Hemostasis Flashcards
Intrinsic Path (measured): _ elements which activates…. to produce…
(PTT); exposed collagen +XII -> XI, IX-> X which activates thrombin to produce fibrin
Extrinsic pathway (measured): _elements -> _elements-> _product
(PT); tissue factor + VII -> activaed X -> fibrin
_ is common to both extrinsic and intrinsic pathway
X
_ crosslinks _ to form ‘plug’
XIII crosslinks fibrin to form ‘plug’
… is best single test to evaluate synthetic function of the liver
PT
Banked blood is low in _ which increases _
low in 2,3-DPG which increases Hgb affinity for o2 (left shift)
Cryo contains _ and _; used in _, _, _
fibrinogen and VWF-VIII; used in vWD, hemophilia A, and DIC if fibrinogen low
Vit K inhibits:
II, VII, IX, X, protein C and protein S
Protein C degrades…
active V and VIII; Protein S helps protein C
_ and _ are labile factors, low levels stored in blood
V and VIII
_ only factor no made in liver…. made by _
Factor VIII made by reticuloendothelial system
Von Willebrands Disease:
PTT, BT, +/- ristocetin test?
Long PTT, long BT, +test
Types of VWD with low amount:
Types of VWD with poor quality:
Type I and III have low amounts of vWF, these respond to ddAVP; type II is quality poor vWF
VwD inheritancy
autosomal dominant
Rx for VWD: _, _, _
VIII, vWF or cryoprecipitate
ddAVP causes _; also useful in _
release of VWF; useful in pts on ASA or w uremic plt
Glanzman’s thrombasthenia:
defect. ..
effect. ..
plts have IIb/IIa receptor deficieny; decreases plt aggregation
Brenard Soulier:
defect. ..
effect. ..
Ib deficiency; decre adherence to exposed collagen
VII deficiency causes:
long PT, normal PTT
Hemophilia A=
Inheritancy…
Preop replace…
PTT? PT? Newborn?
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
Hemophilia B=
Inheritancy…
Preop replace…
IX deficiency= christmas disease; also sex-linked; achieve 50% levels pre-op
Rx Hemophiliac joint
DO NOT ASPIRATE; ice ROM therapy, give factor VIII
Lupus anticoagulant: pro/anti coagulant?
antiphospholipid antibodies; not necessarily with Luppus and generally pro-coagulant
Dx Lupus anticoagulant:
long Russel viper venom time, long PTT, which does not correct by adding normal plasma
Factor XII: activated by…. need for…
Hagemann factor; activated by cardiopulmonary bypass -> need for heparin
Factor V Leiden:
Defect…
Effect…
Resistance to activated protein C; common cause of DVT
Plasmin degrades _; inhibited by _
fibrinogen, inhibited by alpha-2-plasmin inhibitor
Heparin binds/activates… and inactivates… PTT? How to counteract?
binds ATIII; inactivates factor 9-12; prolongs PTT; counteract with protamine
Epsilon-ACA (Epsilon amino caproic acid); inhibits _; Rx for _
inhibits fibrinolysis; rx for overdose thrombolytics
Best test to monitor thrombolysis
Thrombin
DIC: platelets? PT? PTT? Fibrinogen? Fibrin Split products?
low platelets, prolonged PT/PTT, low fibrinogen, high fibrin split products
HIT: Defect... Effect... Use _ to anticoagulate When to see? Less often with?
‘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
Prostacylcin
abv?
from?
Effect _, _, _
PGI2; from endothelium; decr plt aggregation, causes vasodilatation, bronchial relaxation
Thromboxane:
from?
Effects?
from platelets; increase plt aggregation, VC, bronchial constriction
Best preop test for pt on NSAIDS/ASA
Bleeding time
