DIT Heme Flashcards
Hemophilia symptoms?
Macrophemorhage: bleeding into joints. Easy bruising. High PTT (b/c intrinsic pathway)
VIII is for accelerating 9’s activation of X
VI is for activation of X
Tx: recomb VIII in hemophilia A
Vit K deficiency is what?
Clotting factors 2, 7, 9 and 10, C and S
It is from gut bacteria (newborns)
Warfarin
End stage liver disease can look like it
What is factor V leiden?
V is accelerating factor (inhib by C and S normally) but it is MUTATED so resistant to activated protein C
most common kind
What is a prothrombin gene mutation causing?
Untranslated region causes more production of prothrombin and more clots
It is gene 20210 (like beverly hills!)
What is result of antithrombin deficiency? What is the cause?
No effect on PT, PTT or thrombin time, but can’t break down clots well. HEPARIN WON’T WORK B/c thats the mechanism of heparin (antithrombin activation)
Caused by inherited deficiency OR nephrotic syndrome as antithrombin is lost in urine
What tissues use malate shuttle and what uses G3P shuttle?
32 ATP are from mAlate shuttle
Heart and liver (a in malate is for extra ATP)
G3P is in muscle for 30 atp
Heparin action
toxicity
Antidote?
Increases antithrombin activity (less Xa and thrombin)
Short half life
Tox: osteoporosis, Bleeding, HIT
HIT is heparin induced thrombocytopenia: heparin binds platelet factor 4, autoantibody for heparin PF4 complex activates the platelets and thrombosis and thrombocytopenia!
What do you use if patient has HIT but still needs anticoag?
Thrombin inhibitors (same part of coag cascade, but different mechanism). After you stop heparin, of course
Bivalirudin
Argatroban
What does warfarin inhibit?
Synthesis of gamma carboxylation of Vit K dependent clotting factors II VII IX X and C and S
What does antithrombin act on?
Decreases action of IIa (thrombin) and Xa
What are the thrombolytics? What is the mechanism?
What do you give for toxicity? (KNOW THAT)
Alteplase, urokinase, and streptokinase
Activate PLASMIN which breaks down fibrin clots
STEMI if no cath lab
Acute Stroke if early on
AMINOCAPROIC ACID! KNOW THAT
What causes potter syndrome?
Failure of devo of ureteric bud
Life span of RBC? High yield factoid.
120 days (4 months)
Basophilic stippling looks like what? is caused by what?
Purple dots in RBC.
Lead is the LEADING cause of basophilic stippling. Remember that.
Thalassemia, anemia of chronic disease and alcohol can also do it
Echinocytes look like what? caused by what?
Regular spikes are caused by uremia/renal failure
Acanthocytes
Spur cells. Spikey but irregular.
Liver disease and abetalipoproteinemia (states of cholesterol dysregulation)
Spherocyte caused by what?
hereditary spherocytosis or autoimmune hemolysis
Schistocytes are caused by what? What do they look like?
Helmet cell seen in: DIC, TTP/HUS (pathologic clotting causing cells to be forced through the fibrin and they get sheared), traumatic hemolysis (heart valve prosthesis)
Target cells caused by what? mnemonic alert
THAL
Thalassemia
Hemoglobin C disease
Asplenia
Liver disease