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Clin Lab Med > Exam 1: Coagulation Studies > Flashcards

Exam 1: Coagulation Studies Flashcards

1
Q

What causes acquired platelet dysfunction?

A

Drugs, uremia, liver disease, VWD, and myeloproliferative disease

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2
Q

What is the treatment for platelet dysfunction?

A

Treatment of the underlying cause and platelet transfusion

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3
Q

What happens in splenic sequestration?

A

The spleen takes in the platelets and destroys them

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4
Q

What are the disorders that cause increased destruction of platelets?

A

Immune thrombocytopenia (ITP). Disseminated Intravascular Coagulation (DIC), Heparin induced thrombocytopenia (HIT), and thrombotic microangiopathies

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5
Q

What are the two types of thrombotic microangiopathies?

A

Thrombotic Thrombocytopenic purpura (TTP) and hemolytic uremic syndrome

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6
Q

What is Heparin induced thrombocytopenia?

A

New-onset thrombocytopenia while on heparin therapy
-Anti-platelet antibodies cause platelet activation, which increases risk of venous and arterial thrombosis, eventually leading to thrombocytopenia and prothrombotic states

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7
Q

What are thrombotic microangiopathies?

A

Characterized by thrombocytopenia due to the incorporation of platelets into thrombi in the micro vasculature and microangiopathic hemolytic anemia

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8
Q

What is microangiopathic hemolytic anemia?

A

Mechanical shearing of RBCs as they pass through platelet-rich micro thrombi in the microvasculature

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9
Q

What is the difference between acquired and hereditary thrombotic thrombocytopenia purpura?

A

Acquired is autoantibodies directed against ADAMTS-13 and hereditary is inherited ADAMTS-13 mutations

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10
Q

What is TTP?

A

A medical emergency of micro thrombi formed throughout the body

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11
Q

What is the Pentad of TTP?

A

Microangiopathic hemolytic anemia, thrombocytopenia, AKI, neurological deficits, and fever

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12
Q

What is hemolytic uremic syndrome?

A

Shiga toxin-mediated HUS

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13
Q

What is the etiology of HUS?

A

Shiga toxin producing E. Coli and most have a recent or current diarrheal illness, often hemorrhagic

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14
Q

What is the triad of HUS?

A

Microangiopathic hemolytic anemia, thrombocytopenia, and AKI

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15
Q

What will be seen on lab work for thrombotic microangiopathies?

A

-Microangiopathic hemolytic anemia, thrombocytopenia, PT and aPTT are normal, and AKI

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16
Q

How is Microangiopathic hemolytic anemia seen on lab work?

A

Fragmented RBCs (shistocytes), increased LDH, increased indirect bili, decreased serum haptoglobin, and negative Coombs test.

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17
Q

What is the treatment for thrombotic microangiopathies?

A

Plasma exchange and supportive care

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18
Q

What conditions can cause impaired production of platelets?

A

Congenital bone marrow failure, acquired bone marrow failure, exposure to chemo or radiation, bone marrow infiltration, and nutritional deficiencies

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19
Q

What are the coagulation studies?

A

PTT or aPPT, anti Xa, and PT/INR

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20
Q

What is PTT or aPTT used to measure?

A

Evaluate the intrinsic and common pathways and used to monitor unfractionated heparin therapy

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21
Q

What is anti-factor Xa used to monitor?

A

Monitors unfractionated heparin and LMWH/Lovenox therapy, preferred over PTT and aPTT

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22
Q

What does PT measure?

A

Evaluates the extrinsic and common pathways and used to monitor warfarin/Coumadin therapy

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23
Q

What is INR?

A

A more accurate reflection of PT, calculated as a ratio of the patients PT to a control PT.
-Used to monitor warfarin/Coumadin therapy

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24
Q

What is inhibitor screen?

A

Coagulation factor deficiency vs inhibitor protein

25
Q

What is thrombin time?

A

Measures the final step of coagulation, the conversion of fibrinogen to fibrin.
-Not used as an initial screen

26
Q

What can the fibrinogen lab test indicate?

A

Low levels can result in impaired clot formation and increased bleeding risk

27
Q

What are the components of the hypercoagulable panel?

A
  • Antithombin
  • factor V-Leiden
  • Protein C
  • Protein S
  • Prothombin gene mutation
  • Lupus anticoagulant
  • MTHFR gene
28
Q

What are the 2 classes of Direct Oral Anticoagulants?

A

Factor Xa and Oral direct thrombin inhibitors

29
Q

What are the 4 Factor Xa inhibitors?

A

Fonduparinux, Rivaroxaban, Apixiban, and edoxaban

30
Q

What kind of drug is Dabigatran?

A

Direct oral thrombin inhibitor

31
Q

Which anticoagulants have to follow 5-10 days of parental anticoagulation?

A

Dabigatran and Edoxaban

32
Q

What is recommended for patients with a DVT or PE without an underlying malignancy?

A

DOAC are recommended over Warfarin

33
Q

What is recommended for patients with a DVT or PE in the setting of underlying malignancy?

A

LMWH

34
Q

What are the baseline labs to obtain if a patient is on UFH?

A

PT/INR, aPTT, and CBC

35
Q

What labs are ordered for monitoring UFH?

A

Factor Xa or aPTT

36
Q

What are the baseline labs to order if a patient is on LMWH?

A

PT/INR, aPTT, CBC, and creatinine (you cant use lovenox if creatinine clearance is less than 30)

37
Q

What labs are used to monitor LMWH?

A

None, but if required, anti-factor Xa activity testing

38
Q

What are the baseline labs to order if a patient is on a DOAC?

A

PT/INR, CBC, and creatinine

39
Q

What labs are used for monitoring DOAC use?

A

None, but is required, anti-factor Xa activity testing

40
Q

What are the baseline labs to order when a patient is put on Warfarin?

A

PT/INR, aPTT, CBC, creatinine, LFTs

41
Q

What labs do you order to monitor Warfarin use?

A

PT/INR

42
Q

Warfarin should be administered at an initial dose of **.

A

5mg/day

43
Q

Why is a loading dose of Warfarin not recommended?

A

It may increase hemorrhagic conditions and does not offer rapid protection

44
Q

What does bridging therapy mean in regards to Warfarin use?

A

Parenteral therapy of UFH or LMWH should overlap with warfarin for at least 5 days and until the INR is therapeutic for a minimum of 24 hours 2 consecutive days

45
Q

When starting a patient on Warfarin, how often should you check their INR?

A

Daily, then weekly. Once stabilized, every 2-4 weeks.

46
Q

What is the target INR for prophylactic therapy?

A

1.5-2

47
Q

What is the target INR for VTE?

A

2-3

48
Q

What is the target INR for a fib?

A

2-3

49
Q

What is the target INR for mechanical mitral valve?

Mechanical aortic valve?

A

2.5-3.5

2-3

50
Q

What should you do if your patient has an INR of 4.5-10 and no evidence of bleeding?

A

Hold warfarin and possibly recommend use of PO vitamin K

51
Q

What should you do if your patients INR is greater than 10 and has no evidence of bleeding?

A

Hold warfarin and give PO vitamin K

52
Q

What should you do if your patient has a Vitamin K antagonist associated major bleeding?

A

Hold warfarin, rapid reversal of warfarin with PCC, and give IV vitamin K

53
Q

What is the reversal agent of UFH?

A

Protamine

54
Q

What is the reversal agent for LMWH?

A

Protamine

55
Q

What is the reversal agent for warfarin?

A

Vitamin K or 4factor-PCC

56
Q

What is the reversal agent for Direct thrombin inhibitors?

A

Idarucizumab, and supportive care for non-life threatening bleeding

57
Q

What is the reversal agent for Apixiban and Edoxaban?

A

Andexanet

58
Q

What is the reversal agent for Rivaroxaban?

A

Supportive care

Clin Lab Med (8 decks)

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