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Foundations of Anesthesia 1 > Exam 2 Coag Questions > Flashcards

Exam 2 Coag Questions Flashcards

1
Q

What are 5 procoagulants

A

Coagulation Factors
Collagen
vWF
Fibronectin
Thrombomodulin

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2
Q

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

What is their function?

A

Procoagulant
Function to promote clotting/coagulation

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3
Q

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

What is their function?

A

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

“Tensile strength” can withstand force.

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4
Q

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

What is their function?

A

Procoagulant.

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

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5
Q

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

What is their function?

A

Procoagulant

Mediates cell adhesion

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6
Q

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

What is their function?

A

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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7
Q

What are 4 AntiCoagulant mediators?

A

AntiThrombin III
Protein C
Protein S
Tissue Pathway Factor Inhibitor

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8
Q

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

What is their function?

A

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

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9
Q

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

What is their function?

A

AntiCoagulants

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

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10
Q

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

What is their function?

A

AntiCoagulant
Inhibits Tissue Factor

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11
Q

What are two vasodilatory mediators

A

Nitric Oxide and Prostacyclin

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12
Q

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

What is their function?

A

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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13
Q

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

What is their function?

A

Vasodilates, inhibits aggregation
Promotes smooth muscle relaxation

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14
Q

What are three vasoconstrictor mediators

A

Thromboxane A2
ADP
Serotonin

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15
Q

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

What is their function?

A

Vasoconstrictor
vasoconstricts lol (add more later)

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16
Q

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

What is their function?

A

Vasoconstrictor
vasoconstricts lol (add more later)

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17
Q

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

What is their function?

A

Vasoconstrictor
vasoconstricts lol (add more later)

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18
Q

What are three fibrinolytic mediators?

A

Plasminogen
tPA (tissue plasminogen activator)
Urokinase

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19
Q

What kind of mediator is Plasminogen classified as? :

What is its function?

A

Fibrinolytic

Converts to plasmin

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20
Q

What kind of mediator is tPA classified as? :

What is its function?

A

Fibrinolytic

Activates plasmin

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21
Q

What kind of mediator is Urokinase classified as? :

What is its function?

A

Fibrinolytic

Activates plasmin

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22
Q

What are two anti-fibrinolytics?

A

Plasminogen Activator Inhibitor
alpha-antiplasmin

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23
Q

What kind of mediator is Plasminogen Activator Inhibitor

What is its function?

A

Antifibrinolytic

Inactivates tPA and urokinase

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24
Q

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

What is its function?

A

Antifibrinolytic
Inhibits Plasmin

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25
Q

What factors make up the Extrinsic Pathway

A

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

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26
Q

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

A

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

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27
Q

What are two antifibrinolytic (anticlot breakdown) medications?

A

Aminocaproic Acid
Tranexamic Acid (TXA)

28
Q

How does Aspirin affect coagulation?

A

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

29
Q

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

A

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

30
Q

What is a normal INR?

A

Apex: ~1
Nagelhout: 1.5-2.5

31
Q

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

A

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

32
Q

Normal ACT

A

Apex: 90-120
Nagelhout: 90-150

33
Q

ACT is used to measure?

A

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

34
Q

TEGs provide an indication of what 5 processes?

A
  1. Clot Strength
  2. Platelet number and function
  3. Intrinisic Pathway defects
  4. Thrombin formation
  5. Rate of fibrinolysis
35
Q

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

A

Neurosurgery
Ocular surgery (except cataracts)
Thyroid Surgery
Prostatectomy

75,000-100,000 plts

36
Q

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

A

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

37
Q

Which blood product carries the greatest risk for bacterial transmission?

A

platelets

38
Q

Fresh Frozen Plasma (FFP) contains?

A

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

39
Q

What lab values may indicate you should administer FFP?

A

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

40
Q

Cryoprecipitate contains?

A

Factor 8 and 13.
Fibrinogen
vWF
Fibronectin

41
Q

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

A

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

42
Q

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

A

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.

43
Q

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

A

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

44
Q

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

A

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

45
Q

Lab Values Consistent with DIC

A

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]

46
Q

What is the universal FFP donor and acceptor?

A

Donor: AB

Acceptor: O

47
Q

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

A

If you have time: Vitamin K to reverse (takes a few hours)

If it’s emergent: FFP or Prothrombin Complex Concentrate

48
Q

What extrinsic factor is produced in the liver?

A

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

49
Q

What are the factors of the final common pathway

A

10, 5, 2, 1, and 13

50
Q

What are the intrinsic factors

A

12, 11, 9, 8

51
Q

How does Heparin work?

A

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

52
Q

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

A

FFP
Plts
Cryo

53
Q

Injured blood vessel - what mediators are released

A

Procoagulants
and
Thromboxane A2
ADP
vWF

54
Q

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

A

75,000-100,000

55
Q

How do you transfuse a woman of childbearing years?

A

Give O neg to prevent Rh+ antibodies develop

56
Q

Disease description of hypercoagulable state

A

HIT type 2
DIC
Vasooclusive crisis SCD

57
Q

Describe HIT Type I

A

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

58
Q

Describe HIT type II

A

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

59
Q

How do you treat vWB disease

A

Type 1 and 2a: Desmopressin - stimulates the release of vWF

Type 2b and 3: Factor 8 or Cryo

60
Q

How much does Hgb and Hct change after one unit PRBC

A

1 hgb unit
2-3% Hct

61
Q

What are the effects of being banked on blood?

A

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

62
Q

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

A

1mL PRBC for every 2mL blood loss

63
Q

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

A

1:1-2

64
Q

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

A

1 plt per 6 PRBC

65
Q

How does MTP of banked blood change the oxyhemoglobin curve

A

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.

66
Q

Difference between Whole Blood and PRBCs

A

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

67
Q
A

Foundations of Anesthesia 1 (24 decks)

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