Disorders of Secondary Hemostasis Flashcards
Types of Disorders
Platelets
Vessels
Coagulation Factors
Patient Evaluation
History & Physical - very important to know
Type of bleeding
Medications
Age
Sex
Family History
Screening Laboratory Tests
PT, APTT
TT
Fibrinogen Assay
Platelet Count
Followup Laboratory Tests
Bleeding Time
Platelet Function
Vessel Function
Correction Studies
Inhibitor Testing
Factor Assays
Congential Disorders
Decreased synthesis of factors
Abnormal function of factors
Aquired Disorders
Vitamin K deficiency
DIC
Liver Disease
Factor 1 Inheritance
AR Inherited
Factor 1 Clinical Presentation
Bleeding
Hemarthrosis
Factor 1 Testing
PT - prolonged
APTT - prolonged
BT - prolonged
TT - prolonged
Fibrinogen concentration - decreased
Factor 1 Therapy
FFP
Cryoprecipitate
Factor 1 concentrates
Dysfibrinogenemia Inheritance
AD Inheritance
Dysfibrinogenemia Clinical Presentation
Usually asymptomatic
Bleeding
Thrombosis
Poor Wound Healing
Dysfibrinogenemia Laboratory Testing
PT - prolonged
APTT - prolonged
TT - prolonged
RT - prolonged
Fibrinogen concentration - normal
BT - normal
Dysfibrinogenemia Therapy
Anticoagulant therapy
Factor 2 Inheritance
AR Inheritance
Factor 2 Clinical Presentation
Bleeding
Factor 2 Laboratory Testing
PT - prolonged
APTT - prolonged
Fibrinogen concentration - normal
BT - normal
TT - normal
Factor 2 Therapy
FFP
Prothrombin Complex Concentrate (2, 7, 9, 10)
Factor 5 Inheritance
AR Inheritance
Factor 5 Clinical Presentation
Bleeding
Bruising
Factor 5 Testing
PT - prolonged
APTT - prolonged
Fibrinogen concentration - normal
BT - normal
TT - normal
Factor 5 Therapy
FFP
Poss Factor 5 concentration
Factor 5 Leiden Inheritance
Activated Protein C Resistance (APCR)
Genetic Mutation
Point where Protein C binds to inactivate Factor 5
Factor 5 Leiden Clinical Presentation
Thrombosis
Factor 5 Leiden Laboratory Testing
Modified APTT
PCR
Factor 5 Leiden Therapy
Anticoagulant Therapy
Factor 7 Inheritance
AR Inheritance
Factor 7 Clinical Presentation
Bleeding
Factor 7 Laboratory Testing
PT - prolonged
APTT - normal
BT - normal
TT - normal
Fibrinogen - normal
Factor 7 Therapy
FFP
Prothrombin complex concentrate
Factor 10 Inheritance
AR Inheritance
May be acquired with amyloidosis (vessels and organs)
Factor 10 Laboratory Testing
PT - prolonged
APTT - prolonged
BT - normal
TT - normal
Fibrinogen - normal
Factor 10 Therapy
FFP
Prothrombin complex concentrate
Factor 8 Inheritance
Hemophilia A
Sex-linked Recessive
- women are carriers
Factor 8:c Clinical Presentation
Bleeding
- Severe (0-1%), Moderate (2-5%), Mild (5-20%)
Factor 8:c Laboratory Testing
APTT - prolonged
PT - normal
BT - normal
TT - normal
Fibrinogen - normal
8:c - decreased
VWF:Ag - normal or increased
VWF:Rco - normal or increased
Factor 8:c Therapy
Factor 8 concentrates
Counseling
Factor 8:c Considerations
Inhibitors
- Time and Temperature dependent
- Bethesda Titer
- No response to therapy
- Alternative therapies
VWF Inheritance
AD Inheritance
VWF Types of disease
Type 1 - Normal structure, defective release
Type 2 - Abnormal structure
Type 3 - Absent synthesis
VWF Clinical Presentation
Bleeding (mucosal)
VWF adheres to Gp1b on platelets
Homozygotes resemble hemophilia A
VWF Laboratory Testing
APTT - prolonged
BT - prolonged
PT - normal
TT - normal
Fibrinogen - normal
Platelet Count - normal to decreased
8:c, VWF:Ag, VWF:Rco - decreased
Platelet aggregation to ristocetin - abnormal
VWF Therapy
Cryoprecipitate
DDAVP (type 1)
Factor 9 Inheritance
Hemophilia B
Sex-linked Recessive
Factor 9 Clinical Presentation
Bleeding (may be similar to Hemophilia A)
May develop inhibitor
Factor 9 Laboratory Testing
APTT - prolonged
PT - normal
Fibrinogen concentration - normal
BT - normal
TT - normal
Factor 9 Therapy
Factor 9 concentrates
Factor 10 Inheritance
AR Inheritance
Acquired with amyloidosis
Factor 10 Clinical Presentation
Bleeding
Factor 10 Laboratory Testing
PT - prolonged
APTT - prolonged
ST - prolonged
Fibrinogen concentration - normal
BT - normal
TT - normal
Factor 10 Therapy
Prothrombin Complex concentrates
FFP
Factor 11 Inheritance
AR Inheritance
Mainly in Jewish population
Factor 11 Clinical Presentation
Bleeding
Factor 11 Laboratory Testing
APTT - prolonged
PT - normal
Fibrinogen concentration - normal
BT - normal
TT - normal
Factor 11 Therapy
FFP
Factor 12 Inheritance
AR Inheritance
Factor 12 Clinical Presentation
Thrombosis
Factor 12 Laboratory Testing
APTT - prolonged
PT - normal
Fibrinogen concentration - normal
BT - normal
TT - normal
Factor 12 Therapy
Treat thrombosis
FFP
Prekallekrein (PK) Inheritance
AR Inheritance
PK Clinical Presentation
Thrombosis
PK Laboratory Testing
APTT - prolonged
PT - normal
Fibrinogen concentration - normal
BT - normal
TT - normal
PK Therapy
Treat thrombosis
FFP
High Molecular Weight Kininogen (HMWK) Inheritance
AR Inheritance
HMWK Clinical Presentation
Thrombosis
HMWK Laboratory Testing
APTT - prolonged
PT - normal
Finbrinogen concentration - normal
BT - normal
TT - normal
HMWK Therapy
Treat thrombosis
FFP
Factor 13 Inheritance
AR Inheritance
Factor 13 Clinical Presentation
Bleeding (delayed, umbilical cord)
Poor wound healing
Factor 13 Testing
PT - normal
APTT - normal
Fibrinogen concentration - normal
BT - normal
TT - normal
Clot solubility test - abnormal
Factor 13 Therapy
FFP
Alpha 2 antiplasmin Inheritance
AR Inheritance
Alpha 2 antiplasmin Clinical Presentation
Bleeding - not delayed
Alpha 2 antiplasmin Laboratory Testing
PT - normal
APTT - normal
Fibrinogen concentration - normal
BT - normal
TT - normal
Alpha 2 antiplasmin Therapy
FFP