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Hematology 2 (Lecture) > Laboratory Evaluation of Coagulation (F) > Flashcards

Laboratory Evaluation of Coagulation (F) Flashcards

1
Q

How is clotting time performed?

A

It is performed by measuring the time interval needed before an evident clot appears from skin puncture, assessing it at 30-sec interval, and reporting the result in mins and secs

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2
Q

What is the principle followed by clotting time?

A

It follows the principle of visible clot formation evaluated using our eyes

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3
Q

Who first designed clotting time?

A

Lee and White

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4
Q

What is the normal range for clotting time?

A

2 - 4 mins

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5
Q

How is prothrombin time performed?

A

It is performed by adding a small amt of PT rgnt to citrated PPP, measuring the time interval needed before an evident clot appears, and reporting the result in secs or in INR

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6
Q

What is the principle followed by PT?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

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7
Q

What does PT measure?

A

It measures the integrity of extrinsic and common pathways

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8
Q

What does PT monitor?

A

It monitors the effects of warfarin therapy

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9
Q

PT is considered as the best what?

A

Best indicator of vitamin K deficiency

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10
Q

What is the composition of PT rgnt?

A

Tissue thromboplastin + phospholipids + ionized calcium; no separate rgnt for calcium

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11
Q

What is the normal range (in secs) for PT?

A

12.6 - 14.6 secs

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12
Q

What is the formula for INR?

A

INR = PT test / PT normal (ISI)

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13
Q

What is the normal range in INR w/out warfarin?

A

0.8 - 1.2

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14
Q

What is the normal range in INR w/ warfarin?

A

2.0 - 3.0

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15
Q

What is the result of increased / prolonged PT?

A

Decreased / low extrinsic and common pathway factors

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16
Q

What is the process (or steps) of PT?

A

1) Incubate PT rgnt at 37 DC
2) Transfer 50 - 100 uL of citrated PPP into a cuvette
3) Incubate citrated PPP aliquot at 37 DC for 3 mins
4) Add 100 - 200 uL of PT rgnt directly to the citrated PPP aliquot

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17
Q

What is the simplified process (or steps) of PT?

A

1) PPP + Tissue Factor (TF) + Phospholipid
2) Incubate at 37 DC
3) + Calcium
4) Record clotting time

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18
Q

How is partial thromboplastin time performed?

A

It is performed by adding a small amt of PTT rgnt to citrated PPP followed by calcium chloride, measuring the time interval needed before an evident clot appears, and reporting the result in secs

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19
Q

What is the principle followed by PTT?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

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20
Q

What are measured by PTT?

A

It measures the integrity of intrinsic and common pathways

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21
Q

What are monitored by PTT?

A

It monitors the effects of unfractionated heparin therapy

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22
Q

What are detected by PTT?

A

It detects the presence of lupus anticoagulants and factor inhibitors

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23
Q

What is the composition of PTT rgnt?

A

phospholipids (cephalin or partial thromboplastin) + negatively charged particulate activators (silica, kaolin, ellagic acid, celite); has a separate rgnt for calcium

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24
Q

What is the normal range of PTT in secs w/out heparin?

A

25 - 35 secs

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25
Q

What is the normal range of PTT in secs w/ heparin?

A

60 - 100 secs

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26
Q

What is the result if PTT is increased / prolonged?

A

Decreased / low intrinsic and common pathway factors

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27
Q

What is the meaning of APTT?

A

Activated Partial Thromboplastin Time

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28
Q

What is the process (or steps) of PTT?

A

1) Incubate PTT rgnt and CaCl2 rgnt at 37 DC
2) Transfer 50 - 100 uL of citrated PPP into cuvette
3) Incubate citrated PPP aliquot at 37 DC for 3 mins
4) Add 50 - 100 uL of PTT rgnt directly to the citrated PPP aliquot
5) Incubate the mixture at 37 DC for 3 mins
6) Add 50 - 100 uL of CaCl2 directly to the citrated PPP aliquot

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29
Q

What is the simplified process (or steps) of PTT?

A

1) PLT Poor Plasma (PPP) + activator (e.g. celite / silica) + phospholipid
2) Incubate
3) + Calcium
4) Record clotting time

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30
Q

How is thrombin clotting time performed?

A

It is performed by adding a small amt of thrombin rgnt to citrated PPP, measuring the time interval needed before an evident clot appears, and reporting the results in secs

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31
Q

What is the principle followed by thrombin clotting time?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

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32
Q

What is measured by thrombin clotting time?

A

It measures the integrity of the last part of common pathway

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33
Q

What are monitored by thrombin clotting time?

A

It monitors the effects of dabigatran

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34
Q

What is determined by thrombin clotting time?

A

It determines the presence of unfractionated heparin, paraproteins, and fibrin degradation products

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35
Q

What is the composition of TCT rgnt?

A

exogenous thrombin + ionized calcium; no separate rgnt for calcium

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36
Q

What is the normal range of thrombin clotting time in secs?

A

< or equal to 21 secs

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37
Q

What is the meaning of TCT?

A

Thrombin Clotting Time

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38
Q

What are the result if TCT is increased / high?

A

1) Decreased / low fibrinogen

2) Increased / high fibrin degradation products, paraproteins

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39
Q

What is the meaning of TT?

A

Thrombin Time

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40
Q

What is the process (or steps) of TCT?

A

1) Incubate TCT rgnt at 37 DC for 3 - 10 mins
2) Transfer 100 uL of citrated PPP into a cuvette
3) Incubate citrated PPP aliquot at 37 DC for 3 - 10 mins
4) Add 200 uL of TCT rgnt directly to the citrated PPP aliquot

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41
Q

What is the simplified process (or steps) of TCT?

A

1) PPP + thrombin (bovine or human)

2) Record clotting time

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42
Q

How is reptilase time performed?

A

It is performed by adding a small amt of Bothrops atox venom to citrated PPP, measuring the time interval needed before an evident clot appears, and reporting the result in secs

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43
Q

What is the principle followed by reptilase time?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

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44
Q

What does reptilase time measure?

A

It measures the integrity of the last part of common pathway

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45
Q

What is the purpose of reptilase time?

A

It determines the presence of paraproteins and fibrin degradation products

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46
Q

What is the composition of the RT rgnt?

A

Batroxobin + ionized calcium; no separate rgnt for calcium

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47
Q

What is the normal range for reptilase time?

A

< or equal to 21 secs

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48
Q

What are the results of RT is increased / high?

A

Decreased / low fibrinogen

Increased / high fibrin degradation products, paraproteins

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49
Q

What is the meaning of RT?

A

Reptilase time

50
Q

What is the process (or steps) of RT?

A

1) Incubate RT rgnt at 37 DC for 3 - 10 mins
2) Transfer 100 uL of citrated PPP into a cuvette
3) Incubate citrated PPP aliquot at 37 DC for 3 - 10 mins
4) Add 200 uL of RT rgnt directly to the citrated PPP aliquot

51
Q

What is the simplified process (or steps) of RT?

A

1) PPP + batroxobin

2) Record clotting time

52
Q

How is stypven time performed?

A

It is performed by adding a small amt of Daboia russelii venom to citrated PPP, measuring the time interval needed before an evident clot appears, and reporting the result in secs

53
Q

What is the principle followed by Stypven time?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

54
Q

What is the purpose of Stypven time?

A

It measures the integrity of common pathway

55
Q

Stypven time is considered as an alternative to what?

A

It is considered as an alternative to PT, yet it became obsolete

56
Q

What is the composition of ST rgnt?

A

Russell viper venom + ionized calcium; no separate rgnt for calcium

57
Q

What is the normal range for Stypven time?

A

20 - 30 secs

58
Q

What is the meaning of ST?

A

Stypven time

59
Q

What is the result if ST is increased / high?

A

Decreased / low common pathway factors

60
Q

What is the process (or steps) of ST?

A

1) Incubate ST rgnt at 37 DC for 3 - 10 mins
2) Transfer 100 uL of citrated PPP into a cuvette
3) Incubate citrated PPP aliquot at 37 DC for 3 mins
4) Add 200 uL of ST rgnt directly to the citrated PPP aliquot

61
Q

What is the simplified process (or steps) of ST?

A

1) PPP + Russell viper venom

2) Record clotting time

62
Q

What are the 2 types of protocol for mixing studies?

A

1) Mixing studies using old protocol

2) Mixing studies using current protocol

63
Q

How are mixing studies (old) performed?

A

It is performed by using the pt’s citrated PPP w/ a prolonged PT or PTT result and mixing it w/ rgnt plasma and rgnt serum, evaluating for result correction, and reporting the result in secs

64
Q

What is the principle followed by mixing studies (old)?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

65
Q

What is the purpose of mixing studies (old)?

A

Distinguish bet coagulation factor deficiency, presence of lupus anticoagulant, or presence of inhibitors

66
Q

What is corrected mixing studies (old)?

A

The PT or PTT of a sx w/c was originally prolonged will become normal after the addition of rgnt plasma and rgnt serum

67
Q

What is not corrected mixing studies (old)?

A

The PT or PTT of a sx w/c was originally prolonged will remain prolonged after the addition of rgnt plasma and rgnt serum

68
Q

If it is a coagulation factor deficiency, it can be what (in terms of mixing studies, old)?

A

It can be immediately determined after the test

69
Q

What is the result of normal PT/PTT?

A

Normal PT/PTT = correction of mixture = coagulation factor deficiency

70
Q

What is the result of prolonged PT/PTT?

A

Prolonged PT/PTT = failure of correction of mixture = presence of LAC or inhibitors

71
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + fresh plasma

A

Normal PT or PTT: prolonged PT or PTT

72
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + aged plasma

A

Normal PT or PTT: prolonged PT or PTT

73
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + adsorbed plasma

A

Normal PT or PTT: prolonged PT or PTT

74
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + fresh serum

A

Normal PT or PTT: prolonged PT or PTT

75
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + aged serum

A

Normal PT or PTT: prolonged PT or PTT

76
Q

What is the status of factors for the ff:

Given factor: Factor I

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Present
4) Absent
5) Absent

  • the deficient factor should be present in corrected and absent in not corrected
77
Q

What is the status of factors for the ff:

Given factor: Factor II

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Absent
4) Present
5) Absent

  • the deficient factor should be present in corrected and absent in not corrected
78
Q

What is the status of factors for the ff:

Given factor: Factor V

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Absent
3) Present
4) Absent
5) Absent

  • the deficient factor should be present in corrected and absent in not corrected
79
Q

What is the status of factors for the ff:

Given factor: Factor VII

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Absent
4) Present
5) Present

  • the deficient factor should be present in corrected and absent in not corrected
80
Q

What is the status of factors for the ff:

Given factor: Factor VIII

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Absent
3) Present
4) Absent
5) Absent

  • the deficient factor should be present in corrected and absent in not corrected
81
Q

What is the status of factors for the ff:

Given factor: Factor IX

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Absent
4) Present
5) Present

  • the deficient factor should be present in corrected and absent in not corrected
82
Q

What is the status of factors for the ff:

Given factor: Factor X

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Absent
4) Present
5) Present

  • the deficient factor should be present in corrected and absent in not corrected
83
Q

What is the status of factors for the ff:

Given factor: Factor XI

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Present
4) Present
5) Present

  • the deficient factor should be present in corrected and absent in not corrected
84
Q

What is the status of factors for the ff:

Given factor: Factor XII

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Present
4) Present
5) Present

  • the deficient factor should be present in corrected and absent in not corrected
85
Q

What is the status of factors for the ff:

Given factor: Factor XIII

1) Fresh plasma
2) Aged plasma
3) Adsorbed plasma
4) Fresh serum
5) Aged serum

A

1) Present
2) Present
3) Present
4) Absent
5) Absent

  • the deficient factor should be present in corrected and absent in not corrected
86
Q

How are mixing studies (current) performed?

A

These are performed by mixing a rgnt PLT-poor normal plasma w/ a pt’s citrated PPP w/ a prolonged PT or PTT, evaluating for result correction, and reporting the result in secs

87
Q

What is the principle followed by mixing studies (current)?

A

It follows the principle of detectable clot formation evaluated using an optical sensor or electromechanical sensor

88
Q

What is the purpose of mixing studies (current)?

A

Distinguish bet coagulation factor deficiency, presence of lupus anticoagulant, or presence of inhibitors

89
Q

What is corrected mixing studies (current)?

A

The PT or PTT of a sx w/c was originally prolonged will become normal after the addition rgnt PLT-poor normal plasma

90
Q

What is not corrected mixing studies (current)?

A

The PT or PTT of a sx w/c was originally prolonged will remain prolonged after the addition of rgnt PLT-poor normal plasma

91
Q

If it is a coagulation factor deficiency (in terms of mixing studies, current), it cannot be what?

A

It cannot be immediately determined after the test

92
Q

What is the result of correction of initial mix?

A

Coagulation factor deficiency

93
Q

What is the result of correction w/ initial mix?

A

Presence of LAC

94
Q

What is the result of incubated mix w/ bleeding?

A

Presence of inhibitors

95
Q

What is the result of failure of correction of incubated mix w/out bleeding?

A

Presence of LAC

96
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + PLT-poor normal plasma (initial mix)

A

Normal PT or PTT: corrected

Prolonged PT or PTT: not corrected

97
Q

What is the result and interpretation of the mixture:

Mixture: Pt’s citrated PPP + PLT-poor normal plasma (incubated mix -> 1 - 2 hrs at 37 DC)

A

Normal PT or PTT: corrected

Prolonged PT or PTT: not corrected

98
Q

What is the interpretation for the ff clot-based test profiles:

1) PT: prolonged
2) PTT: normal
3) TCT: normal
4) RT: normal
5) ST: normal
* w/out bleeding

A

Presence of lupus anticoagulant

99
Q

What is the interpretation for the ff clot-based test profiles:

1) PT: prolonged
2) PTT: normal
3) TCT: normal
4) RT: normal
5) ST: normal
* w/ bleeding

A

Deficiency in factor VII

100
Q

What is the interpretation for the ff clot-based test profiles:

1) PT: normal
2) PTT: prolonged
3) TCT: normal
4) RT: normal
5) ST: normal
* w/out bleeding

A

Deficiency in factor XII, PK, and HMWK

Presence of lupus anticoagulant

101
Q

What is the interpretation for the ff clot-based test profiles:

1) PT: normal
2) PTT: prolonged
3) TCT: normal
4) RT: normal
5) ST: normal
* w/ bleeding

A

Deficiency in factor XI, IX, and VIII

102
Q

What is the interpretation for the ff clot-based test profiles:

1) PT: prolonged
2) PTT: prolonged
3) TCT: normal
4) RT: normal

A

Deficiency in factor X, II, and V

Intake of warfarin & vitamin-K deficiency

103
Q

What is the interpretation for the ff clot-based test profiles:

1) TCT: prolonged
2) RT: normal

A

If PTT is prolonged: intake of unfractionated heparin or dabigatran

104
Q

What is the interpretation for the ff clot-based test profiles:

1) TCT: normal
2) RT: normal

A

If PTT is prolonged: no intake of unfractionated heparin

105
Q

What is the interpretation for the ff clot-based test profiles:

1) PT: prolonged
2) PTT: prolonged
3) TCT: prolonged
4) RT: prolonged
5) ST: prolonged

A

Deficiency in factor I if less than 100 mg/dL

Paraproteinemia

106
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor I deficiency

Prolonged PT - prolonged PTT

106
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor I deficiency

Prolonged PT - prolonged PTT

107
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor XIII deficiency

Normal PT - normal PTT

108
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: corrected
4) Fresh serum: corrected
5) Aged serum: corrected

A

Factor XI deficiency

Normal PT - prolonged PTT

w/ bleeding

109
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: corrected
4) Fresh serum: corrected
5) Aged serum: corrected

A

Factor XII deficiency

Normal PT - prolonged PTT

w/out bleeding

110
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: uncorrected
4) Fresh serum: corrected
5) Aged serum: corrected

A

Factor VII deficiency

Prolonged PT - normal PTT

111
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: uncorrected
4) Fresh serum: corrected
5) Aged serum: corrected

A

Factor IX deficiency

Normal PT - prolonged PTT

112
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: uncorrected
4) Fresh serum: corrected
5) Aged serum: corrected

A

Factor X deficiency

Prolonged PT - prolonged PTT

113
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: corrected
3) Adsorbed plasma: uncorrected
4) Fresh serum: corrected
5) Aged serum: uncorrected

A

Factor II deficiency

Easiest to determine; these mixing study results are only sp for factor II

114
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: uncorrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor V deficiency

Prolonged PT - prolonged PTT

115
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: uncorrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor VIII deficiency

Normal PT - prolonged PTT

115
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: uncorrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor VIII deficiency

Normal PT - prolonged PTT

115
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: uncorrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor VIII deficiency

Normal PT - prolonged PTT

115
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: uncorrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor VIII deficiency

Normal PT - prolonged PTT

115
Q

What is the interpretation for the ff clot-based test profiles:

1) Fresh plasma: corrected
2) Aged plasma: uncorrected
3) Adsorbed plasma: corrected
4) Fresh serum: uncorrected
5) Aged serum: uncorrected

A

Factor VIII deficiency

Normal PT - prolonged PTT

Hematology 2 (Lecture) (11 decks)

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