HEME-Coagulation D/o Flashcards
Who and what is Virchow Triad?
Rudulph Virchow-
- Venous Statis
- Vascular injury
- Hypercoagulabilty
What is the foundation of clotting?
Fibrin
Contained in a thrombus
Active form of FACTOR 1
Fibrinogen= precursor of fibrin COMMON PATH
What inhibits platelets by the endothelial lining of blood vessels? What activates platelets?
Inhibited- NO and ADPase-
Activate.- injury, von Willebrand’s Factor vWF- activate from exposure of collagen which release vWF
Activation of platelets-change shape form mesh
Does DEC in proteins such as vWF, factors, fibrongen cause issues with clotting?
NO- platelets don”t require a lot of protein. Only needed for aggregation. Little Damage=
What is a clot composed of?
erythrocytes, platelets, and fibrin.
What does Plasmin do?
THROMBOLYSIS- eat the fibrin web
Blood wavering btwn clotting and thrombolysis.
*Tissue Plasminogen active plasminogen to plasmin- TPA clot buster
What are 2 causes of bleeding excessive/repetitive at unusual sites?
Bleeding Disorders
- problems with platelets- skin and mucosa
A. epistaxis, gum bleeding, menorrhagia. - clotting factor deficiencies- skin and muscles. A. hemathroses)
The following are part of what kind of bleeding d/o: Vascular integrity Platelet function Fibrinolysis Coagulation factors
Congenital -single defect - one protein
The following are part of what kind of bleeding d/o: Cancer* infection, shock, obstetrics, malabsorption, autoimmune disorders drugs NSAIDs, aspirin, thiazides, anticoagulants
Acquired: liver, kidneys, collagen, immune
What compares PT to a standard;
0.9-1.2 is normal
INR = International Normalized Ratio
What measures rate of conversion between fibrinogen and fibrin?
Thrombin clotting time
Mr. Purple c/o of skin bruising. PE- petechiae, purpura in mount and skin. What is likely d/o?
Thrombocytopenia ● MCC for abnormal bleeding. ●DEC in platelets. ● Causes: impaired production, INC destruction, splenic sequestration-traped in spleen, gets large dilution.
Mr. Sklyer is a child post URI with the following work up: what is DX? ■Plateles- 10K-20K mild anemia ○ Peripheral smear-megathrombocytes ○ Coags Normal- PT, PTT, INR= N
ITP: Idiopathic Thrombocytopenic Purpura
What is difference btwn acute and chronic ITP?
Acute: children, **self-limited, autoimmune, recent viral URI.
● Chronic: any age
women, w/ other
autoimmune
Mr. Purple petechia is mild. He has PMH of epistaxis and mouth bleeds? Is this chronic or acute?
CHRONIC ITP
Acute-abrupt petechiae, purpura, or even hemorrhagic bullae on skin and mucous membranes.
Which status of ITP requires treatment?
CHRONIC
high dose prednisone
■ IV immunoglobulin, stem cell therapy
■ Splenectomy
What d/o is in children where destruction of platelets L/T anemia, kidney failure d/t small vessel damage?
Hemolytic-uremic syndrome (HUS)
What d/o is INC blood clots formed in blood vessels make it hard for O2 to reach organs, ie kidneys?
Thrombotic thrombocytopenic purpura (TTP)
FATAL
RARE
WOMEN
IMC-HIV
Known cause genetic mutation L/T microvascular infarcts
What d/o is bleeding in people with severe underlying
illness, sepsis, cancer?
Disseminated intravascular coagulation (DIC)
TX- all d/o tranfusion, steriods, plasmpheresis
Are von Willebrand’s factor enzymes or binding factors?
NOT an enzyme- no catalyzing function.
Binds to:
- collagen,
- platelets,
- ** Factor VIII.
Mr. Von has prolonged bleeding in mucous membranes.
Labs- Low vWF+Factor VIII, prolonged INR
Which factor is import in Von Willebrand dz?
AD- Congenital
FACTOR VIII- binds to vWF
thrombin doesn’t have enough Factor VIII to activate, so Factor X doesn’t get activated as much.
DEC 8= DEC X=DEC Thrombin= NO Clots= INC Bleeding
What endocrine hormone treats vWV dz?
Desmopression-vaospression-ADH
Transfusion Factor VIII
This bleeding d/o affects MEN only. Risk include
a. epistaxis, intracranial bleeding, hematemesis, melena, microscopic hematuria.
What is hallmark sign of this condition?
Hemophilia A8-X-linked AR-rare
HEMEARTHROSIS + FACTOR VIII deficiency
What factor is related with Hemophilia B9?
Factor IX- X-linked AR
Rare
