Hemostasis

Question 1

What is the difference between the Primary and Secondary phases in Hemostasis?

Answer 1

Primary

• Vascular phase = immediate response
• Platelet phase = 1-2 seconds

Secondary

• Coagulation phase = 10-20 seconds
• Fibrin formation = 1-3 minutes

Question 2

What platlet count defines Thrombocytopenia?

Answer 2

< 150,000 MicroL

Question 3

What are some Acquired Quantitative Platelet Disorders?

Answer 3

• Liver Disease
• Bone Marroe Disease
• Alcohoic Suppression of Marrow
• Medications
• Idiopathic

Question 4

What is an Inherited Disease that is both Quantitative and Qualitative in regards to Platelet Disorders?

Answer 4

Von Willebrands Disease

Question 5

What is Von Willderand’s Disease?

Answer 5

• Most commone inherited bleeding disorder
• Autosomal dominant; 1:1000 people
• Qualitative or Quantitative defect of vWF

Question 6

What are the 3 tyeps of Von Willebrand’s Disease?

Answer 6

1. Most common; quantitative, 70-80%
2. Has subyptes; qualitative
3. Most Severe; quantitative, < 5%

Question 7

Define Bleeding Time…

Answer 7

Question 8

What is aPTT (Active Partial Thromboplastin Time)?

How is it different than PT?

Answer 8

Question 9

Describe the clotting cascade…

Answer 9

Question 10

How do you treat Von Willdebrand’s Disease?

Answer 10

• DDAVP (Desmopressin Acetate)
• Cryo Therapy
• Factor VIII

Question 11

What is PFA?

Answer 11

Question 12

What is a CBC?

Answer 12

Packed Cell Volume…% of whole blood that are RBCs…

Question 13

What is a normal platelet count?

Answer 13

150,000 - 400,000/ml

Question 14

What are 3 Inherited Coagulation Disorders?

Answer 14

• Hemophilia A - Factor VIII
• Hemophilia B - Factor IX
• Hemophilia C - Factor XI

Question 15

What are 2 Acquired Coagulation Disorders?

Answer 15

• Liver Disease
• Vit K Deficiency

Question 16

What are 7 drugs that cause therapeutic anticoagulation?

Answer 16

1. Coumadin
2. Pradaxa
3. Eliquis
4. Xarelto
5. Heparin
6. Levenox
7. Arixtra

Question 17

What is the most common cause of prolonged bleeding?

Answer 17

Acquired Coagulation Disorders

Question 18

What are some indications for Therapeutic Anticoagulation?

Answer 18

• Mechanical heart valves
• Atrial fibrillation
• Hx of thromboembolic stroke, TIA
• Hx of deep venous thrombosis
• Hx of pulmonary embolism

Question 19

Describe Coumadin…

Answer 19

• Half life - 2.5 days
• Taken PO
• Inhibits Vit K
• Inhibits Factors: II, VII, IX, X

Question 20

Describe Heparin…

Answer 20

• Half life - 60-90 minutes
• Given IV
• Inhibits the Intrinsic Pathway

Question 21

Describe Lovenox…

Answer 21

• Half life - 4-7 hours
• Given SQ (Sub-Cutaneous Injection)
• Inhibits Intrinsic Pathway

Question 22

Describe Lepirudin…

Answer 22

• Half life - 1-2 hours
• Given IV
• Direct Thrombin Inhibitor

Question 23

Describe Arixtra…

Answer 23

• Half life - 17-21 hours
• Given SQ (Sub-Cutaneous)
• Direct Thrombin Inhibitor

Question 24

Describe Pradaxa…

Answer 24

• Half life - 12-17 hours
• Given PO
• Direct Thrombin Inhibitor

Question 25

Describe Xarelto/Eliquis...

Answer 25

* Half life - 8-15 hours * Given PO * Activated F 10 inhibitor

Question 26

What is the average PT?

Answer 26

* Prothrombin Time * 10-12 seconds

Question 27

What is the average aPTT?

Answer 27

* Activated Partial Thromboplastin Time * 25-30 seconds

Question 28

Describe the critical role of fibrin...

Answer 28

Question 29

What is INR?

Answer 29

Question 30

What are normal values of INR?

Answer 30

Question 31

What are some ways you can medically manage a patient with bleeding disorders regarding Blood or Blood Products?

Answer 31

* FFP (Fresh Frozen Plasma) - Coagulation Factors * Factor VIII * Cryoprecipitate - Factors: 1, 5, 8, vWF

Question 32

What vitamin is critical in medical management of coagulation chalenged patients?

Answer 32

Vitamin K

Question 33

Where do you manage a pt on Heparin?

Answer 33

In patient

Question 34

Where can you manage a patient on Lovenox?

Answer 34

Out patient

Question 35

Describe different dental procedures you can do in respect to low/high INR ranges...

Answer 35

Question 36

When is Post-Op Hemorrage reported for Coumadin under what INR ranges?

Answer 36

* 4.4% (7 cases of 162) * INR 1.5 - 1.99 - 2 cases of 80 * INR 2.0 - 2.49 - 5 cases of 50 * INR 2.5 - 2.99 - 0 cases of 27 * INR \> 3.0 - 0 cases of 5

Question 37

What are 3 things a dentist can do to achieve hemostasis?

Answer 37

1. Presure 2. Excellent Surgical Technique 3. Primary Closure if Possible

Question 38

What are 5 chemo therapeutic agents you can use to help achieve hemostasis?

Answer 38

* Microfibrillar Collagen * Gelfoam * CollaPlug * Surgicel * Topical Thrombin

Question 39

What is Microfibrillar Collagen?

Answer 39

Question 40

What is Gelfoam?

Answer 40

Question 41

What is CollaPlug?

Answer 41

Question 42

What is Surgicel?

Answer 42

Question 43

What is Topical Thrombin?

Answer 43

Question 44

What is plasminogen?

Answer 44

The inactive precursor of the enzyme plasmin present in blood

Question 45

Describe Fribrinolysis...

Answer 45

Question 46

What are 2 drugs that counteract Fibrinolysis?

Answer 46

* Transexamic Acid * Amicar (episilon aminocaproic acid)

Question 47

If you order a CBC, what values can you expect to see?

Answer 47

Question 48

What is a CHEM 7 Lab Test?

Answer 48

This test can be used to evaluate kidney function, blood acid/base balance, and your levels of blood sugar, and electrolytes. Depending on which lab you use, a basic metabolic panel may also check your levels of calcium and a protein called albumin.

Question 49

If you order a COAGS lab test, what are you ordering?

Answer 49