Hemostasis

Question 1

Intrinsic Path (measured): _ elements which activates…. to produce…

Answer 1

(PTT); exposed collagen +XII -> XI, IX-> X which activates thrombin to produce fibrin

Question 2

Extrinsic pathway (measured): _elements -> _elements-> _product

Answer 2

(PT); tissue factor + VII -> activaed X -> fibrin

Question 3

_ is common to both extrinsic and intrinsic pathway

Answer 3

X

Question 4

_ crosslinks _ to form ‘plug’

Answer 4

XIII crosslinks fibrin to form ‘plug’

Question 5

… is best single test to evaluate synthetic function of the liver

Answer 5

PT

Question 6

Banked blood is low in _ which increases _

Answer 6

low in 2,3-DPG which increases Hgb affinity for o2 (left shift)

Question 7

Cryo contains _ and _; used in _, _, _

Answer 7

fibrinogen and VWF-VIII; used in vWD, hemophilia A, and DIC if fibrinogen low

Question 8

Vit K inhibits:

Answer 8

II, VII, IX, X, protein C and protein S

Question 9

Protein C degrades…

Answer 9

active V and VIII; Protein S helps protein C

Question 10

_ and _ are labile factors, low levels stored in blood

Answer 10

V and VIII

Question 11

_ only factor no made in liver…. made by _

Answer 11

Factor VIII made by reticuloendothelial system

Question 12

Von Willebrands Disease:

PTT, BT, +/- ristocetin test?

Answer 12

Long PTT, long BT, +test

Question 13

Types of VWD with low amount:

Types of VWD with poor quality:

Answer 13

Type I and III have low amounts of vWF, these respond to ddAVP; type II is quality poor vWF

Question 14

VwD inheritancy

Answer 14

autosomal dominant

Question 15

Rx for VWD: _, _, _

Answer 15

VIII, vWF or cryoprecipitate

Question 16

ddAVP causes _; also useful in _

Answer 16

release of VWF; useful in pts on ASA or w uremic plt

Question 17

Glanzman’s thrombasthenia:

defect. ..
effect. ..

Answer 17

plts have IIb/IIa receptor deficieny; decreases plt aggregation

Question 18

Brenard Soulier:

defect. ..
effect. ..

Answer 18

Ib deficiency; decre adherence to exposed collagen

Question 19

VII deficiency causes:

Answer 19

long PT, normal PTT

Question 20

Hemophilia A=
Inheritancy…
Preop replace…
PTT? PT? Newborn?

Answer 20

VIII deficiency; sex linked recessive, replace to 100% levels pre-op; long PTT, normal PT; newborn has VIII from mom, may not bleed at cicumcision

Question 21

Hemophilia B=
Inheritancy…
Preop replace…

Answer 21

IX deficiency= christmas disease; also sex-linked; achieve 50% levels pre-op

Question 22

Rx Hemophiliac joint

Answer 22

DO NOT ASPIRATE; ice ROM therapy, give factor VIII

Question 23

Lupus anticoagulant: pro/anti coagulant?

Answer 23

antiphospholipid antibodies; not necessarily with Luppus and generally pro-coagulant

Question 24

Dx Lupus anticoagulant:

Answer 24

long Russel viper venom time, long PTT, which does not correct by adding normal plasma

Question 25

Factor XII: activated by…. need for…

Answer 25

Hagemann factor; activated by cardiopulmonary bypass -> need for heparin

Question 26

Factor V Leiden:
Defect…
Effect…

Answer 26

Resistance to activated protein C; common cause of DVT

Question 27

Plasmin degrades _; inhibited by _

Answer 27

fibrinogen, inhibited by alpha-2-plasmin inhibitor

Question 28

Heparin binds/activates… and inactivates… PTT? How to counteract?

Answer 28

binds ATIII; inactivates factor 9-12; prolongs PTT; counteract with protamine

Question 29

Epsilon-ACA (Epsilon amino caproic acid); inhibits _; Rx for _

Answer 29

inhibits fibrinolysis; rx for overdose thrombolytics

Question 30

Best test to monitor thrombolysis

Answer 30

Thrombin

Question 31

DIC: platelets? PT? PTT? Fibrinogen? Fibrin Split products?

Answer 31

low platelets, prolonged PT/PTT, low fibrinogen, high fibrin split products

Question 32

HIT:
Defect...
Effect...
Use _ to anticoagulate
When to see?
Less often with?

Answer 32

‘white clot syndrome’; thrombocytopenia due to anti-platelet antibody causing plt aggregation; use dextran to anticoagulate; see after 5 days of heparin; less frequent with LMWH

Question 33

Prostacylcin
abv?
from?
Effect _, _, _

Answer 33

PGI2; from endothelium; decr plt aggregation, causes vasodilatation, bronchial relaxation

Question 34

Thromboxane:
from?
Effects?

Answer 34

from platelets; increase plt aggregation, VC, bronchial constriction

Question 35

Best preop test for pt on NSAIDS/ASA

Answer 35

Bleeding time