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Coagulation > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

What are the 3 different types of bleeding

A

local or general
mucocutaneous or anatomic
acquired or congenital

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2
Q

Define localized vs generalized bleeding

A

local-bleeding from a single location
general-bleeding from multiple sites

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3
Q

Define mucocutaneous vs anatomic bleeding

A

muco-skin or body orifices
ana-bleeding in soft tissue, muscle, joint, deep tissue

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4
Q

What is hematemesis

A

blood in vomit

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5
Q

Define acquired vs Congenital

A

acquired-physical trauma induced, not p 2
congenital-acquired at birth

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6
Q

What are the 3 most most common congenital deficiencies in order

A

VWD
Factor VIII hemophilia A
Factor IX hemophilia B

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7
Q

What does systemic shock lead to

A

reduction of ADAMTS13

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8
Q

What is the massive transfusion component ratio

A

6:6:1
6 RBC
6 plasma
1 platelet

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9
Q

What is the first coag facor to decrease activity in liver disease

A

factor VII

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10
Q

What factor is the best early marker of liver disease
What lab test

A

prolonged PT- factor VII issue

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11
Q

What factors can be used to differentiate liver disease from vitamin K deficiency

A

factor V and VII- if decreased means liver disease
if the only VII, means vitamin K

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12
Q

When is there a change in fibrinogen

A

increases in early or mild liver disase

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13
Q

What factors are unaffected or elevated in liver disease

A

VWF, F VIII, XIII

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14
Q

How is renal disease related to bleeding deficiencies

A

fibrinogen is deposited into renal microvasculature, if the kidney fails there is reduced glomerular function

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15
Q

What coag factors are lower in newborns

A

II, VII, IX, X proteins C, S, Z

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16
Q

How does a vitamin K deficiency or coumadin treatment lead to bleeding

A

coumadin disrupts enzymes involved in vitamin K coag factors
vitamin K needed for vitamin K dependent factors to create a clot

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17
Q

How do PIVKA factors affect coagulation factors

A

they inactivate factors II, VII, IX and X and proteins C, S, Z

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18
Q

What lab tests indicate a vitamin K deficiency

A

prolonged PT
prolonged PTT

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19
Q

What is a common diagnostic of acquired hemophilia

A

the presence of autoanti fator VIII

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20
Q

What testing is done to find hemophilia

A

PT, TT, PTT
in mixing studies- the presence of inhibitor

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21
Q

What is the most prevalent congenital mucocutaneous bleeding disorder

A

VWD

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22
Q

What are the 2 types of VwD

A

type 1 quantitative
type 2 qualitative

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23
Q

What causes impaired primary hemostasis

A

decreased plt adhesion to vessel walls

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24
Q

What is the function of VWF

A

mediates plt adhesion to subendothelial collagen in areas of high flow rate and shear force

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25
Q

Explain the process started by VWF

A

VWF binds to exposed collagen
plts adhere to GPIb IX/V site to the VWF carpet
plts activated and express GPIIb/ IIIa
allows plt aggregation

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26
Q

severe quantitative VWF deficiency leads to ___ factor deficiency

A

VIII

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27
Q

Which VWD is most common

A

Type 1 quantitative

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28
Q

How to ristocetin affect VWF

A

infolds it and reduces neg charges,

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29
Q

Define hemophilia

A

congenital single factor deficiency marked by anatomic soft tissue bleeding

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30
Q

What gender does hemophilia mostly occur in

A

Males

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31
Q

What factor causes hemophilia A

A

factor VIII deficiency

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32
Q

How does factor VIII affect the coagulation pathway

A

slows the pathway i its production of thrombin

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33
Q

What chromosome carries the gene of hemophilia A

A

X chromosome
Males affect all daughters and all sons are carriers

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34
Q

What are the clinical manifestations of hemophilia A

A

muscle and joint hemorrhages, hematomas, wound oozing and bleeding into CNS

35
Q

PT, FBG, and TT normal
prolonged PTT

A

Hemophilia A

36
Q

What other name does hemophilia B have

A

christmas disease Factor IX deficiency

37
Q

What causes hemophilia B

A

deficiency of factor IX, vitamin K factor dependent.

38
Q

How does hemophilia B cause bleeding, what type of bleeding

A

soft tissue anatomic bleeding, reduces thrombin production

39
Q

PT, TT, FBG normal
PTT prolonged
Factor IX assay

A

hemophilia B

40
Q

What other name does hemophilia C have

A

rosenthal syndrome
factor XI deficiency

41
Q

PT normal
PTT prolonged

A

hemophilia C

42
Q

What populations are more prone to hemophilia C

A

Ashkenazi Jews

43
Q

How is
hemophilia A
hemophilia B
hemophilia C treated

A

A:
B: purified factor IX concentrates
C: plasma infusions

44
Q

How is
hemophilia A
hemophilia B
hemophilia C treated

A

A: raise factor VIII
B: purified factor IX concentrates
C: plasma infusions

45
Q

What does the Russel viper venom time test do

A

activates coag mechanism at factor X level
can find factor VII deficiency

46
Q

What test is done to find factor XIII deficiencies

A

screening assay, suspended in 5 molar urea solution

47
Q

Define thrombosis

A

inappropriate formation of a platelet or fibrin clot

48
Q

What are the 2 main consequences of thrombotic obstructions

A

ischemia- loss of bleed
necrosis

49
Q

Define thrombophilia

A

hypercoagulability, predisposition to thrombosis

50
Q

Define emboli

A

fragments of thrombi that move through circulation and get lodged onto veins

51
Q

What is the most frequent cause of MIs and strokes

A

arterial thrombosis

52
Q

2 main examples of venous thrombosis

A

Pulmonary embolisms and deep vein thrombosis

53
Q

2 main examples of arterial thrombosis

A

Myocardial infarction
stroke

54
Q

What is the most common inherited thrombosis risk factor

A

factor V Leiden gene mutation

55
Q

What is the second most common inherited thrombosis risk factor

A

prothrombin G2021A gene mutation

56
Q

What is APC resistance

A

a risk factor: factor V leiden mutation causes factor V to become resistant to APC

57
Q

What is prothrombin G20210A

A

a mutation in prothrombin where prothrombin activity becomes elevated

58
Q

What are antiphospholipid antibodies

A

APLAs immunoglobulins that bind protein phospholipid complexes
they increase the risk of thrombosis
non specific inhibitor

59
Q

What are the 3 main types of APLAs in order of importance

A

lupus anticoagulants LACs
anticardiolipin abs
anti beta GPI abs

60
Q

What are the signs of APLAs

A

recurrent fetal loss
thrombocytopenia unexplained thrombosis

61
Q

What are mixing studies for

A

to differentiate an LAC from a factor deficiency

62
Q

PTT -> TT ->repeated then PTT is long, if PTT remains uncorrected

LAC
factor deficiency
factor inhibitor

A

LAC

63
Q

PTT long, TT normal,
PTT mix is corrected

A

next PTT corrects-factor deficiency
next PTT doesn’t correct-factor inhibitor or LAC

64
Q

What are the 2 most common tests required for an LAC profile

A

DRVVT- factor X
Silica PTT-factor XII

65
Q

What result from DRVVT indicates the presence of an LAC

A

if shortened
>1.2 LAC present
<1.2 must do silica based low phospholipid

66
Q

Describe APC resistance and why it is important

A

APC has Arg that resists APC hydrolysis
resistant factor Va remains active and causes clot formation
presence of APC is 3X more thrombosis risk

67
Q

What is the FVL assay

A

Factor V Leiden mutation assay to confirm APC resistance

68
Q

How does G20210A affect hemostasis

A

elevates plasma prothrombin levels, gene mutation

69
Q

How does Antithrombin affect hemostasis

A

SERPIN neutralizes thrombin slows down clot formation

70
Q

How does PC or PS affect hemostasis

A

causes recurrent venous thrombosis

71
Q

increased lipoprotein A mean ___ thrombosis

A

increased

72
Q

How does CRP help predict thrombosis

A

if high, increased risk of MI or stroke

73
Q

How does fibrinogen affect the changes of thrombosis

A

if high, increased thrombotic risk

74
Q

Increased homocysteine levels ___ risk of thrombosis

A

increase

75
Q

What are the cardinal symptoms of DVT

A

edema, erythema, pain, sensation of heat

76
Q

distended neck veins, tachycardia, shortness of breath

A

DVT

77
Q

What tests can predict risk of DVT

A

D-dimer- if normal rules it out
if high- rules it in

78
Q

What is DIC

A

disseminated intravascular coagulation bleeding and clotting at the same time

79
Q

What occurs to lab tests in DIC
plt count
coag factors
PT/PTT/TT
FSP
D-dimer

A

plt count- decreased
coag factors- decreased
PT/PTT/TT- prolonged
FSP-increased
D-dimer-increased

80
Q

What cells are in smears in pts with DIC

A

schistocytes

81
Q

What is HIT

A

Heparin induced thrombocytopenia
immune response to UFH and LMWHabs against platelet factor 4

82
Q

How does HIT affect hemostasis

A

reduces plt count,

83
Q

Venous or arterial thrombosis

lipoprotein a
CRP
homocysteine
high fibrinogen
high VIII
DVT
PE

A

DVT
PE
venous

everything else arterial

Coagulation (7 decks)

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