Lecture 11 - Hemostasis part 3

Question 1

List the causes of Vitamin K deficiencies and antagonism.

Answer 1

“BAIL Moldy”

Question 2

Warfarin inhibits the synthesis of active forms of Vitamin-K dependent clotting factors: ?

Answer 2

2, 7, 9, 10

Question 3

What are the clinical signs of Vitamin K deficiency and antagonism?

Answer 3

Question 4

What are the laboratory features of Vitamin K deficiency and antagonism?

Answer 4

As well as:
Prolonged PT (initially b/c Factor 7 has shortest half life)
Prolonged PTT/aCT

Question 5

In an animal with suspicious medical history or rat poison exposure, and an increased PT only you should consider what as apart of your DDx?

Answer 5

Warfarin exposure
B/c the PT will be the first test to be prolonged/abnormal b/c Factor 7 has the shorted half life.
The animal may not show signs of bleeding yet.

Question 6

DIC is an acquired syndrome characterized by the _________ activation of __________ with loss of __________ arising from different causes. It can originate from ___________ and cause damage which IF sufficiently severe can produce organ dysfunction.
DIC is secondary to conditions that continually activate _______ and ________

Answer 6

intravascular, coagulation, localization
microvasculature

coagulation, fibrinolysis

Question 7

What are the causes of DIC?

Answer 7

Question 8

Describe the phases of DIC.

Answer 8

Question 9

What are the clinical signs of DIC?

Answer 9

Question 10

In a case of DIC, serum biochemistry changes depend on the?

Answer 10

Primary disease and location of microthrombosis

Question 11

List the laboratory findings in a case of DIC

Answer 11

Question 12

List the coagulopathies of liver disease.

Answer 12

Question 13

What are the inherited factor deficiencies?

Answer 13

Question 14

Hemophilia A is a deficiency or defect in coagulation factor ?
Is this condition common?
How does this deficiency occur?
What species is this condition seen in?

Answer 14

8
This is the most common coagulopathy in animals and humans
Sex-linked recessive mode of inheritance. Males are clinically affected and females are carriers (no clinical signs)
Dogs, cats, horses, and cattle

Question 15

What are the clinical signs of Hemophilia A?

Answer 15

Mild, moderate, or severe bleeding. Correlates with severity of Factor 8 deficiency.

Question 16

What are the laboratory findings of Hemophilia A?

Answer 16

Prolonged PTT
Normal PT
Normal PLT count
Normal bleeding time

Question 17

Hemophilia B is a deficiency or defect in coagulation factor ?
How does this deficiency occur?
What species is this condition seen in?

Answer 17

9
Sex-linked recessive mode of inheritance. Males are clinically affected and females are carriers (no clinical signs)
Dogs, cats; larger breeds are more severely affected.

Question 18

What are the clinical signs of Hemophilia B?

Answer 18

Similar to Hemophilia A

Question 19

What are the laboratory findings of Hemophilia B?

Answer 19

Similar to Hemophilia A
Prolonged PTT
Normal PT (<6 m old normally have lower F8 and F9 than adults; Test > 6 min)

Question 20

Hageman’s Disease is the most common inherited coagulopathy in which species?
Define this condition. What are the clinical signs? What are the laboratory results?

Answer 20

Cats
This is a deficiency in coagulation factor 12.
Cats are asymptomatic
Coagulation test results: Normal PT, Prolonged PTT.

Question 21

Thromboembolic disease is characterized by?

Answer 21

Thrombosis
Altered blood flow
Endothelial injury
Hypercoagulability

Question 22

Thrombus formation involves a sequence of events similar to the formation of a ______________ _____. The difference is that thrombus formation continues _________ by mechanisms that usually dissolve the plug after it has served its purpose.

Answer 22

hemostasis plug, unrestricted

Question 23

Are you able to distinguish between thromboembolic disease and early DIC?

Answer 23

No because both have similar lab test abnormalities

Question 24

List the examples of Endothelial injury/dysfunction that cause thromboembolic disease.

Answer 24

Question 25

List the examples of blood stasis that cause thromboembolic disease.

Answer 25

Question 26

List the examples of hypercoaguable states that cause thromboembolic disease.

Answer 26

Question 27

What are the clinical signs in the following thromboembolic diseases: 1. Saddle thrombus 2. Pulmonary embolism 3. Renal infarction

Answer 27

1. Rear limb weakness 2. Dyspnea 3. Hematuria

Question 28

In a case of Thromboembolic disease, what would you find in your lab diagnostics?

Answer 28

Question 29

Answer 29

3. Why do these results rule out rodenticide toxicity? * The absence of prolongation in PT rules out rodenticide toxicity. * Because Factor VII has the shortest half-life, approximately 6 hours, and as a result the extrinsic pathway (measured by PT), F7 will be the first to show prolonged clotting time. Since the PT is not prolonged, rodenticide (anticoagulant) toxicity is ruled out. 4. DDx 1: Hemophilia. * Very rare in the cat and unlikely in a cat of this age without previous clinical signs related to bleeding. DDx2: Factor XII (Hageman factor) deficiency. * This condition does not result in clinical signs of bleeding, but may result in prolongation of aPTT. It is thought to be an inherited incompletely dominant trait.

Question 30

In a case of rodenticide toxicity, PT is prolonged due to?

Answer 30

Factor 7 deficiency

Question 31

As rodenticide toxicity progress, the _______ becomes prolonged as well.

Answer 31

aPTT

Question 32

In a case of rodenticide toxicity, Vitamin K-independent factors are not affected because there is a time lag (due to their half life), of anywhere from ___ hours up to ___ days between exposure to the toxin and development of ______ * ______ or ______, bleeding into ____, _____ and _____ cavities, the ______ system and/or ____

Answer 32

12, 7, bleeding, internal, external, joints, thoracic, abdominal, urinary, GIT

Question 33

Answer 33

Question 34

Answer 34

Question 35

Answer 35

Question 36

Answer 36

Question 37

Answer 37

DIC?

Question 38

Question 39

Question 40

Question 41