Exam 5 Coagulation Flashcards
what is a reticulocyte count
reticulocyte= immature RBC in circulation
reported as % of RBCs
indicated bone marrow response
what does an increase reticulocyte count mean?
a decreased??
increased: body producing more immature RBCs and putting into circulation because they are needed
ex: after anemia treatment, in response to hemorrhage
decreased: less new RBCs being made
Ex: leukemia, decreased B12, Fe deficiency, anything that would shut down bone marrow response
What are examples of increased reticulocyte count
ex: after anemia treatment,
in response to hemorrhage
what are examples of decreased reticulocytes
Ex:
leukemia,
decreased B12,
Fe deficiency,
anything that would shut down bone marrow response
name some causes of poor coagulation
genetic
acquired
medication induced (heparin, warfarin)
low platelets
coagulation factor deficiency (Von willebrand disease, hemophilia)
name some causes of excess coagulation
genetic
acquired
medication induced (estrogens)
factor leiden mutation
malignancy
inflammation
impaired circulation
steps of hemostasis
`.1. tissue injury
- platelet response / tissue factor
- platelet adhesion, activation and aggregation, coagulating factors = plug formed
- fibrin degrades (plasminogen/ plasmin) and clot dissolution
how long do platelets last in circulation
7-10 days
what is the first line test in relation to bleeding/clotting
platelet count
what is too many platelets called?
too few?
too many: thrombocytosis
- can be caused by cancer, meds, splenectomy
- can result in clots
too few: thrombocytopenia
- can be caused by cancer, meds, lisinopril, infection (use them up), Idiopathic thrombocytopenia
what is prothrombin time (PT)
assess EXTRINSIC and common pathways
reported in # of seconds take to clot
what increases PT
WARFARIN
anticoagulants
salicylates
Vit K def
liver disease
what is Internationalized normalized ration (INR)
standardization of reporting for PT (prothrombin time)
anticoagulation therapy is adjusted based on INR goals
- aka we want some ppl to bleed a little bit more (why we put them on warfarin)
what is activated partial thromboplastin time (aPTT)
assess INTRINSIC and common pathway
reported as # seconds takes to clot
helps monitor: HEPARIN
and fast acting meds, usually inpatient!!!!!!!!!!!!!!
collect via venipuncture
active part makes it faster
what increases aPTT
Heparin
liver disease
hemophilia A and B
von willebrands
DIC
Vit K def
AKA increasing aPTT= increasing the amount of time it takes to clot = if it increases means harder to clot
are coagulating factors a first line test
no
they are useful for further investigation of unexplained bleeding
$$$
before you run pt should have a family Hx of bleeding disorder and current bleeding probs
how are coagulation factors reported
by the factor as a %
what is the factor V leiden mutation test
when should you run it
tests for an inherited defect in coagulation factor (resistant to clot breakdown)
should run if:
- thrombosis (esp. if young)
- unusual clotting and family hx
sample
-blood OR cells
NOT a first line test
what is the most common HYPER coagulative inherited disorder
factor V leiden mutation
what is the Coombs test
direct vs indirect
NOT A COAGULATION TEST
checks for RBC immune reaction/Abs
DIRECT: checks for Abs on RBCs
- AFTER suspected transfusion reaction or immune hemolysis
INDIRECT: checks for Abs in pt serum
-PRIOR to transfusion cross matching
what test for a 76 yr old man on warfarin
PT/INR
what test for a pt that needs a transfusion
Coombs
what test for pt with iron deficiency anemia
CBC
reticulocyte
Fe
what test for patient post thrombotic stroke and fam hx blood clots
factor 5 leiden mutation
what test for a pt with severe post part hemorrhage intial?
secondary?
intial: CBC, PT, aPTT
secondary: coagulation factors, von willebrand
what does heparin do
increases PTT (intrinisic, inpatient)
what does warfarin do
increases PT and INR (warfarin= extrinisc pathway, outpatient)
76 y/o male takes warfarin for chronic atrial fib and has a history PE
which labs would be useful to monitor pt
PT
INR
no need to get platelet or CBC
what foods cause you INR to go donw
vit k veggies (Avocado)
green tea
female to clinic for follow up post hospitalization for thrombotic stroke, non smoker, normal BP, fam history of blood clots
what labs would be useful initially
what to do if think inherited
platelet count with CBC
PT/INR
PTT
to see if inherited disorder: factor 5 Leiden (fam history clotting)
female referred by OB/Gyn after severe post partum hemorrhage requiring repeat transfusions
pt admits heavy menses in early life
grandma had sim issues
father has severe nose bleeds
which labs would be good initially
which would be appropriate second line labs
initially:
- platelet count with CBC
- PTT
- PT/INR
second line: coagulation factors (bc family history bleeding)
