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Haematology > Haemostasis and Thrombosis > Flashcards

Haemostasis and Thrombosis Flashcards

1
Q

is blood clotted in plasma

A

no (it is clotted in serum)

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2
Q

what is haemostasis

A

process by which blood loss is prevented

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3
Q

what is required for primary haemostasis

A

vWF, platelets

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4
Q

what is required for secondary haemostasis

A

fibrin

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5
Q

what should you administer if low VWF

A

cryoprecipitate- high in VWF

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6
Q

what blood product to give if platelets low

A

platelets

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7
Q

what blood product to give if missing clotting factors

A

FFP

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8
Q

what type of sample for haemostasis test

A

plasma sample

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9
Q

what does the APTT measure

A

intrinsic pathway (activated partial thromboplastin time)

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10
Q

what does the PT measure

A

extrinsic pathway (prothrombin time)

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11
Q

what if the APTT is abnormal and PT normal

A

problem in the intrinsic pathway

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12
Q

what if the PT is abnormal and the APTT is normal

A

problem in the extrinsic pathway

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13
Q

what if APTT and PT are abnormal

A

problem in the common pathway

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14
Q

what factors are involved in intrinsic pathway

A

XII, XI, IX, X

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15
Q

what factors involved in extrinsic pathway

A

VII, X

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16
Q

what is the fibrinogen assay for (clauss assay)

A

fibrinogen- fibrin (IIa- thrombin). see how long it takes fibrin to form

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17
Q

why do you need to test LFTs

A

as this is where coag factors are produced

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18
Q

what is the normal INR

A

2-3

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19
Q

what is INR based on

A

PT: PT patient/PT normal

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20
Q

what factors are affected by warfarin

A

2,7,9,10

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21
Q

how does warfarin work

A

blocks vitamin K cycle, which is needed for carboxylation of factors 2,7,9,10

22
Q

what is the intrinsic pathway responsible for

A

fibrin production

23
Q

which pathway is the initiation phase

A

extrinsic pathway- makes just enough thrombin to trigger- initiation, but not enough to make the fibrin

24
Q

normal lifespan platelet

A

7-10 days

25
Q

when is there reduced lifespan platelets

A

incr consumption- infection, thrombosis, splenic enlargement

26
Q

normal conc platelets

A

140-400 x 10^9/l

27
Q

what stimulates platelet production

A

TPO- thrombopoietin

28
Q

what are coagulation inhibitory factors for

A

inhibit coag cascade and ensure action of thrombin is limited to site of injury

29
Q

what are the coagulation inhibitory factors

A

antithrombin, proteins C and S , tissue factor pathway inhibitor

30
Q

inherited disorders of vessel wall

A

hereditary haemorrhagic telangiectasia, Ehlers Danl;os, Marfan

31
Q

acquired disorders vessel wall

A

vit C def (scurvy), steroids, normal ageing, amyloid, immune complex deposition

32
Q

what is Henoch schlonein purpura

A

allergic vasculitis, after an infection- arthropathy, haematuria, GI

33
Q

what is thrombocytopenia

A

decr platelets- below 140

34
Q

congenital causes thrombocytopenia

A

fanconi (aplastic anaemia), rare selective congenital defects of platelet production

35
Q

acquired causes thrombocytopenia

A

increased destruction- autoimmune, DIC, TTP, drugs, hypersplenism. failure production- bone marrow failure (leukaemia, myeloma, AA, HIV), infiltration (lymphoma, carcinoma)

36
Q

treatment autoimmune thrombocytopenia

A

prednisolone, IV Ig, immunosuppressive therapy, splenectomy

37
Q

what happens in TTP

A

thrombosis in small vessels, red cell fragmentation, haemolytic anaemia, thrombocytopenia

38
Q

what happens to PT and APTT in TTP

A

normal

39
Q

what is there a deficiency of in TTP

A

ADAMTS13- normally cleaves VWF

40
Q

what is haemolytic uraemic syndrome

A

occurs in childhood. thrombosis in small vessels. follows infection- E coli..

41
Q

treatment TTP

A

plasma exchange- FFP. antiplatelets, corticosteroids

42
Q

target INR pulmonary embolism and DVT

A

2-3, 3.5 if recurrent

43
Q

target INR AF

A

2-3

44
Q

target INR prosthetic metallic heart valves for stroke prevention

A

3-4

45
Q

anticoag in DVT/PE

A

at least 6 weeks for below knee DVT, at least 3 months for above the knee DVT or PE. at least 6 months if no cause found

46
Q

what to do if INR is 4.5-6

A

reduce warfarin dose or omit.restart when INR

47
Q

what to do if INR is 6-8

A

stop warfarin. restart when INR

48
Q

what to do if INR is >8

A

if no bleeding stop warfarin. 0.5-2.5mg vitamin K if risk factors for bleeding

49
Q

what to do with warfarin if any major bleed

A

stop warfarin. give prothrombin complex concentrate. FFP. vitamin K

50
Q

problem with vitamin K

A

may take some hours to work and can cause prolonged resistance when restarting warfarirn so avoid if possible if need long term coag

Haematology (12 decks)

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