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Hematology Flashcards

1
Q

Which endothelial layer acts as the lining separating flowing blood from the vessel and is made of endothelial cells?

A

Tunica Intima

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2
Q

Which endothelial layer forms a barrier separating fluid contents within the blood vessel from the highly thrombogenic material?

A

Tunica Intima

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3
Q

Which endothelial layer contains the highly thrombogenic material?

A

Tunica Media

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4
Q

What activates the clotting cascade pathway when injury to the vessel occurs?

A

Tissue factor

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5
Q

Which cofactor is necessary for adherence of platelets to the subendothelial layer?

A

Von Willebrand Factor (vWF)

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6
Q

What two substances can be released from endothelial cells that produce vasoconstriction?

A
  1. Thromboxane A2

2. Adenosine Diphosphate (ADP).

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7
Q

What two substances can be released from the endothelial cells that produce vasodilation?

A
  1. Nitric oxide

2. Prostacyclin

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8
Q

What can be released from the endothelial cells that is a coagulation inhibitor?

A

Tissue Factor Pathway Inhibitor.

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9
Q

What two substances can be released from the subendothelial layer?

A
  1. Collagen

2. Fibronectin

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10
Q

Where are platelets formed?

A

Bone marrow

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11
Q

How long do platelets live?

A

8-12days

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12
Q

What is the main role of the Tunica Adventitia layer?

A

Control of blood flow by influencing the vessel’s degree of contraction

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13
Q

What is the average concentration of platelets in the blood?

A

150,000-300,000/mm3

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14
Q

T/F: Platelet cells do not contain mitochondria, RNA, DNA, and do not reproduce?

A

False; platelets do contain mitochondria

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15
Q

What is thrombin’s 2 roles inside of the platelet?

A
  1. Activate coagulation factors

2. Influence recruitment of platelets

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16
Q

What are the five steps following vessel injury that cause clot formation?

A
  1. Disruption of endothelial lining
  2. Vessel wall contraction
  3. Adhesion
  4. Activation
  5. Aggregation
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17
Q

Does the vessel wall constrict or relax immediately following a vessel injury and why?

A

Constricts via 1. ANS reflex

  1. Thromboxane A2
  2. ADP
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18
Q

What factor begins the adhesion step of forming the primary plug?

A

von Willebrand Factor (vWF).

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19
Q

What does vWF attach to on the platelet cell?

A

Glycoprotein Ib (GpIb

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20
Q

What substance causes the platelet to undergo conformational change and become “activated”?

A

Tissue Factor

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21
Q

What does GpIIb and GpIIIb receptors complex do?

A

Links activated platelets together (called aggregation).

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22
Q

What does the platelet release into the blood once “activated”?

A
  1. Alpha granules
  2. Dense granules
  3. Thrombin
  4. Procoagulant mediators
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23
Q

What is another name for activation of cofactors?

A

Zymogens

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24
Q

What two factors are associated with the extrinsic pathway?

A

III and VII

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25
All coagulation factors are synthesized where (except for 3 factors)?
The liver
26
Where are the other coagulation factors synsthesized?
III=Vascular wall, IV=Ca++ in diet vWF=Endothelial cells
27
How is the extrinsic pathway activated?
Tissue factor that happens outside the tissue wall
28
What are examples of injuries that activate the extrinsic pathway?
1. Organ trauma | 2. Crushing injury
29
Which factor is tissue factor?
Factor III
30
Which factor is Proconvertin?
Factor VII
31
What initiates the intrinsic pathway?
Initiated when damage occurs to blood vessel itself
32
Which factors are involved in the intrinsic pathway?
Factor XII, XI, IX, VIII
33
What is the progression of factors in the intrinsic pathway?
XII, XIIa, XI, XIa, IX, IXa, VIII, VIIIa
34
When the intrinsic and extrinsic pathways meet, what is formed?
XV (Prothrombinase Complex). Combination of Factor X and Factor V
35
What is the name of inactivated Factor II?
Prothrombin
36
What is the name of activated Factor II (Factor IIa)?
Thrombin
37
What is the name of inactive Factor I?
Fibrinogen
38
What is the name of activated Factor I (Factor Ia)?
Fibrin
39
Lastly, what factor acts on Fibrin to produce Fibrin Stabilization?
Factor XIII
40
Once fibrin stabilization has occurred, it is considered a stable or unstable clot?
Stable Clot
41
What is the name of Factor IV? IX?
IV=Calcium | IX=Christmas
42
Which reaction is important step for both intrinsic and extrinsic pathways?
Conversion of Prothrombin to Thrombin
43
What is thrombin's role?
1. Activates Factors V, VIII, I, and XIII | 2. Recruitment of Platelets to injured area
44
T/F: Thrombin can only produce coagulation factors and helps only with coagulation?
False; it can act as anti-coagulation as well
45
How does thrombin produce anticoagulation?
1. Release tPA 2. Stimulates Protein C and Protein S 3. Interferes with coagulation by forming relationship with Factor III
46
Which factors are Vitamin K Dependent?
II, VII, IX, and X
47
What are the three phases of hemostasis described by cell-based theory of coagulation?
1. Initiation 2. Amplification 3. Propagation
48
According to the cell based theory, what is activated by TF/VII complex?
Factor X (common) and IX (intrinsic)
49
Why does the fibrinolytic system exist?
To degrade fibrin
50
What is the first step in the fibrinolytic system?
Increased blood flow to site of injury to remove procoagulant mediators (ADP and Thromboxane)
51
How does antithrombin III interfere with coagulation?
By removing clotting factors from the clotting cascade (XII, XI, X, IX)
52
Three main ways fibrinolytic system works?
1. Tissue factor pathway inhibitor 2. Protein C and S 3. Antithrombin III
53
What substance ultimately degrades fibrin into fibrin degradation products?
Plasmin
54
What stops the fibrinolytic process?
Fibrinolytic mediators called Alpha-Antiplasmin and tissue plasminogen activator inhibitor (tPA inhibitor)
55
What are three herbal medications that influence coagulation?
Gingko, Ginger, Garlic
56
What surgeries are examples of high bleeding risk?
Cardiac surgery, AAA repair, neurosurgery, cancer surgery, TURP, Kidney biopsy, Bilat Knee replacement
57
What surgeries are considered intermediate bleeding risk?
Abd surgery, orthopedic surgery, endarterectomy or carotid bypass, non-cataract eye surgery, extensive dental surgery, cardiac defibrillator insertion,
58
How many days before high, intermediate, or low risk surgeries would you stop warfarin use?
5 days before surgery
59
What is normal PT?
12-14 sec
60
What is normal aPTT?
25-32 seconds
61
What is normal ACT?
80-150 seconds
62
Which laboratory test is altered by coumadin?
Prothrombin Time
63
Which laboratory test is altered by ASA and NSAIDS?
Bleeding time
64
What laboratory test is altered by heparin or lovenox?
aPTT (activated partial thromboplastin time)
65
What is treatment of von Willebrand Disease?
DDAVP and cryoprecipitate
66
What is platelet count is considered thrombocytopenic?
<100,000/mm3
67
Should expect bleeding below what platelet count?
<50,000/mm3
68
Should expect SPONTANEOUS bleeding below what platelet count?
<20,000/mm3
69
Prothrombin time (PT) measures the efficiency of what pathway(s)?
Extrinsic and common pathways
70
Activated partial thromboplastin time (aPTT) measures the efficiency of what pathway(s)?
Intrinsic and common pathways
71
Which laboratory value would you check if patient on coumadin therapy?
Prothrombin time
72
What is the most common inherited coagulation disorder?
von Willebrand Disease
73
Where is vWF synthesized?
1. Endothelial cells | 2. Megakaryocytes
74
Which factor is deficient in Hemophilia Type A?
Factor VIII
75
Which factor is deficient in Hemophilia Type B?
Factor IX
76
What is the most common surgical procedure for patient with Sickle Cell disease?
Cholecystectomy
77
What is intraoperative management of patient with Sickle Cell Disease?
1. Maintain normothermia 2. Maintain spO2>95% 3. Aggressive fluid hydration 4. Transfuse only if necessary and do not elevate Hgb>11
78
What is the mnemonic for memorizing the clotting factors in order?
Foolish People Try Climbing Long Slopes After Christmas, Some People Have Fallen
79
Names the factors in order I-XIII
Fibrinogen, Prothrombin, Tissue Factor, Calcium, Labile Factor, Stable Factor, Antihemophilic Factor, Christmas, Stuart-Prower Factor, Plasma Thromboplastin Antecedent, Hageman factor, Fibrin stabilizing factor
80
Warfarin inhibits what?
All vitamin K dependent factors (II, VII, IX, X) and Proteins C and S
81
What does heparin bind to to produce anticoagulant effects?
Antithrombin (AT) and creates Heparin-AT complex
82
What does Heparin AT Complex neutralize?
Neutralizes Thrombin and Factors XII, XI, X, and IX (and inhibits platelet function)
83
What is pretreatment before surgery for patient with vWD Type III?
Purified VIII and vWF concentrate
84
What is pretreatment before surgery for patient with vWD Type I?
Desmopressin (DDAVP)
85
Why is DDAVP not ideal for vWD Type III?
Because these patients do not produce any vWF
86
What two coagulopathies would cause abnormal aPTT and normal PT?
Hemophilia type A and Hemophilia type B
87
What factor deficiencies would cause a prolonged PTT AND PT?
Deficiency of factors II and X
88
What are four lab abnormalities that characterize DIC?
1. Increased PT/PTT 2. Increased d-Dimer 3. Decreased platelets 4. Decreased fibrinogen
89
What are 5 triggers for Sickle Cell Crisis?
1. Pain 2. Dehydration 3. Hypoxia 4. Acidosis 5. Hypothermia
90
What are two common comorbidities associated with Sickle Cell disease?
1. Asthma (50%) | 2. Pulmonary HTN (10%)

Fundamental 2 (7 decks)

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