Exam 2 Coag Questions Flashcards by Tricia Vantino

What are 5 procoagulants

Coagulation Factors
Collagen
vWF
Fibronectin
Thrombomodulin

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Coagulation Factors are classified as what kind of mediator? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Procoagulant
Function to promote clotting/coagulation

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What kind of mediator is collagen classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Procoagulant.
A potent and important stimulus for platelet attachment to the vessel wall.

“Tensile strength” can withstand force.

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What kind of mediator is vWF classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Procoagulant.

Makes platelets “sticky” and allows platelets to adhere to the site of injury.

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What kind of mediator is Fibronectic classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Procoagulant

Mediates cell adhesion

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What kind of mediator is Thrombomodulin classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Procoagulant
Regulates anticoagulation pathway.

(per Ninja nerd, binds thrombin. Thrombin then activates Protein C. Protein C inactivates factors 5 and 8.)

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What are 4 AntiCoagulant mediators?

AntiThrombin III
Protein C
Protein S
Tissue Pathway Factor Inhibitor

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What kind of mediator is AntiThrombin III classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

AntiCoagulant
Degrades Factors 10a, 9a and 2, (12 &11?)

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What kind of mediators are Protein C and S classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

AntiCoagulants

Protein S is a cofactor for Protein C.
Protein C degrades Factor 5 and 8.

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What kind of mediator is Tissue Factor Pathway Inhibitor classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

AntiCoagulant
Inhibits Tissue Factor

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What are two vasodilatory mediators

Nitric Oxide and Prostacyclin

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What kind of mediator is Nitric Oxide classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Vasodilator

-Promotes smooth muscle relaxation and vasodilation
-Reduces platelet adhesion and aggregation by inhibiting binding of fibrinogen between glycoproteins
-Reduces leukocyte (WBC) adhesion

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What kind of mediator is Prostacyclin classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Vasodilates, inhibits aggregation
Promotes smooth muscle relaxation

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What are three vasoconstrictor mediators

Thromboxane A2
ADP
Serotonin

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What kind of mediator is Thromboxane A2 classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Vasoconstrictor
vasoconstricts lol (add more later)

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What kind of mediator is ADP classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Vasoconstrictor
vasoconstricts lol (add more later)

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What kind of mediator is Serotonin classified as? :
Procoagulants
AntiCoagulants
Vasodilator
Vasoconstrictor
Fibrinolytic
or Antifibrinolytic

What is their function?

Vasoconstrictor
vasoconstricts lol (add more later)

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What are three fibrinolytic mediators?

Plasminogen
tPA (tissue plasminogen activator)
Urokinase

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What kind of mediator is Plasminogen classified as? :

What is its function?

Fibrinolytic

Converts to plasmin

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What kind of mediator is tPA classified as? :

What is its function?

Fibrinolytic

Activates plasmin

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What kind of mediator is Urokinase classified as? :

What is its function?

Fibrinolytic

Activates plasmin

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What are two anti-fibrinolytics?

Plasminogen Activator Inhibitor
alpha-antiplasmin

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What kind of mediator is Plasminogen Activator Inhibitor

What is its function?

Antifibrinolytic

Inactivates tPA and urokinase

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What kind of mediator is alpha-antiplasmin classified as? :

What is its function?

Antifibrinolytic
Inhibits Plasmin

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What factors make up the Extrinsic Pathway

Factor 3 - Tissue Factor (Thromboplastin) Factor 7 - Proconvertin Factor (labile)

Vitamin K is created by? And is it necessary for the formation of which factors?

Created from bacteria in the gut and is necessary for the formation (in the liver) of Factors 2, 7, 9, 10

What are two antifibrinolytic (anticlot breakdown) medications?

Aminocaproic Acid Tranexamic Acid (TXA)

How does Aspirin affect coagulation?

Directly affects the life of the platelet by !irreversibly! inhibiting cyclooxygenase (COX), resulting in decreased platelet function

The PT lab value will be prolonged when patients have abnormalities or deficiencies in?

factors specific to the extrinsic (3 & 7) and common pathways (10, 9?, 2, 1)

What is a normal INR?

Apex: ~1 Nagelhout: 1.5-2.5

aPTT is used to evaluate the efficiency of the ____ and the common coagulation pathway. This includes which factors?

Intrinsic: 12, 11, 9, and 8 Common: 10, 5, 2, 1 and ultimately 13

Normal ACT

Apex: 90-120 Nagelhout: 90-150

ACT is used to measure?

Activated Clotting Time. Ability to clot. Also can be used to regulate heparin therapy.

TEGs provide an indication of what 5 processes?

1. Clot Strength 2. Platelet number and function 3. Intrinisic Pathway defects 4. Thrombin formation 5. Rate of fibrinolysis

What are four very high risk for bleeding procedures? What should the minimum platelet count be?

Neurosurgery Ocular surgery (except cataracts) Thyroid Surgery Prostatectomy 75,000-100,000 plts

What is the MABL (maximum allowable blood loss) equation?

MABL = EBV x (Starting Hct(or hgb) - Minimum acceptable Hct(or hgb) ) / divided by hematocrit (or hgb) level

Which blood product carries the greatest risk for bacterial transmission?

platelets

Fresh Frozen Plasma (FFP) contains?

All coagulation factors, especially factors 2, 7, 9, and 10 AND Albumin (plasma proteins) Fibrinogen [Antithrombin 3, Protein C and S (hemostasis equilibrium)]

What lab values may indicate you should administer FFP?

PT and/or aPTT prolonged more than 1.5 times normal. (FFP=Factors 2,7,9,10. Albumin. Fibrinogen.)

Cryoprecipitate contains?

Factor 8 and 13. Fibrinogen vWF Fibronectin

Describe Type 1 and 2a vWF disease and how you would treat it before surgery?

Mild-moderate reduction in vWF production. Treated with Desmopressin (0.3mcg/kg) Cryo if there is no response or availability of Factor 8 concentrate.

Describe Type 2b and 3 vWF disease and how you would treat it before surgery?

vWF is not produced or doesn't work correctly. Bleeding patients with type 3 should be given vWF/Factor 8 concentrate or Cryo. Desmopressin will not work.

What coagulation lab values would you expect in a patient with Hemophilia A? What would be the treatment before surgery?

PTT increased and PT normal Mild - can try DDAVP (vWF carries factor 8 around) Factor 8 Concentrate before surgery Cryo (has more Factor 8) > FFP Recombinant Factor 7 last-ditch effort

What coagulation lab values would you expect in a patient with Hemophilia B? What would be the treatment before surgery?

PTT increased and PT normal. Remember Factor 9 is on intrinsic pathway. Factor 9 - Prothrombin Concentrate Complex FFP Recombinant Factor 7 last-ditch effort NOT desmopressin. Has no effect on Factor 9

Lab Values Consistent with DIC

Decreased Platelets [less than 100] Decreased Fibrinogen [under 150] Decreased AntiThrombin [less than 80%] Increased D-Dimer [over 500] Increased PT[over 14] or aPTT[over 32]

What is the universal FFP donor and acceptor?

Donor: AB Acceptor: O

Pt needs surgery. You have a patient taking Warfarin, INR is high, what do you do?

If you have time: Vitamin K to reverse (takes a few hours) If it's emergent: FFP or Prothrombin Complex Concentrate

What extrinsic factor is produced in the liver?

Factor 7 Produced in the liver. Vitamin K required for synthesis

What are the factors of the final common pathway

10, 5, 2, 1, and 13

What are the intrinsic factors

12, 11, 9, 8

How does Heparin work?

It binds to antithrombin and accelerates its anticoagulant ability 1,000 fold. (remember ATIII corrals 12, 11, 10, 9 and 2) Inhibits intrinsic, common pathway, and plt function

Pt looks to be in DIC. You need to administer something before OR, what are three things you could choose from?

FFP Plts Cryo

Injured blood vessel - what mediators are released

Procoagulants and Thromboxane A2 ADP vWF

Patient needs a craniotomy, what is the minimal plt value needed

75,000-100,000

How do you transfuse a woman of childbearing years?

Give O neg to prevent Rh+ antibodies develop

Disease description of hypercoagulable state

HIT type 2 DIC Vasooclusive crisis SCD

Describe HIT Type I

Non-Immune Mediated Onset typically 1-4 days start of heparin Mild thrombocytopenia <100,000 Often resolves spontaneously Not associated with thrombosis and death

Describe HIT type II

Immune Mediated - IgG Onset typically 5-14 days after start of heparin Severe thrombocytopenia < 60,000 Does not resolve spontaneously - heparin should be stopped Associated with thrombosis and mortality

How do you treat vWB disease

Type 1 and 2a: Desmopressin - stimulates the release of vWF Type 2b and 3: Factor 8 or Cryo

How much does Hgb and Hct change after one unit PRBC

1 hgb unit 2-3% Hct

What are the effects of being banked on blood?

Decreased 2,3-DPG Decreased ATP Decreased pH (acidosis) Hypocalcemia Increased Potassium - Hyperkalemia Impaired shape/morphology Hemolysis Absence of factors 5 and 8 Increased proinflammatory mediators

Recommendations for PRBC infusion for adults PRBC:Pt blood loss ratio

1mL PRBC for every 2mL blood loss

In an MTP, what is the recommended plasma:PRBC infusion ratio

1:1-2

In an MTP, what is the recommended plt:PRBC infusion ratio

1 plt per 6 PRBC

How does MTP of banked blood change the oxyhemoglobin curve

Left Shift. Decreased 2,3 DPG and conversion of citrate to sodium bicarb leads to alkalosis. Hgb holds on to oxygen longer, delaying release into tissues.

Difference between Whole Blood and PRBCs

PRBCs have lost plasma and clotting factors. Usually WBC lost as well from irradiation