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ABSITE > Hematology > Flashcards

Hematology Flashcards

1
Q

Primary hemostasis is achieved initially with…

A

Platelet aggregation

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2
Q

The 3 initial responses to vascular injury:

A
  1. Vasoconstriction
  2. Platelet aggregation
  3. Thrombin generation
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3
Q

Intrinsic vs. Extrinsic pathway

A

Extrinsic (INR)

Intrinsic (PTT)

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4
Q

Prothrombin complex

A

10, 5, Ca, platelet factor 3, prothrombin

* Catalyzes the formation of thrombin

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5
Q

Which factor is the convergence factor for both coagulation pathways?

A

Factor 10

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6
Q

Which factor helps cross-link fibrin?

A

Factor 13

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7
Q

The key factor to the coagulation cascade

A

Thrombin

  • Converts fibrinogen to fibrin
  • Activates factor 5 & 8
  • Activates platelets
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8
Q

The key factors to anti-coagulation

A

AT3, protein C-S

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9
Q

Anti-thrombin 3

A

Binds to and inhibits thrombin; inhibits 9, 10, 11

Heparin activates AT3 (1,000x activity)

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10
Q

Protein C/S

A

C: degrades 5, 8, fibrinogen
S: co-factor

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11
Q

T/F Protein C-S are vitamin K dependent

A

True

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12
Q

Released from endothelium & converts plasminogen to plasmin

A

TPA

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13
Q

What factor degrades factors 5, 8, fibrinogen and fibrin?

A

Plasmin

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14
Q

Inhibitor of plasmin

A

Alpha-2-antiplasmin (released from endothelium)

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15
Q

Factor with the shortest half-life

A

Factor 7

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16
Q

Factors 5 & 8 are labile. Are there properties lost in stored blood? How about FFP?

A

Yes; no

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17
Q

Which is the only coagulation factor not synthesized in the liver?

A

Factor 8; synthesized in endothelium with VWF

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18
Q

Which are the vitamin K-dependent clotting factors?

A

2, 7, 9, 10, C, S

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19
Q

Until how long does IV Vitamin K take effect?

A

12 hours

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20
Q

FFP’s effect is…

A

Immediate

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21
Q

Half-life of RBC, platelet, PMN

A

RBC: 120 days; 7 days; 1-2 days

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22
Q

Prostacyclin (PGI2) vs. TXA2

A

Prostacylcin (endothelium); decreases platelet aggregation, and promotes vasodilation (antag to TXA2), increases cAMP in platelets
TXAs (platelets); increases aggregation; vasoconstriction; Calcium release in platelets– exposes Gp1b (platelet-collagen); Gp2b/3a (platelet-platelet)

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23
Q

Which blood product contains the highest [] of VWF-Factor 8?

A

Cryo; also has high levels of fibrinogen

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24
Q

T/F FFP has high levels of all coagulation factors, protein C, S, AT3

A

True

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25
DDAVP & conjugated estrogens cause release of
Factor 8 & VWF
26
Best test for synthetic liver function
INR
27
Routine anticoagulation PTT goal
60-90
28
ACT goal for routine anticoagulation
150-200
29
ACT goal for CP bypass
>480
30
Relative contraindication INR for surgery
>1.5
31
Relative contraindication INR for specials
>1.3
32
MCC surgical bleeding
Incomplete hemostasis
33
MC congenital bleeding disorder
VWF
34
MC symptom VWF deficiency
Epistaxis
35
Types 1, 2, 3 VWF deficiency inheritance. Which is most common? Which is most severe?
1,2: AD; 3: AR; Type 1 most common (70%); mild; Type 3 most severe
36
VWF binds to ________ on platelets and collagen
gp1b
37
In VWF deficiency, what are the bleeding/coagulation test expectations?
Bleeding time: Inc INR: Normal PTT: Normal or Inc
38
What is the ristocetin test?
Bleeding time
39
Type 1 VWF deficiency; treatment?
Reduced quantity | Treatment: Recombinant 8/VWF; DDAVP; Cryo
40
Type 2 VWF deficiency; treatment?
Defect in the molecule | Treatment: Recombinant 8/VWF; Cryo; DDAVP
41
Type 3; treatment?
Complete deficiency; recombinant; cryo | ** DDAVP will not work **
42
Hemophilia A vs. B | * Most common sx?
A: Factor 8; need levels 100% pre-op; 80-100% for 10-14 days post-op; follow PTT q8 hours post-op B: Factor 9; need levels 100% pre-op; 30-40% 3-4 days post-op * Hemarthroses
43
T/F Factor 8 crosses the placenta
True; a baby may not bleed at circumcision
44
Treatment of joint bleeding in a hemophliac.
Do NOT aspirate; ice/keep joint mobile; factor 8 or cryo
45
Treatement of epistaxis; intracerebral hemorrhage; hematuria in a hemophiliac
Recombinant factor 8; cryo
46
Christmas disease
Hemophilia B
47
Treatment for Hemophilia B
Recombinant factor 9; FFP
48
Platelet disorders (inherited)
Acquired thrombocytopenia: H2 blockers, heparin Bernard-Soulier: deficiency gp1b receptor on platelets (platelet-collagen); treatment-- platelets Thrombasthenia of G/N: deficiency gbp2b/3a receptor on platelets; (fibrin links these together); treatment -- platelets Uremia
49
Uremia leads to coagulopathy at what level?
60-80; inhibits platelet function (mainly the release of von Willebrand factor) * Treatment: dialysis, DDAVP (acute reversal), cryo (mod-severe)
50
Decreased platelets, low fibrinogen, high fibrin split products (high D-dimer); Prolonged PT and prolonged PTT
DIC; Often initiated by tissue factor | Tx: need to treat the underlying cause (eg sepsis)
51
How long before surgery should ASA be stopped?
7 days; inhibits COX which decreases TXA2; platelets lack DNA so they cannot resynthesize
52
Plavix is an ___________ antagonist.
ADP receptor antagonist; platelets (treatment for bleeding)
53
What to do if Plavix needs to be stopped pre-operatively in a patient with a fresh stent?
Tx: bridge with Integrilin (eptifibatide [GpIIb/IIIa inhibitor])
54
Treatment for Comadin bleeding?
FFP and Vitamin K
55
How far in advance should you bridge heparin/Coumadin pre-op?
7 days
56
Pre-op/post-op platelet goals?
50,000; 20,000
57
Prostate surgery can release .... Treatment?
Urokinase --> thrombolysis; Amicar (aminocaproic acid) which inhibits thrombolysis
58
Best way to predict bleeding risk?
H & P
59
T/F A normal circumcision rules out a bleeding disorder.
False (placental crossing of factors)
60
Abnormal bleeding with tooth extraction or tonsillectomy picks up what percentage of bleeding disorders?
99%
61
This sx is most common with bleeding/platelet disorders
Epistaxis
62
This sx is most common with bleeding disorders in females.
Menorrhagia
63
T/F Avoid giving platelets in HIT.
True; can cause thrombosis
64
HIT is 2/2
Anti-heparin antibodies (IgG heparin-PF4 Ab) resulting in platelet destruction
65
T/F HIT can induce thrombosis?
True; aggregation/thrombosis; platelets <100 or a drop by 50% from admission
66
T/F HIT can occur with low doses of heparin
True
67
Treatment of HIT
Stop heparin; start argatroban
68
Type 1 vs. 2 HIT
Type 1: benign (within 2 days); Type 2: severe

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