal carriers).
__ product infusion to replace factor VIII:C
Cryoprecipitate
hemophilia A
For milder cases, administration of pharmacologic agent such
as __ may be
substituted for donor component.
1-desamino-8-D-arginine-vasopressin (DDAVP)
hemophilia A
Intravenous administration of DDAVP rise plasma levels of
plasma factor VIII:C how manytimes
threefolds to sixfolds
used to monitor therapeutic progress of
patients with hemophilia A
factor assays
Patients who have developed antibodies against factor VIII:C
may be given with ____ component to purge the antibody from plasma. But this was believed to be ineffective
plasma pheresed
__ components are
used or reserved especially for life threatening situations.
Porcine factor VIII:C and prothrombin factor
Factor IX Deficiency is also called as
hemophilia B; Christmas disease
Factor IX Deficiency represents approx ____ of hemophilia cases in the US
14%
Milder form of hemophilia than factor VIII:C deficiency
Factor IX Deficiency (Hemophilia B; Christmas Disease
- Deficiency reduces thrombin production and may lead to soft tissue bleeding that is indistinguishable from
hemophilia A.
Factor IX Deficiency (Hemophilia B; Christmas Disease)
Three variants of the factor IX deficiency based on antigenic reactivity
of it:
cross reactive material positive (CRM+)
cross reactive material negative (CRM-)
cross reactive material reduced (CRMr)
lab findings of hemophilia B
prolonged aptt which is corrected with aged serum but with not adsorbed plasma
specific factor IX assay - used for diagnosis and to assess actvity levels during therapy
therapy for hemophilia B
administration of commercial concentrate products
plasma exchange with normal donor plasma have been performed to achieved 50% to 100% activity levels and to prevent cardiac overload
Factor XI Deficiency (Hemophilia C; Rosenthal
Syndrome)
mode of inheritance
autosomal dominant hemophilia
year 1926, ____ described this disorder at autosomal dominant disorder that produces a prolonged bleeding time and evidence of vascular fragility
eric von willebrand
Caused by defects in both in factor VIII:C and VIIIR:Ag of factor VIII complex.
von willebrand disease
In 1971, __ demonstrated that the vWF portion
of the VIII complex is reduced or absent in von willebrand disease
Zimmerman
Platelets in von Willebrand’s plasma, in contrast to platelets in normal plasma, do not aggregate in the presence of __.
ristocetin
Patients demonstrate easy bruisability, epistaxis, menorrhagia and hemorrhage from tooth extraction
von Willebrand’s Disease