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Path Y > Haematology - Haematosis & Thrombosis > Flashcards

Haematology - Haematosis & Thrombosis Flashcards

1
Q

What is the triad of symptoms in thrombophlebitis syndrome?

A

Recurrent pain
Swelling
Ulcers

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2
Q

What catalyses the conversion of fibrinogen to fibrin?

A

Thrombin

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3
Q

Which 4 anticoagulant molecules are expressed on the blood vessel wall?

A

Thrombomodulin
Endothelial Protein C receptor
TFPI (Tissue Factor Pathway Inhibitor)
Heparans

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4
Q

How does inflammation affect the blood vessel wall?

A

It makes it prothrombotic

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5
Q

Recall 4 effects of inflammation on the blood vessel wall

A
  1. Anticoagulant molecules are downregulated
  2. TF expressed
  3. Prostacyclin decreased
  4. Adhesion molecules upregulated
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6
Q

How do neutrophils contribute to immunothrombosis?

A

Neutrophils release DNA, which is procoagulant

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7
Q

What is the mechanism of action of clopidogrel?

A

Inhibits ADP receptors

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8
Q

Give 4 ways in which blood stasis promotes thrombosis

A
  1. Accumulation of activated factors
  2. Promotes platelet adhesion
  3. Promotes leukocyte adhesion and transmigration
  4. Hypoxia produces inflammatory effect on endothelium
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9
Q

What is the broad mechanism of action of heparins?

A

Potentiate antithrombin
antithrombin inhibits thrombin and factor 9 & Xa,

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10
Q

What is one risk of long term heparin use?

A

Osteoporosis

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11
Q

Give an example of an anti-Xa drug

A

Rivaroxaban/Apixaban

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12
Q

Give an example of an anti-2a drug

A

Dabigatran

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13
Q

How does warfarin affect vit K?

A

vitamin K epoxide reductase (VKER) inhibitor
vitamin K antagonist

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14
Q

Which procoagulant factors fall as a result of warfarin medication?

A

2,7, 9, 10, protein c and protein s
factor 7 and protein c drop first

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15
Q

How is warfarin monitored?

A

INR measure
INR will usually be between 0.9 and 1.3. if not taking warfarin
if you are target is usually 2.5

A low INR = coagulates too easily and puts you at risk of developing a blood clot.
A high INR result = thin blood, you risk bleeding.

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16
Q

Why should warfarin never be given to pregnant women?

A

It is teratogenic

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17
Q

Give an example of an LMWH

A

Enoxaparin/ Tinzaparin

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18
Q

What scoring system is used to calculate risk of thrombosis?

A

Chads-vasc

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19
Q

Which surgeries carry the highest risk of thrombosis?

A

Orthopaedic

20
Q

Which surgeries carry highest risk of bleeding?

A

Neuro, spinal or eye surgery

21
Q

Which class of anti-coagulants carries a significantly lower risk of intracranial bleeding?

A

DOACs

22
Q

What is the best drug to use as a long-term anticoagulant in a patient who has had an idiopathic VTE?

A

DOACs

23
Q

Recall 3 minor precipitants of thrombosis

A

COPD
flights
trauma

24
Q

After someone has suffered a thrombosis due to a minor precipitant, how long should they be anti-coagulated for?

A

3 months

25
Q

Recall the order in which the different coagulation factors in the intrinsic pathway catalyse each other?

A

12
11
9
8
10 - common

26
Q

Which coagulation measure is used to monitor heparin therapy?

A

APTT

27
Q

Which coagulation measure is used to monitor warfarin therapy?

A

(INR)
you must monitor

28
Q

Which factor does the extrinsic pathway start with?

A

tissue factor which goes on to activate factor VII to factor VIIa

29
Q

5 things that increase risk of thrombosis?

A

 Reduced prothrombin
 Thrombocytopenia
 Reduced protein C
 Elevated anti-thrombin
 Increased fibrinolysis

30
Q

Virchow triad?

A

intravascular vessel wall damage, stasis of flow, and the presence of a hypercoagulable state.

31
Q

give 2 antiplatelet factors secreted by vessel wall

A

 Prostacyclin (PGI2) from vessel wall
 NO

32
Q

which factors confers the highest risk of thrombosis?

A

first antithrombin deficiency
then APC, FVL

33
Q

what is factor 2 and 2a?

A

2 - prothrombin
2a - thrombin

34
Q

give an advantage of DOAC’s over warfarin?

A

no monitoring required

35
Q

how do you monitor heparin therapy and what for?

A

LMWH - anti-10a assay - renal failure, weight loss/gain
unfractionated - anti 10a assay or APTT

36
Q

which factor has the shortest half life and which has the longest

A

7 - 6 hours = shortest
2 - 60 hours = longest

37
Q

give 4 methods of thromboprophylaxis

A

 LMWH – Tinzaparin or Clexane, not monitored
 TED (Thrombo-Embolus Deterrent (TED) ) stockings for surgery or if heparin CI
 Flowtron – intermittent compression – increases flow
 Sometimes DOAC +/- aspirin

38
Q

when is no coagulation, short term and long term indicated?

A

o After a surgical precipitant, no long-term anticoagulation needed
o After minor precipitants, 3 months anticoagulation usually adequate
o If idiopathic cause  long-term anticoagulation (10-20% recurrence in 2 years)

39
Q

what score to predict probability of a PE? what’s the treatment?

A

wells score
if over 4 CTPA
Low molecular weight heparin (LMWH).

40
Q

what are factor 1,2,3 known as?

A

Factor I - fibrinogen
Factor II - prothrombin
Factor III - tissue thromboplastin (tissue factor)

41
Q

liver must be able to use vitamin k to produce which factors?

A

2,7,9,10

42
Q

which factor remains at the same level throughout life from brith to adulthood

A

factor 8 (called stable factor)

43
Q

what is the extrinsic pathway

A

The Extrinsic pathway is the other route to coagulation. It requires Tissue Factor (tissue thromboplastin), a substance which is “extrinsic to”, or not normally circulating in the vessel. Tissue Factor is released when the vessel wall is ruptured.

starts w Factor 7 to 7a

intrinsic - aptt (heparin acts here)
extrinsic - pt

44
Q

explain link between INR and PT

A 
An INR (international normalized ratio) is a type of calculation based on PT test results. Prothrombin is a protein made by the liver. It is one of several substances known as clotting (coagulation) factors.
INR of 2-3 = prothrombin time 2 to 3 times as long as in a person not on warfarin with normal clotting, using standardised conditions
45
Q

outline the interpretation of PT and APTT together in bleeding

A

both prolonged = DIC
both normal = thrombocytopenia, factor XIII deficiency, mild form of von Willebrand’s disease,
PT prolonged, APTT normal = liver disease, decreased vitamin K, decreased or defective factor VII
APTT prolonged, PT normal = decreased or defective factor VIII, IX, XI or XII, von Willebrand disease, or lupus anticoagulant present

46
Q

what begins the common pathway

A

factor 5

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