Exam 5 Coagulation

Question 1

what is a reticulocyte count

Answer 1

reticulocyte= immature RBC in circulation

reported as % of RBCs

indicated bone marrow response

Question 2

what does an increase reticulocyte count mean?

a decreased??

Answer 2

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

Question 3

What are examples of increased reticulocyte count

Answer 3

ex: after anemia treatment,

in response to hemorrhage

Question 4

what are examples of decreased reticulocytes

Answer 4

Ex:
leukemia,

decreased B12,

Fe deficiency,

anything that would shut down bone marrow response

Question 5

name some causes of poor coagulation

Answer 5

genetic

acquired

medication induced (heparin, warfarin)

low platelets

coagulation factor deficiency (Von willebrand disease, hemophilia)

Question 6

name some causes of excess coagulation

Answer 6

genetic

acquired

medication induced (estrogens)

factor leiden mutation

malignancy

inflammation

impaired circulation

Question 7

steps of hemostasis

Answer 7

`.1. tissue injury

2. platelet response / tissue factor
3. platelet adhesion, activation and aggregation, coagulating factors = plug formed
4. fibrin degrades (plasminogen/ plasmin) and clot dissolution

Question 8

how long do platelets last in circulation

Answer 8

7-10 days

Question 9

what is the first line test in relation to bleeding/clotting

Answer 9

platelet count

Question 10

what is too many platelets called?

too few?

Answer 10

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

Question 11

what is prothrombin time (PT)

Answer 11

assess EXTRINSIC and common pathways

reported in # of seconds take to clot

Question 12

what increases PT

Answer 12

WARFARIN

anticoagulants

salicylates

Vit K def

liver disease

Question 13

what is Internationalized normalized ration (INR)

Answer 13

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)

Question 14

what is activated partial thromboplastin time (aPTT)

Answer 14

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

Question 15

what increases aPTT

Answer 15

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

Question 16

are coagulating factors a first line test

Answer 16

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

Question 17

how are coagulation factors reported

Answer 17

by the factor as a %

Question 18

what is the factor V leiden mutation test

when should you run it

Answer 18

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

Question 19

what is the most common HYPER coagulative inherited disorder

Answer 19

factor V leiden mutation

Question 20

what is the Coombs test

direct vs indirect

Answer 20

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

Question 21

what test for a 76 yr old man on warfarin

Answer 21

PT/INR

Question 22

what test for a pt that needs a transfusion

Answer 22

Coombs

Question 23

what test for pt with iron deficiency anemia

Answer 23

CBC

reticulocyte

Fe

Question 24

what test for patient post thrombotic stroke and fam hx blood clots

Answer 24

factor 5 leiden mutation

Question 25

what test for a pt with severe post part hemorrhage intial?

secondary?

Answer 25

intial: CBC, PT, aPTT
secondary: coagulation factors, von willebrand

Question 26

what does heparin do

Answer 26

increases PTT (intrinisic, inpatient)

Question 27

what does warfarin do

Answer 27

increases PT and INR (warfarin= extrinisc pathway, outpatient)

Question 28

76 y/o male takes warfarin for chronic atrial fib and has a history PE

which labs would be useful to monitor pt

Answer 28

PT
INR

no need to get platelet or CBC

Question 29

what foods cause you INR to go donw

Answer 29

vit k veggies (Avocado)

green tea

Question 30

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

Answer 30

platelet count with CBC
PT/INR
PTT

to see if inherited disorder: factor 5 Leiden (fam history clotting)

Question 31

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

Answer 31

initially:
- platelet count with CBC
- PTT
- PT/INR

second line: coagulation factors (bc family history bleeding)