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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
Q

DDAVP & conjugated estrogens cause release of

A

Factor 8 & VWF

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26
Q

Best test for synthetic liver function

A

INR

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27
Q

Routine anticoagulation PTT goal

A

60-90

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28
Q

ACT goal for routine anticoagulation

A

150-200

29
Q

ACT goal for CP bypass

A

> 480

30
Q

Relative contraindication INR for surgery

A

> 1.5

31
Q

Relative contraindication INR for specials

A

> 1.3

32
Q

MCC surgical bleeding

A

Incomplete hemostasis

33
Q

MC congenital bleeding disorder

A

VWF

34
Q

MC symptom VWF deficiency

A

Epistaxis

35
Q

Types 1, 2, 3 VWF deficiency inheritance. Which is most common? Which is most severe?

A

1,2: AD; 3: AR; Type 1 most common (70%); mild; Type 3 most severe

36
Q

VWF binds to ________ on platelets and collagen

A

gp1b

37
Q

In VWF deficiency, what are the bleeding/coagulation test expectations?

A

Bleeding time: Inc
INR: Normal
PTT: Normal or Inc

38
Q

What is the ristocetin test?

A

Bleeding time

39
Q

Type 1 VWF deficiency; treatment?

A

Reduced quantity

Treatment: Recombinant 8/VWF; DDAVP; Cryo

40
Q

Type 2 VWF deficiency; treatment?

A

Defect in the molecule

Treatment: Recombinant 8/VWF; Cryo; DDAVP

41
Q

Type 3; treatment?

A

Complete deficiency; recombinant; cryo

** DDAVP will not work **

42
Q

Hemophilia A vs. B

* Most common sx?

A

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
Q

T/F Factor 8 crosses the placenta

A

True; a baby may not bleed at circumcision

44
Q

Treatment of joint bleeding in a hemophliac.

A

Do NOT aspirate; ice/keep joint mobile; factor 8 or cryo

45
Q

Treatement of epistaxis; intracerebral hemorrhage; hematuria in a hemophiliac

A

Recombinant factor 8; cryo

46
Q

Christmas disease

A

Hemophilia B

47
Q

Treatment for Hemophilia B

A

Recombinant factor 9; FFP

48
Q

Platelet disorders (inherited)

A

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
Q

Uremia leads to coagulopathy at what level?

A

60-80; inhibits platelet function (mainly the release of von Willebrand factor)
* Treatment: dialysis, DDAVP (acute reversal), cryo (mod-severe)

50
Q

Decreased platelets, low fibrinogen, high fibrin split products (high D-dimer); Prolonged PT and prolonged PTT

A

DIC; Often initiated by tissue factor

Tx: need to treat the underlying cause (eg sepsis)

51
Q

How long before surgery should ASA be stopped?

A

7 days; inhibits COX which decreases TXA2; platelets lack DNA so they cannot resynthesize

52
Q

Plavix is an ___________ antagonist.

A

ADP receptor antagonist; platelets (treatment for bleeding)

53
Q

What to do if Plavix needs to be stopped pre-operatively in a patient with a fresh stent?

A

Tx: bridge with Integrilin (eptifibatide [GpIIb/IIIa inhibitor])

54
Q

Treatment for Comadin bleeding?

A

FFP and Vitamin K

55
Q

How far in advance should you bridge heparin/Coumadin pre-op?

A

7 days

56
Q

Pre-op/post-op platelet goals?

A

50,000; 20,000

57
Q

Prostate surgery can release …. Treatment?

A

Urokinase –> thrombolysis; Amicar (aminocaproic acid) which inhibits thrombolysis

58
Q

Best way to predict bleeding risk?

A

H & P

59
Q

T/F A normal circumcision rules out a bleeding disorder.

A

False (placental crossing of factors)

60
Q

Abnormal bleeding with tooth extraction or tonsillectomy picks up what percentage of bleeding disorders?

A

99%

61
Q

This sx is most common with bleeding/platelet disorders

A

Epistaxis

62
Q

This sx is most common with bleeding disorders in females.

A

Menorrhagia

63
Q

T/F Avoid giving platelets in HIT.

A

True; can cause thrombosis

64
Q

HIT is 2/2

A

Anti-heparin antibodies (IgG heparin-PF4 Ab) resulting in platelet destruction

65
Q

T/F HIT can induce thrombosis?

A

True; aggregation/thrombosis; platelets <100 or a drop by 50% from admission

66
Q

T/F HIT can occur with low doses of heparin

A

True

67
Q

Treatment of HIT

A

Stop heparin; start argatroban

68
Q

Type 1 vs. 2 HIT

A

Type 1: benign (within 2 days); Type 2: severe

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