Hemostasis and Thrombosis

Question 1

what is primary hemostasis

Answer 1

platelet plug formation. Aspirin inhibits this process.

Question 2

normal and abnormal platelet ranges

Answer 2

norm: 15-45*10^10/L
if <50 you have increased risk of bleeding post trauma.
- if <20 risk of spontaneous bleeding
- <10 risk of intracranial haemorrhage

Question 3

what is PFA-200

Answer 3

is platelet function assay, which sends blood through cartilages, and exposed it to ADP, collagen, and epinephrine which encourage aggregation

Question 4

what is secondary hemostasis

Answer 4

involves the coagulation system, and results in fibrin deposition and formation. It stabilises the platelet plug

Question 5

what are FVII, protein S and C

Answer 5

anti coagulants

Question 6

what is tertiary hemostasis

Answer 6

clot dissolution. Occurs by hydrolysis of fibrin by plasmin

Question 7

what tests do you use to evaluate bleeding patients

Answer 7

• PT should be 10-13 s
• activated PTT should 23-26
• fibrinogen test should be 130-330 mg/dL
• measure coagulation factors and diagnosis test for vWF

Question 8

second or reactive thrombocytosis is

Answer 8

the increase in platelet number during inflammation and mild iron deficiency

Question 9

pseudo-thrombocytopenia is

Answer 9

platelet count is normal but they are sticking together. often just a lab issue, remember to collect blood in tube with EDTA

Question 10

main causes of primary hemostatis disorders (aka platelet disorders)

Answer 10

• ITP: pts have antibodies against Gp2b/3a and Gp1b/9 –severe thrombocytopenia, petechiae, purpura, clinical bleeding
• DIT
• HIT (due to immune reaction to unfractioned heparin) – for these patients use argatroban or fondaparinux instead of heparin

Question 11

treatment of bleeding disorders

Answer 11

• reach normal platelet count, corticosteroids, anti-d globulin.
• splenectomy, rituximab, thrombo plug

Question 12

most relavent inherited and acquired thrombotic disorders

Answer 12

• TAR syndrome (mutation in RBM8A)
• Congenital amehakaryocytosis
• gray platelet syndrome (mutation in NBEAL2)
• May hegglin syndrome (mutation in MYH9 for myosin)

Question 13

treatment of thrombosis

Answer 13

• transfusion of platelet concentrates
• activated favtor VII
• desmopressin to elease vWF
• anti fibbrinolytics like tranexamic acid