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DISEASE - endocrine and haem > Haemostasis and thrombosis > Flashcards

Haemostasis and thrombosis Flashcards

1
Q

in primary haemostasis what is the process of platelet adhesion?

A

unactivated platelets bind to vWF in subendothelial matrix

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2
Q

what on the platelets binds to vWF in the vessel walls?

A

GP1b receptors

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3
Q

what happens when platelets are activated?

A

they release their granules

the express phospholoipid and GPIIb and GPIIIa

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4
Q

what do activated platelets express?

A

phospholipid
GPIIb
GPIIIa

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5
Q

where is vWF produced?

A

liver

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6
Q

apart from in the vessel wall where else is vWF in the body?

A

in the blood

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7
Q

what factor is carried by vWF?

A

FVIII

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8
Q

WRT primary haemostasis - what do endothelial cells store?

A

FVIII and vWF

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9
Q

WRT secondary haemostasis, what is the extrinsic pathway initiated by?

A

tissue factor

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10
Q

WRT secondary haemostasis - what is the intrinsic pathway initiated by?

A

phospholipid expressed on platelets

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11
Q

very briefly, what is are the 4 steps of fibrin formation?

A

1 - extrinsic pathway
2 - thrombin formation
3 - intrinsic pathway
4 - fibrin formation

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12
Q

which pathway is activated first - intrinsic or extrinsic?

A

extrinsic

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13
Q

which pathway is initiated by tissue factor?

A

extrinsic

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14
Q

which pathway is initiated by phospholipid on platelets?

A

intrinsic

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15
Q

which 2 factors are involved in the extrinsic pathway?

A

tissue factor

FVII

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16
Q

which 4 factors are involved in the intrinsic pathway?

A

FXII
FXI
FIX
FVIII

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17
Q

the activation of which 2 factors depends on the meeting of the intrinsic and extrinsic pathways?

A

FX

FV

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18
Q

which 3 factors are activated by thrombin?

A

VIII
IX
XI

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19
Q

which factor in the intrinsic pathway starts the pathway but isn’t actually an important factor?

A

XII

why - the rest of the chain are activated by thrombin and the pathway initiated by platelet phospolipid

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20
Q

what is the pathway from prothrombin to cross linked fibrin?

A

prothrombin (FII) - thrombin - fibrinogen (FI) - cross linked fibrin

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21
Q

what are FI and FII AKA?

A

FI - fibrinogen

FII - prothrombin

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22
Q

which ion in the plasma is essential in secondary haemostasis?

A

Ca2+

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23
Q

which pathway do the following test?
APTT
PT
TT

A

APTT - intrinsic
PT - extrinsic
TT - thrombin

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24
Q

what are the normal values for:
APTT
PT
TT

A

APTT - 32s
PT - 12s
TT - 18s

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25
Q

which coag screen examines fibrinogen quality and quantity?

A

TT

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26
Q

which coag screen measures the extrinsic pathway?

A

PT - INR

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27
Q

which coag screen measures the intrinsic pathway?

A

APTT

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28
Q

which coag screen is prolonged by heparin?

A

TT

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29
Q

which test would you use to diagnose blood coag disorders and the effectiveness of fibrinogen therapy?

A

TT

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30
Q

which coag screen measures factors I, II, V, VII, X?

A

PT

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31
Q

which coag screen measures factors VIII, IX, X, XI, XII?

A

APTT

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32
Q

which coag screen do you use for warfarin dosing?

A

PT - INR

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33
Q

which coag screen would you use for heparin levels and clotting abnormalities such as haemophilia and vWF disease?

A

APTT

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34
Q

what coag test would you use to diagnose thrombosis and DIC?

A

D dimer

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35
Q

what is D dimer?

A

product of fibrin degredation

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36
Q

when would you test for fibrin levels and they would be low?

A

DIC

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37
Q

what is the purpose of fibrinolysis?

A

removal of clots

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38
Q

what is the process of fibrinolysis?

A

tissue plasminogen activator (urokinase) - plasminogen - plasmin - fibrin - fibrin degradation products

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39
Q

which factor is tested by both APTT and PT?

A

FX - if one pathway is normal then FX will be OK

40
Q

which factor could be the problem if both pathways did not work?

A

FX

41
Q

what are the 2 naturally occurring inhibitors of blood coagilation?

A

1 - antithrombin

2 - protein C system

42
Q

where is antithrombin synthesised?

A

liver

43
Q

what does antithrombin inhibit?

A

thrombin

FXa

44
Q

which naturally occurring inhibitor of blood coagulation is affected by heparin?

A

antithrombin

45
Q

which naturally occurring method of blood coag inhibition is vit k dependent?

A

protein C system

46
Q

where is protein C synthesised?

A

liver

47
Q

which factors does the protein C system inhibit?

A

FVa

FVIIIa

48
Q

how is protein C activated?

A

endothelial damage - thrombin + thrombomodulin formed - protein C activated

49
Q

what does protein C activate?

A

protein S

50
Q

what does activated protein S do?

A

cleaves FVIIIa and FVa to FV and FVIII

51
Q

in primary haemostasis what is exposed when the vessel is damaged?

A

vWF

collagen

52
Q

problems with primary haemostasis are caused by problems with what?

A

platelets

53
Q

how can platelet disorders be categorised?

A

qualitative - inherited/acquired

quantitative - dec production/inc destruction

54
Q

what are the 2 inherited platelet disorders?

A

1 - bernard-soulier disease - lack of GP1b

2 - glanzmann’s thrombasthenia - lack of GPIIb/IIIa

55
Q

what is the difference between bernard-soulier disease and glanzmann’s thrombasthenia?

A 
BS = abnormal platelets
GT = n platelets that fail to aggregate
56
Q

what are 2 acquired qualitative problems with 1ry haemostasis?

A

1 - drugs - asprin, NSAIDS

2 - renal disease - uraemia inhibits platelet adhesion, activation, aggregation

57
Q

in thrombocytopenia due to dec production, what are 2 possible causes?

A

1 - BM failure

2 - rare causes - wiskott-aldrich syndrome, congenital infections - CMV, rubella

58
Q

in thrombocytopenia with inc destruction, what are the 4 possible causes?

A

1 - splenomegaly
2 - alloimmune
3 - immune thrombocytopenia
4 - intravascular thrombosis

59
Q

intravascular thrombosis causing thrombocytopenia can manifest in 3 ways, what are these?

A

DIC
haemolytic uraemic syndrome
thrombotic thrombocytopenic purpura

60
Q

whats the difference between DIC and TTP and HUS?

A

DIC - all vessels

TTP and HUS - microangiopathic

61
Q

what happens in immune thrombocytopenia?

A

immunological destruction of platelets, usually post-viral

62
Q

problems wit primary haemostasis can be divided into 2 broad categories, what are they?

A

vessel problems

platelet problems

63
Q

vessel disorder affecting primary haemostasis can be divided into acquired and inherited, what are the causes for each?

A

acquired - henoch-schonlein purpura, senile purpura, infections, drug reactions, prolonged steriods, trauma, scurvy

inherited - hereditary haemorrhagic telengiectasia (HHT), CTDs - ehlor’s-danlos, marfans, pseudoxanthoma

64
Q

what is senile purpura?

A

bruising with old age - vessel disorder in 1ry haemostasis

65
Q

what is henoch-schonlein purpura?

A

vessel disorder 1ry haemostasis

vasculitis leading to petichae

66
Q

what causes henoch-schonlein purpura?

A

allergic vasculitis following infection

usually in children

67
Q

which disorder of primary haemostasis usually presents with epistaxis?

A

heriditary haemorrhagic telengiectasia

68
Q 
what would the coag profile of DIC look like?
platelets
d-dimer
PT
APTT
fibrinogen
RBCs
A 
platelets - dec
d-dimer - inc
PT - inc
APTT - inc
fibrinogen - dec
RBCs - fragmented
69
Q

what are the inherited causes of coagulation disorders - 2ry haemostasis?

A

haemophilia
von willibrand disease

also - FXI deficiency, congenital deficiencies of FII, V, VII, X, fibrinogen deficiency, dysfibrogenaemia

70
Q

which factors do haemophilia A and B affect?

A

A - FVIII

B - FIX

71
Q

which haemophilia is most common?

A

A

72
Q

how would you diagnose haemophilia?

A

coag screens - n PT, n/inc APTT

assay for FVIII and IX

73
Q

what do you absolutely not give haemophiliacs?

A

NSAIDs
asprin
IM injections

74
Q

how would you treat haemophilia?

A

coag factors
desmopressin
tranexamic acid

75
Q

what is the most common coag disorder?

A

vWD

76
Q

what is the characteristic of vWD?

A

mucosal bleeding

77
Q

how would you treat vWD?

A

vWF
desmopressin
tranexamic acid

78
Q

what acquired coagulation problems can you have?

A 
liver disease
vit k deficiency
anticoags - iatrogenic
massive blood transfusion
DIC
inhibitors to coag factors
79
Q

what could cause vit K deficiency?

A 
malabsorption
malnourished
CF
IBD
liver disease
new borns
80
Q

what would the levels of the following be in - liver disease

bleeding time
TT
PT
APTT
fibrinogen
A 
bleeding time - n
TT - inc
PT - inc
APTT - inc
fibrinogen - dec
81
Q

what would the levels of the following be in - haemophilia

bleeding time
TT
PT
APTT
fibrinogen
A 
bleeding time - n
TT - n
PT - n
APTT - inc
fibrinogen - n
82
Q

what would the levels of the following be in - vWD

bleeding time
TT
PT
APTT
fibrinogen
A 
bleeding time - inc
TT - n
PT - n
APTT - inc
fibrinogen - n
83
Q

what would the levels of the following be in - DIC

bleeding time
TT
PT
APTT
fibrinogen
A 
bleeding time - inc
TT - inc
PT - inc
APTT - inc
fibrinogen - dec
84
Q

what would the levels of the following be in - thrombocytopenia

bleeding time
TT
PT
APTT
fibrinogen
A 
bleeding time - inc
TT - n
PT - n
APTT - n
fibrinogen - n
85
Q

for disorders of 1ry and 2ry haemostasis - where is the site of bleeding?

A

1ry - mucous membranes, skin

2ry - soft tissue, joints, tissues

86
Q

for disorders of 1ry and 2ry haemostasis - ??bleeding after minor cuts??

A

1ry - yes

2ry - not usual

87
Q

for disorders of 1ry and 2ry haemostasis - ??petichae

A

1ry - present

2ry - absent

88
Q

for disorders of 1ry and 2ry haemostasis - ??echymoses

A

1ry - small superficial

2ry - large, palpable

89
Q

for disorders of 1ry and 2ry haemostasis - ??haemarthrosis, muscle haematomas

A

1ry - rare

2ry - common

90
Q

for disorders of 1ry and 2ry haemostasis - bleeding after surgery

A

1ry - immediate, mild

2ry - delayed, severe

91
Q

where would you find white clots - fibrin and platelets?

A

arteries

92
Q

where would you find red clots - RBCs and fibrin?

A

veins

93
Q

what are the 3 mechanisms of thrombophilia that are inherited?

A

1 - deficiency of anticoags - antithrombin, protein C/S
2 - abnormal proteins - FV leiden, FII, dysfibrinogen
3 - inc. procoagulant - prothrombin, FVIII

94
Q

how long would you give warfarin for with PE?

A

3/12 if clear cause

6/12 if no clear cause

95
Q

what ECG changes would you see with a PE?

A

prominent S1, Q3, T3
new RBBB

  • indication strain on the RHS of heart

DISEASE - endocrine and haem (5 decks)

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