Hemostasis 2

Question 0

What factor # is vWF?

Answer 0

VIII

Question 1

Average half-life span of platelet

Answer 1

8-12 days

Question 2

How does vWF work?

Answer 2

Anchors platelets to collagen layer of damaged subendothelium of vessel.
One end attaches to vessel wall , other end attaches to platelet

Question 3

What is the most inherited coagulation defect?

Answer 3

Von Willebrand’s disease

Question 4

When should you suspect Von Willebrand’s disease?

Answer 4

Suspect In any person with increased bleeding time despite normal platelet count and normal clot retraction.

Question 5

What is the first line treatment for Von Willebrand’s disease?

Answer 5

DDAVP (desmopressin)

Causes release of endogenous stores of vWF.

Question 6

What factors does cryoprecipitate have?

Answer 6

VIII (vWF)
I (fibrinogen)
XIII
- give to pts with Von Willebrand’s who are not responsive to DDAVP.

Question 7

What 2 substances released from the activated platelet, stimulate platelet aggregation?

Answer 7

A2 and ADP

Question 8

What clotting factor activates the platelet at the site of vascular injury?

Answer 8

Thrombin (factor IIa)

Question 9

What substance links platelets together (aggregates them)?

Answer 9

Fibrinogen

Question 10

What agents inhibit platelet aggregation by impairing cyclo-oxygenase?

Answer 10

Asprin - lifetime of the platelet

NSAIDS - impair for 24-48 hrs

Question 11

What clotting factors are found in the extrinsic pathway?

Answer 11

III - thromboplastin
VII
“For .37 cents you can buy the extrinsic pathway”

Question 12

What clotting factors are found in the intrinsic pathway?

Answer 12

XII, XI, IX, VIII

“If you can not buy the intrinsic pathway for $12, you can get it for $11.98”

Question 13

What factors are found in the final common pathway?

Answer 13

X, V, II, I, XIII
“The final common pathway can be purchased at the five & dime (V, X), on the 13th (XIII) of the month for $1-$2 (I, II).”

Question 14

What clotting factor is considered the physiologic initiator of the coagulation cascade?

Answer 14

III - Tissue factor or Thromboplastin

Question 15

What clotting factor promotes fibrin cross-linking?

Answer 15

XIII - fibrin stabilizing factor

Question 17

Antithrombin III inhibits what five clotting factors? Which of these is in the intrinsic pathway? What two of these are most profoundly inhibited?

Answer 17

1. II, IX, X, XI, XII
2. IX, XI, XII
3. II, X

Question 18

What four clotting factors are Vit K dependent? Which is in the extrinsic pathway?

Answer 18

1. II, VII, IX, X

2. VII

Question 19

How does heparin work?

Answer 19

heparin works by increasing antithrombin effectiveness by 1,000 fold or more

Question 20

How does coumadin work?

Answer 20

Binds to Vit K receptor in liver and competatively inhibits Vit K which leads to Vit K dependent clotting factors being depressed

Question 21

What anticoagulent affects the intrinsic and final common pathways?

Answer 21

Heparin

Question 22

What 2 coagulation tests assess the extrinsic pathway?

Answer 22

PT, INR

Question 23

What 2 coagulation tests assess the intrinsic pathway?

Answer 23

PTT, ACT

Question 24

How does protamine work on heparin? What kind of reaction is this?

Answer 24

1. Protamine (positively charged) binds with heparin (negatively charged).
2. NEUTRALIZATION REACTION

Question 25

What enzyme is responsible for breaking down fibrin?

Answer 25

Plasmin

Question 26

What two pharmacological agents inhibit plasmin?

Answer 26

Aprotinin (Trasylol)
Epsilon (Amicar)
** Both are used in cardiac surgery to slow bleeding

Question 27

Name 3 substances that convert plasminogen to plasmin?

Answer 27

Tpa, Urokinase, Streptokinase

Question 28

When is aprotinin generally used in anesthesia? How does it work?

Answer 28

Used in cardiac surgery. Inhibits plasmin which slows fibrin breakdown and helps decrease surgical blood loss.

Question 29

What is a normal Activated Coagulation Time (ACT)?

Answer 29

80-150 sec

Question 30

What is the best test of primary hemostasis or platelet function?

Answer 30

ACT

Question 31

What is the most common reason for coagulopathy after a massive blood transfusion?

Answer 31

• Stored blood is deficient in platelets and factors V and VIII
• Diffuse bleeding during massive transfusion is due to thrombocytopenia

Question 32

What clotting factors are found in FFP?

Answer 32

all clotting factors but NO PLATELETS

Question 33

Cryoprecipitate contains what clotting factors?

Answer 33

VIIIc, VIII-vWF, 1 (Fibrinogen), XIII

Question 34

What are the typical manifestations of disseminated intravascular coagulopathy?

Answer 34

oozing and bleeding while labs show consumption of clotting factors and enhanced fibrinolysis

Question 35

Transfused blood is deficient in what two coagulation factors?

Answer 35

Factors V and VIII

Question 36

What is the most common cause of an isolated elevated PT?

Answer 36

Liver disease

Question 37

How much will 1 unit of platelets increase your platelet count?

Answer 37

5,000 - 10,000

Question 38

How much will 1 unit PRBC increase your hgb and hct?

Answer 38

Hgb - 1%
Hct - 3-4%
***remember Hct is usually 3 times higher than your Hgb

Question 39

What are the 3 byproducts of Tumor Lysis Syndrome that will be elevated in the blood?

Answer 39

Potassium
Phosphates
Uric Acid