lab eval of hemostasis

Question 1

pro-coagulation results in

Answer 1

obstruction & stasis –> ischemia

Question 2

anti-coagulation results in

Answer 2

bleeding, blood loss

Question 3

what is hemostasis dependent upon?

Answer 3

Vessel wall integrity
platelet #
Fxnl platelets
Clotting Factors #
Fxnl Fibrinolytic pathway

Question 4

extrinsic pathway initiated by

Answer 4

Tissue Factor

Question 5

plt is in what unit? on what panel? in what tube?

Answer 5

platelet count
# platelets/mm3
CBC
Lavender EDTA

Question 6

plt methods

Answer 6

manual counting
automated: optical/flow cytometry
ratio method: platelet fxn

Question 7

normal platelet count:

Answer 7

adults: 150-450,000
Peds: 150-350,000

Question 8

Thrombocytopenia platelet counts

Answer 8

<150,000
Mild: 50-100,000: no symptoms
Severe <50,000: 1st symptoms
<10,000 : life - threatening

Question 9

High platelet ct. ddx:

Answer 9

Acute phase rxn
early CML
ET
PV
post splenectomy

Question 10

Low platelet ct. ddx:

Answer 10

hemolytic anemia:
DIC (sepsis/trauma)
hypersplenism

ITP
leukemia
prosthetic heart valve
recent transfusion

Question 11

what does bleeding time measure?

Answer 11

platelet-BV wall interaction -> Blood Clots

Question 12

Bleeding time is used to dx what?

Answer 12

vWF

Question 13

bleeding time high from

Answer 13

DIC
leukemia
Liver Dz
thrombocytopenia
vWF
vasculitis
platelet dysfunction

Question 14

PT measures what type of clotting? which pathway?

Answer 14

Vit. K dependent clotting

extrinsic pathway

Question 15

PT/INR is used to screen who?

Answer 15

pt.s on warfarin (coumadin) –> affects Vit. K clotting

screening test

Question 16

PT/INR normal values

Answer 16

Adults; 11-13sec / 1-2

Question 17

What is an INR of someone with DVT?

Answer 17

2-3

Question 18

what is the INR of someone with a mechanical valve or anti-phospholipid Ab (miscarriages) syndrome?

Answer 18

2.5-3.5

Question 19

High PT/PTT ddx:

Answer 19

BOTH:
DIC
Liver Dz
Vit. K deficiency

PT:
Factor 2,5,7,10 def.
anti-phospholipid Ab synd

PTT:
heparin therapy
Hemophilia
Factor 8,911,12 def.

Question 20

PTT stands for

Answer 20

activated partial thromboplastin time

Question 21

PTT measures what? and which pathway?

Answer 21

cloth with citrate, Ca++, and phospholipid

Intrinsic Pathway

Question 22

PTT is used to monitor/screen who?

Answer 22

monitor heparin

screen for Lupus anticoag

Question 23

T or F: PT/PTT/TT are in the Light Blue/EDTA tube

Answer 23

FALSE
Light Blue with Citrate
Light Blue with EDTA doesn’t exist!

Question 24

TT measures what and which pathway?

Answer 24

conversion of fibrinogen to fibrin

fibrinolytic pathway

Question 25

Normal TT:

Answer 25

15-20sec

Question 26

TT is high ddx:

Answer 26

DIC
Liver Dz

Dysfibrinogenemia
paraproteinemia
uremia

Question 27

TT is low ddx:

Answer 27

erythrocytosis

dysfibrinogenemia: WHAT?! ON BOTH LISTS?!

Question 28

what meds scream “COAG STUDIES!”?

Answer 28

heparin and coumadin (aka warfarin)

Question 29

what Dz = COAG STUDIES!

Answer 29

Liver Dz

Question 30

if you have a PT of greater than _____ and aren’t taking anti-coag meds then check for ____ Dz

Answer 30

1.5

Liver Dz

Question 31

when you evaluate a pt your first question should be:

Answer 31

What is the bleeding site?!

—-also how many bleeding sites?

Question 32

These are symptoms of:

• gum bleeding
• easy bruising
• epistaxis
• petechiae
• prolonged bleeding from minor cuts
• ABNORMAL BT and NORMAL PT/PTT

Answer 32

Platelet # Low

Question 33

Hemophilia is a _____ def.

Answer 33

factor

Question 34

These are symptoms of:

• hemarthROSES
• easy bruising
• delayed bleeding
• postop hemorrhage
• muscle hematoma
• NORMAL BT and ABNORMAL PTT

Answer 34

Factor deficiencies

Question 35

a normal PT/PTT
abnormal BT
DDX?

Answer 35

platelet/cellular deficiency or malfxn

Question 36

a normal BT
abnormal PT/PTT
DDX?

Answer 36

Factor deficiencies

*** could be hemophilia