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Haematology > Haem: Coagulation > Flashcards

Haem: Coagulation Flashcards

1
Q

What are the pro coagulant elements?

A

Platelets
Endothelium
vWF

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2
Q

What are the anti coagulant elements?

A

Anti-thrombins
Protein C/ S
Tissue factor pathway inhibitor (TFPI)

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3
Q

What are the 3 responses to vessel wall injury?

A

Vasoconstriction- in order to minimise blood loss (as reduces blood flow to this area)
Platelet aggregation and activation- forms the primary haemostatic plug
Activation of the coagulation cascade

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4
Q

What forms a stable platelet plug?

A

vWF

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5
Q

How are platelets produced?

A

In the bone marrow from megakaryocytes

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6
Q

What is the life span of platelets?

A

10 days

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7
Q

What regulates platelet production?

A

Thrombopoietic factors

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8
Q

What are the 2 ways platelets adhere to the endothelium?

A

via glycoprotein 1a

via glycoprotein 1b to vWF

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9
Q

How do platelets adhere to each other?

A

Glycoprotein 2b/3a

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10
Q

What happens when platelets attach to the endothelium?

A

They release ADP and thromboxane A2 to aggregate more platelets

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11
Q

What inhibits ADP?

A

Clopidogrel

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12
Q

How does aspirin work and how is it different from NSAIDs

A

Ireeversibly inhibits COX, while NSAIDs inhibit COX reversibly

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13
Q

What is the limiting factor for fibrinogen formation?

A

Factor 10a

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14
Q

What is the most important element of the coagulation cascade?

A

Thrombin / Factor 2a as this converts fibrinogen to fibrin

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15
Q

Explain the coagualtion cascade;

A

Tissue factor activates factor 7a

Factor 7a activates factors 9a and 10a

10a binds to 5a

10a and 5a will produces 2a/thrombin

Thrombin will activate platelets, 8a and 11a

11a will activate 9a

8a will activate more 5a

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16
Q

What causes large activation of thrombin?

A

Platelets, 5a, 8a and 9a will activate more 10a

10a will not cause massive thrombin release

This thrombin will convert fibrinogen to fibrin thereby forming a stable fibrin clot

*All these would happen only after the formation of a primary platelet plug

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17
Q

What happens in Factor 5 Leiden

A

5a cannot bind to 10a

Higher risk of VTE

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18
Q

Why do you need bile to absorb vit k?

A

As it is fat soluble. So obstruction of the biliary tree can cause vit k deficiency

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19
Q

Will you still produce clotting factors in vit k deficiency?

A

Yes, but they will be inactive

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20
Q

How is a fibrin clot broken down?

A

By tissue plasminogen activator and urokinase

21
Q

What can inhibit fibrin breakdown?

A

TAFI

22
Q

Which anti thrombin is the most active?

A

Anti thrombin 3

23
Q

What does LMWH do?

A

Augments antithrombin 3

24
Q

How do proteinc c and s work?

A

Work with thrombomodulin to inhibit factors 5a and 8a

25
Q

What happens to protien c in factor 5 leiden?

A

Protein c resistance

Prothrombotic state

26
Q

What are the 2 factors causing protein c resistance?

A

Factor 5 mutations

High levels of factor 8

27
Q

What are the features of bleeding disorders due to platelet disorders?

A

Bleeding from skin and mucous membranes

Petechiae present

Small superficial bruises

Rare haemarthrosis

Bleeding after cuts and scratches

Immediate mild bleeding after trauma

28
Q

What are the features of bleeding disorders due to clotting factor disorders?

A

Bleeding into soft tissues, joints and muscles

Petechiae absent

Large deep bruises

Haemarthrosis is common

No bleeding after cuts and scratches

Delayed severe bleeding after trauma

29
Q

When do you need to treat platelet disorders?

A

When platelet count drops below 30 x 10(9) / L

30
Q

What is It is pseudothrombocytopaenia?

A

Where the platelets clump together, creating an erroneously low platelet count

31
Q

What is Grey Platelet Syndrome

A

Large platelets

32
Q

What can cause thrombocytopaenia

A 
Drug induced - Quinines, rifampicin, vancomycin 
SLE
Rheum arthiritis 
CLL
Lymphomas
Sarcoidosis

DIC
MAHA

33
Q

What are the features of thrombocytopaenia?

A

Non blanching petechiae
Haematomas
Subconjunctival haemorrhages

Look for B12 def and acute leukaemia

34
Q

What can cause clotting factor disorders?

A

DIC
Vit K def
Warfarin
Liver disease

Haemophilia A and B
vWD

35
Q

What is haemophilia?

A

Deficiency of factors 8 or 9

X linked

36
Q

What are the features of haemophilia?

A

Haemarthroses (fixed joints)
Soft tissue haematomas (muscle atrophy)
Prolonged bleeding

37
Q

What will the APTT and PT be in haemophilia?

A

Prolonged APTT - due to problematic intrinsic pathway

Normal PT

38
Q

What is the main feature of vWD?

A

Mucocutaneous bleeding

39
Q

What are the 3 types of vWD?

A

Partial quantitative def

Qualitative def

Total quantitative def

40
Q

What elements of the clotting cascade require vit K?

A

Factors 2,7,9 and 10

Proteins C and S

41
Q

How to treat Vit K def?

A

IM Vit K if GI obstruction

FFP

42
Q

What happens in DIC?

A

Emx

Activation of both coagulation and fibrinolysis due to sepsis, trauma…

43
Q

What are the features of DIC?

A 
Prolonged APTT, PT, TT
Decreased fibrinogen 
Increased FDP
Decreased platelets 
Schistocytes on blood film
Elevated D dimer
44
Q

How to treat DIC?

A

Heparin
Platelet transfusion
FFP

45
Q

How to treat haemostatic defects in liver disease?

A

PO Vit K, FFP

Cryoprecipitate

46
Q

How do you monitor warfarin overdose?

A

INR

The higher it is, the higher the risk of bleeding

47
Q

What is an indicator of the intrinsic pathway?

A

PTT

48
Q

What is an indicator of the extrinsic pathway?

A

PT

Haematology (10 decks)

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