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CVPR 330 Blood > Graham Hemostasis 2012 / Exam 2 / 2nd deck > Flashcards

Graham Hemostasis 2012 / Exam 2 / 2nd deck Flashcards

1
Q

How does fibrinogen change to fibrin ?

A

The enzyme Thrombin converts fibrinogen into Fibrin Monometer, Fibrinopeptide A&B. Fibrin Monometers then connect to each other and form the fibrin clot.

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2
Q
  1. ) What Lab Test can we run to measure Fibrinogen quantification (see if Fibrinolysis is taking place) ?
  2. ) What are the normal values?
A

1.) D Dimer
2.) 200 - 400 mg/dL
Newborns = 150 - 300 mg/dL

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3
Q

Preparation of a Sample for Coagulation Testing ?

A
  • Sodium citrate
  • Ratio of blood to
    anticoagulant 9:1
  • Tube must be full
  • Should not be the first tube drawn
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4
Q

Prothrombin Time (PT)

3 minutes @ 37 degrees

A
  • Measures the amount of clotting factors 7, 10, 5, & 2 in the Extrinsic System.
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5
Q

Activated Partial Thromboplastin Time (APTT)

5 min @ 37 degrees

A

(Plasma) + Activator phospholipid + surface contact + Calcium Chloride = Time it takes to clot

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6
Q

APTT Normal Lab Value:

A

25 - 35 sec

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7
Q

PT Normal Lab Values:

A
  • Normal Lab Value: 50 - 150 % of normal activity

- Normal Lab Value: 10-13 sec

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8
Q

Thrombin Time

3 min at 37 degrees

A

Test to diagnose Thrombin Inhibition.

- Normal Lab Value: 10-15 sec

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9
Q

What study can you use to determine deficiency vs. inhibitor ?

A

Mixing Study
- Patient plasma is mixed with an equal amount of normal plasma and the APTT is then repeated.

  • If the time corrects = Deficiency
  • If the time does not correct = Inhibitor is present; heparin or antibody.
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10
Q

Plasminogen

A

Anticoagulant Protein

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11
Q

Plasminogen may be activated to the proteolytic enzyme PLASMIN by a number or agents, name 2 of them?

A

TPA

Urokinase

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12
Q

Plasmin

A

proteolytic enzyme that digests fibrin

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13
Q

Explain the D -Dimer test ?

A

Antibody-d-dimer + Plasma = Positive if Agglutination occurs.

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14
Q

Congenital factor deficiencies that may prolong PT ?

A 
I
II
V
X
VII
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15
Q

Aquired factor deficiencies that may prolong PT or APTT ?

  • May be single factor deficiency or multiple factor deficiency. that my prolong PT ?
A
  • It could be a production problem.

- or a Consumption problem.

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16
Q

Inhibitors that may prolong PT ?

A
  • Heparin (some heparins in some test systems)
  • Lupus-like anticoagulant (high dose)
  • Paraproteins
  • Elevated FSP
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17
Q

Congenital factor deficiencies

that may prolong APTT ?

A 
I
II
V
X
VIII
IX
XI
XII
18
Q

Inhibitors that may prolong APTT ?

A
  • Heparin
  • Specific factor inhibitor
  • Lupus-like anticoagulant
  • Paraproteins
  • Elevated FSP
19
Q

Patient is
Bleeding,
Mixing study corrects Abnormal APTT.

What Factors are deficient?

A 
I
II
V
X
VII (vWF)
IX
20
Q

Patient is
NOT bleeding,
Mixing study corrects Abnormal APTT.

What Factors are deficient?

A

XI

XII

21
Q

Patient is
Bleeding,
Mixing study does NOT correct Abnormal APTT.

What’s the problem?

A

INHIBITORS

  • Heparin
  • Specific factor inhibitor
  • Paraproteins
  • Elevated FSP
22
Q

Patient is
NOT bleeding,
Mixing study does NOT correct Abnormal APTT.

What’s the problem?

A

LLAC

23
Q

Factors that may prolong the Thrombin Time ?

A
  • Decreased fibrinogen
  • Abnormal fibrinogen
  • Thrombin Inhibitors
    Heparin
    Paraproteins
    Increased FSP
24
Q

What is the most common congenital bleeding disorder ?

A

von Willebrand Disease

25
Q

Criteria for diagnosis of LUPUS

A
  • Prolongation of PT / PTT
  • Uncorrectable prolongation of the PT / PTT with addition of normal plasma.
  • Absence of specific inhibitory activity against any specific coagulation inhibitor
26
Q

Natural Anticoagulants

A
  • Antithrombin
  • Protein C & Protein S
  • Tissue factor pathway
    inhibitor
27
Q

What natural anticoagulant neutralizes serine proteases ?

A

Antithrombin

28
Q

What natural anticoagulant inhibit Va and VIIIa ?

A

Protein C & Protein S

29
Q

What natural anticoagulant neutralizes VIIa and Xa ?

A

Tissue factor pathway inhibitor

30
Q

Thrombotic Complications in CPB

A
  • Consumptive and hemodilutional losses of natural anticoagulants
  • Transfusion of hemostatic products can result in excessive thrombin generation
  • HIT
  • Inherited hypercoagulable states
31
Q

Heparin Induced Thrombocytopenia (HIT)

A
  • 1-5% of pts exposed to unfractionated heparin will develop HIT.
  • 30% of those will develop thrombosis
  • Patient forms antibodies to the complex of heparin with PF4 found in the alpha granules of platelets
32
Q

Name 5 Inherited Hypercoagulable States?

A
  • Factor V Leiden
  • Prothrombin G20210A
  • Elevation of vWF, VIII,
    fibrinogen
  • Deficiency of natural
    anticoagulants
  • Increased levels of
    Lipoprotein (a) inhibits fibrinolysis
33
Q

Disseminated Intravascular Coagulation (DIC) definition ?

A

Secondary condition that results in the increased generation of thrombin. Making clots leads to fibrinolysis (the breaking down of clots) which leads to a vicious cycle.

34
Q

Disseminated Intravascular Coagulation (DIC) fibrinolytic example ?

A

Hemorrhagic PurpuraMeningococcal Septicemia

35
Q

Disseminated Intravascular Coagulation (DIC) Thrombotic example ?

A

GangreneHaemophilus B Septicemia

36
Q

Thrombin Removes fibrinopeptides A and B, forming fibrin monomers which
results in ?

A

Decreased Fibrinogen

37
Q

Thrombin Activates V, VIII, and XIII. As it is formed, it consumes what ?

A

factor II

38
Q

Thrombin also Stimulates platelets, which leads to what ?

A

thrombocytopenia

39
Q

Activation of Fibrinolysis leads to 4 things, what are they?

A
  • Increased plasmin generation
  • Lysis of clots
  • Consumption of fibrinogen
  • Increased levels of FSP and
    D-Dimer
40
Q

Laboratory Results in DIC

A 
↑ PT, PTT, TT 
↑ Fibrin Split Products 
↓ Fibrinogen 
↓ Platelets 
- Schistocytes on peripheral   
  smear
41
Q

6 Conditions Associated with DIC?

A
  • Infections
  • Obstetric complications
  • Surgery, including CPB
  • Malignancies
  • Massive tissue injury
  • Snakebite
42
Q

Anticoagulant Therapy

A
  • Thrombin Inhibitors
    • Heparin
    • Direct thrombin inhibitors
  • Warfarin compounds
    (Coumadin)
  • Antiplatelet therapy

CVPR 330 Blood (25 decks)

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