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Coagulation > Laboratory > Flashcards

Laboratory Flashcards

1
Q

What is the purpose of Neoplastin

A

starting reagent for PT that contains a heparin inhibitor made of rabbit brain, helps ID factor deficiencies

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2
Q

What are the contents and purpose of PTT reagent. **

A

contains-CaCl, starting reagent for PTT test

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3
Q

What test is for evaluating the intrinsic pathway?

A

PTT

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4
Q

What test is for evaluating the extrinsic pathway

A

PT

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5
Q

What test can be used to evaluate the functioning of the common pathway

A

both PT and PTT

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6
Q

What is the mechanism of heparin

A

binds to anti-thrombin to form a complex, inhibits Xa

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7
Q

How is the therapeutic range of heparin determined

A

PTT will be 2-3x normal when pt is on heparin

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8
Q

What test is used to monitor heparin therapy

A

PTT

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9
Q

What protein accelerates the effects of heparin

A

AT3

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10
Q

What neutralizes the effects of heparin

A

protamin sulfate

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11
Q

What is the action of coumadin

A

its an oral anticoagulant that affects the vitamin K dependent factors

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12
Q

What factors are vitamin K dependant

A

2,7,9,10

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13
Q

What neutralizes coumadin

A

vitamin K

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14
Q

What test is used to monitor coumadin

A

PT

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15
Q

Why is coumadin overlapped with heparin therapy

A

they overlap for 5-7 days because protein C levels drop in this time period and the pt is at risk of throwing a clot

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16
Q

What is the INR

A

the standardized PT standardized thromboplastin across the country and world

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17
Q

What is the formula for the INR

A

patients PT/ mean PT of population

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18
Q

What is the ISI, how is it determined

A

international sensitivity index, calculated by manufacturer with each lot of STA neoplastine- changes once a year

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19
Q

What is the PTT reference range

A

23.5-32.9

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20
Q

What is the INR range for pts on coumadin

A

2-3

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21
Q

What kind of plasma do routine specimen have

A

plt poor plasma

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22
Q

What is the centrifuge time and speed for coag specimen

A

10 min
3000rpm

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23
Q

What is the reason a coag tube should be completely full

A

9:1 ratio of coagulant vs blood

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24
Q

What are 2 reasons a coag specimen will be rejected

A

clotted
QNS

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25
Q

What does an increased hematocrit do to PTT results

A

if higher than 55%, PTT increases, less plasma in tube, less factors, clot takes longer

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26
Q

What mechanism does the anticoagulant in blue top tubes use, which anticoagulant is it

A

sodium citrate, binds Ca, prevents clot from forming

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27
Q

What methodology does the STAR MAX use

A

mechanical for detecting clot times

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28
Q

What should you do if QC fails on STAR MAX

A

rerun QC. if still bad makeup new reagents, if still bad- rerun patients and make new reagents again
if still bad, recalibrate

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29
Q

What is the principle of Clauss FBG, what is the purpose of diluting the specimen

A

measures the amount of FBG through clotting method Clauss. quantitative test
dilutions are to keep value in range of what the instrument can read- within linearity

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30
Q

What is the normal range for FBG

A

200-400

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31
Q

What disease states cause FBG to be low

A

DIC, fibrinogenolysis, hypofibrinogenemia

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32
Q

What disease states cause BG to be high

A

DIC, diabetes, obesity
pregnancy or trauma- really high

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33
Q

What coag tests are normally ordered for a pt that has just delivered a baby

A

PTT, PT, FBG

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34
Q

What is the principle of the D-dimer test

A

photometry measures particles that coat monoclonal D-dimer abs, quantifies D-dimer present by turbidity

increased agglutination=increased turbidity = increased absorbance= increased D-dimer abs

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35
Q

The presence of D-dimer is proof that the _____system is in action

A

fibrinolytic

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36
Q

What disease states cause an elevated D-dimer

A

covid, fibrinolysis, infections, bleeding, VTW

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37
Q

What fibrin split products are early degradation? Which ones are late degradation products?

A

early-X and Y
late- D and E

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38
Q

What coag factor splits fibrin products

A

plasmin

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39
Q

What is the principle of FDP/ FSP testing

A

Test that measures latex beads that coat abs against D and E, which are late products of X and Y, measured agglutination

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40
Q

What disease states are associated with increased FSP/FDP

A

DIC, increased fibrinolysis,
DVT 10-40,
pulmonary embolism higher than 40,
myocardial infarction 40-160
snake bites
pregnancy complications, hemolytic anemia, transfusion rxns

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41
Q

What tube is FSP performed with

A

FDP vacutainer with atrox venom a rapid clotting promoter that works even if heparin is present
specimen must clot before centrifuging

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42
Q

What is the principle of the thrombin time test

A

measures the time it takes to convert
FBG into fibrin, tests clotting time, functionality of FBG

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43
Q

What are the 2 inhibitors that affect TT?

A

heparin increases TT
hirudin, argatroban

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44
Q

What conditions cause an elevated TT?

A

DIC, dysfibrinogenemia
hypofibrinogenemia- congenital or acquired by liver disease
ant thrombin medication like heparin

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45
Q

What is the difference between FBG and TT?

A

FBG- measure amount of FBG present
TT- measures functionality of FBG
If FBG is low. TT will be high

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46
Q

What if the principle of a PFA

A

platelet function test- measures quality of aggregation and plts

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47
Q

What does it mean if in a PFA, both EPI and ADP are abnormal?

A

indicates pt has VWD or Glanzmann’s thrombastenia

48
Q

What does it mean if in a PFA, EPI is abnormal but the ADP is normal

A

aspirin is causing plt inhibition

49
Q

What is the mechanism of aspirin

A

it binds to arachidonic acid and cyclo oxygenase

50
Q

What do factor assays measure

A

clotting time for specific factors

51
Q

What is the principle of the P2Y12 Assay?

A

detects the P2Y12 inhibitor that inhibits plavix a stroke/ heart disease medication

52
Q

If an assay result is too high even after being diluted, then the patient has a

A

factor deficiency

53
Q

What is the most common hemophilia and what factor is deficient in it

A

VIII
Hemophilia A

54
Q

How quickly should a mixing study correct

A

within 5 seconds

55
Q

If a mixing study correct then the pt has a

A

factor deficiency

56
Q

If a mixing study doesnt correct, the pt has a

A

inhibitor

57
Q

What is CACS

A

circulating anticoagulant screen
inhibitors are the circulating anticoagulants here

58
Q

What is the most commonly found factor inhibitor

A

anti-VIII

59
Q

IF a pt has a factor inhibitor, what will the results of the mixing study be

A

will stay prolonged

60
Q

What is the unit in which factor inhibitors are expressed

A

Bethesda

61
Q

What is the principle of TEG

A

a large test that measures full coag cascade, measures clot formation

62
Q

What test is ordered for HIT

A

heparin induced thrombocytopenia
an assay that measures abs to heparin

63
Q

What is the role of VWF

A

a carrier protein for factor VIII

64
Q

What test results for DIC
FBG
PT, PTT and TT
D-dimer
plt count

A

FBG decreases
PT, PTT and TT increase- takes longer to clot
D-dimer and FSP increase
plt count decreases
factors and plts are eaten and destroyed, takes longer time to form clot

65
Q

Which one is affected by diet? and body weight?
coumadin
heparin

A

coumadin- not affected by body weight, is affected by diet
heparin- affected

66
Q

What are the main reasons we do coag testing

A

diagnose:
Myocardial infarctions
Deep vein thrombosis
Strokes- ischemic and hemorrhagic
pulmonary embolism

67
Q

Which test tube binds to Ca- reversible and irreversible
EDTA
Sodium citrate

A

EDTA- irreversible
sodium citrate- reversible

68
Q

How soon must a sodium citrate tube be spun, what temp should it be at

A

within 8hrs, room temp

69
Q

What are some main reasons coag specimen get rejected

A

hemolysis, WNS, clotted, Delayed transportation

70
Q

What are the HCT requirements in coag and why do we care

A

must be >55% causes prolonged tests

71
Q

What is the formula to obtain HCT from a CBC EDTA tube

A

(60/ 100-pt HCT) x 4.5

72
Q

Match the instrument and reagents used in these tests
PT
PTT
TT
FBG
D-Dimer

A

PT- Neo and KOH desorb
PTT- PTT, CaCl, Desorb KOH
TT- thrombin, desorb
FBG- FBG, OK buffer, KOH
D-dimer- latex particle with anti- human D-dimer, TRIS buffer

73
Q

What is a critical value for a PTT

A

> 200 secs or less than <20

74
Q

What is cephalin

A

a plt substitute

75
Q

What might interfere with a PTT result

A

heparin therapy especially if high PF4

76
Q

What are the common causes of factor deficiencies?

A

Liver disease
DIC
Fibrinolysis
Autoimmune disorders- lupus
heparin or anticoagulant therapy
thrombin inhibitors

77
Q

What is the TT reference range

A

15.4-18

78
Q

What factor deficiency will not prolong a TT

A

factor XIII

79
Q

When is a TT necessary

A

if PT or PTT is abnormal but unexplained

80
Q

What does an abnormal TT indicate

A

dysfibrinogenemia

81
Q

Which is susceptible to lipemia, which isnt

A

otpical detection- sucseptible
mechnical- not affected

82
Q

What are the clinical uses of a PFA

A

preoperative
menorrhagia evaluation
drug indcuced plt dysfunction
pt compliance with aspirin and other antiplt drugs
determining if high risk pregnancy
pts with suspected VWD

83
Q

What are in the ADP and EPI cartridges for a PFA and why

A

collagen- in both, plts adhere to it start coag cascade
EPI-epinephrine
ADP- adenosine diphosphate

84
Q

What is the normal range for EPI? and ADP?

A

EPI- 98-172
ADP-50-132

85
Q

How long is the half life of FBG

A

3-5 days

86
Q

What does TPA do

A

tissue plasminogen activator- degrades fibrin

87
Q

What neutralizes plasmin

A

alpha 2 antiplasmin

88
Q

What is fibrin cleaved into

A

D-dimer and FDP

89
Q

What is the normal D-dimer range

A

<0.50

90
Q

How is FDP testing performed

A

Thrombo Welllcotest Kit

91
Q

What are the normal results for Anti-Xa assay

A

0

92
Q

What does Xa do

A

cleaves prothrombin into thrombin, creates fibrin

93
Q

Why is the Anti-Xa assay performed

A

to measure LMWH and UFH

94
Q

What pts do not need FFP

A

pts with no coagulation deficiencies or active bleeds

95
Q

What does it mean if after a mixing study, the results become prolonged again after 1-2 hrs

A

indicates factor VIII inhibitor

96
Q

How is Hemophilia A inherited

A

affects males on X chromosome, F carriers are silent

97
Q

What factor deficiency is associated with Ashkenazi jews

A

Facotr XI

98
Q

What factor deficiency is not associated with any bleeding problems

A

facror XII deficiency

99
Q

What factor deficiency is a very rare disorder

A

factor XIII

100
Q

What are Lupus anticoagulants

A

abs directed against phospholipids and protein complexes

101
Q

What does it mean if a pt has a prolonged PTT with a protein C assay

A

cant stop the activation of Va and VIIIa

102
Q

What does protein C do

A

inhibit factor V and VIII

103
Q

What inhibits protein C

A

alpha 1 antitrypsin

104
Q

What activates protein C

A

agkistrodon contortix vemnon

105
Q

What does protein S do

A

antagonistic to coagulation, cofactor for protein C

106
Q

What consequences can protein S deficiencies cause

A

chronic inflammation, hepatic disorders, nephrotic syndrome, thromboembolism

107
Q

How is HIT tested for

A

ELISA testing detects abs for PF4 that complexes with heparin

108
Q

What blood type tends to have less VWF

A

group O

109
Q

What tube is needed for plt mapping

A

green top

110
Q

What does the TEG activator do
Kaolin
TF
Heparinase

A

maximizes thrombin generation time
kaolin- starts intrinsic pathway
TF- activates extrinsic pathway

111
Q

What do these terms mean in TEG
R
K
Alpha
MA
G
CI
LY30
EPL

A

R clotting time
K and alpha clot kinetics
Ma and G clot strength
CI coagulation index
LY30, EPL- clot stability

112
Q

What does a hemorrhagic TEG look like

A

thinner longer fork
LY30 CI and R show that there are low clotting factors

113
Q

What does a hypercoagulopathy TEG look like

A

Fat fork, prothrombic state due to enzymes and plt hyperativity

114
Q

What does an increased fibrinolytic TEG look like

A

sensei legs, excess of tPA and plasmin

115
Q

What is a DIC

A

disseminated intravascular coagulation- systemic or body wide clotting, multiple organ failure

Coagulation (7 decks)

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