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Professional Development > Part 27 > Flashcards

Part 27 Flashcards

1
Q

2 steps of coagulation and their details

A

1) Formation of platelet plug from aggregation and bridge formation and glycoprotein IIb/IIIa activation on thrombocytes
2) fibrin production from fibrinogen bound to the 2b/3a receptors (coagulation, intrinsic with all the factors present in the vascular system activated when blood makes contact with collagen exposed as a result of trauma to vessel wallor extrinsic with thromboplastin (tissue factor) from outside the vasculature being required to work)

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2
Q

The intrinsic and extrinsic clotting pathways converge at factor ____, this functions to ____ to ____ also known as ___ and ____

A

X, which converts prothrombin to thrombin (factor 2 to factor 2a)

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3
Q

Thrombosis is a disease involving…

A

Pathogenic functioning of hemostatic mechanisms

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4
Q

3 major classes of drug therapy for thromboembolic disorders and their action

A
  • anticoagulants (disrupt coagulation cascade, suppressing fibrin production)
  • antiplatelet drugs (inhibit platelet aggregation)
  • thrombolytic drugs (promote lysis of fibrin acting like plasmin, causing clot dissolution)
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5
Q

Anticoagulants are more effective in preventing ___ while antiplatelets are more effective in preventing ____

A

venous thrombosis, arterial thrombosis

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6
Q

All agents that affect hemostasis affect…

A

…bleeding risk, must assess mucous membranes for internal bleeding when on these drugs

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7
Q

Warfarin drug class, mechanism of action

A
  • Anticoagulant,
  • inhibits synthesis of clotting factors including factor X and thrombin as a vitamin K antagonist
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8
Q

Heparin and dabigatrin drug class, mechanism of action

A
  • Anticoagulant

- inhibit clotting factor activity either Xa or thrombin

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9
Q

Unfractionated heparin definition

A

Injected heparin that activates antithrombin

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10
Q

Heparin activity on antithrombin

A

Binds to antithrombin and thrombin siultaneously, forming a ternary complex needed for thrombin inactivation

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11
Q

Heparin acts within ____ time range

A

minutes of IV administration

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12
Q

Heparin therapuetic uses (2)

A
  • preferred anticoagulant for pregnancy

- preferred agent during PE, stroke, DVT, and MI

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13
Q

Heparin ADR’s (4)

A
  • Hemmorrhaging in about 10% of patients
  • Spinal/epidural hematoma
  • heparin induced thrombocytopenia
  • cross contamination from animal source resulting in allergic rxn
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14
Q

Overdosage of heparin can be treated with…

A

…protamine sulfate

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15
Q

Laboratory test for heparin monitoring is….

A

….activated partial thromboplastin time (APTT)

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16
Q

APTT normal value range

A

24-33 seconds

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17
Q

Low molecular weight heparin advantages (3)

A
  • can be given on fixed dose schedule
  • doesn’t require APTT monitoring
  • As effective of standard heparin
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18
Q

Enoxaprin (lovenox) drug class, indications, administration

A
  • low molecular weight heparin
  • approved for prevention of DVT flollwoing surgery, treatment of DVT and PE
  • administered via SC
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19
Q

Warfarin (coumadin and Jantoven) drug class

A

Vit K antagonist anticoagulatn

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20
Q

Warfarin (coumadin and Jantoven) mech of action

A

Inhibit vit K epixide reductaes complex 1 needed to convert vit K to active form, which then decreases production of active vit K dependent clotting factors (II, VII, IX, X)

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21
Q

Warfarin (coumadin and Jantoven) doesn’t affect ___. As a result it takes ____ to see response

A

clotting factors that are already made, several days

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22
Q

After discontinuation of warfarin (coumadin and Jantoven), how long does coagulation remain inhibited?

A

2-5 days because of long half life of warfarin

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23
Q

Warfarin (coumadin and Jantoven) therapeutic uses

A
  • Prevent venous thrombosis and PE

- prevention of thrombosis during atrial fibrilation

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24
Q

Prothrombin time (PT)/INR

A

Most common test for evaluating warfarin therapy performed by adding a thromboplastin reagent and calcium to citrated plastma and measuring time required for clot to form, have to use INR to standardize reporting of prothrombin time by taking into account relative differences in sensitivity of tissue thromboplastin

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25
Q

When dosage of warfarin (coumadin and Jantoven) is changed, it takes ___ for INR to reflect the effects of the new dose

A

36 hours

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26
Q

Kcentra definition (oh lawdy its a doozy)

A

A 4 factor prothrombin complex concentrate for reversal of warfarin anticoagulation

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27
Q

Direct thrombin inhibitors definition and how do they differ from heparins?

A

Inhibit thrombin directly opposed to heparins that act thru antithrombin

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28
Q

Dabigatran etexilate (pradaxa) drug class

A

Direct thrombin inhibitor

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29
Q

Dabigatran etexilate (pradaxa) advantages over warfarin (4)

A
  • rapid onset
  • no need to monitor anticoaguation
  • lower risks of major bleeds
  • few food drug interactions
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30
Q

Dabigatran etexilate (pradaxa) mechanism of action

A

Synthetic, nonpeptide, reversible direct thrombin inhibitor, therefore preventing conversion of fibriongen to fibrin, prevents activation of factor XIII, preventing conversion of soluble fibrinogen to insoluble fibrin

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31
Q

Rivaroxaban (Xarelto) function

A

Act as a direct factor Xa inhibitor indirectly preventing formation of thrombin

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32
Q

Apixaban (Eliquis)function

A

A direct factor Xa inhibitor indirectly preventing formation of thrombin

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33
Q

3 groups of antiplatelet drugs which is strongest?

A
  • aspirin
  • GP IIb/IIIa receptor antagonists (strongest)
  • P2Y ADP receptor antagonists
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34
Q

Once a clotting cascade begins, it has a…

A

…domino effect where it is self sustaining and self reinforcing

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35
Q

4 vitamin K dependant coagulation factors

A

II, VII, IX, X

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36
Q

Antithrombin III function, what drug is it very involved with?

A

Inactivates clotting factors by forming a complex with them preventing widespread coagulation beyond the site of vessel injury, intimately involved with heparin

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37
Q

Plasmin function, what 2 things activates it?

A

Removal of clot through disolving fibrin after activation from precursor state plasminogen, activated by thrombin and tPA

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38
Q

Fondaparinux sodium (Arixta) drug class, therapeutic uses

A
  • antithrombin identical anticoagulant
  • Enhance antithrombin activity to help prevent DVT
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39
Q

Heparin to warfarin administration

A

Often desirable as warfarin is oral and can allow for discharge, because of delay btwn warfarin administration and antithrombolytic effect, have to overlap approx 4 days and only discontinue heparin when INR is adequate for condition to be treated

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40
Q

Warfarin effect on pregnancy

A

Teratogenic effect and can cause fetal malformation

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41
Q

Aspirin (ASA) mech of action

A

Causes irreversible inhibition of cyclooxygenase enzyme preventing synthesis of thromboxane A2 to promote aggregation and vascular smooth muscle to promote constriction

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42
Q

Clopidogrel (plavix) drug class, mech of action, ADR’s

A
  • Oral antiplatelet
  • irreversibly blocks p2y adp receptors and subsequet activation of glycoprotein iib/iiia complex and aggregation of platelets
  • well tolerated but can cause thrombotic thrombocytopenic purpura
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43
Q

Thrombotic thrombocytopenic purpura

A

Rare autoimmune blood clotting disorder that blocks o2 flow to vital organs

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44
Q

Ticagrelor (Brilinta) mech of action and unique fact

A

-Reversible P2Y ADP receptor antagonist that wears off faster than clopidogrel

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45
Q

Alteplase (activase) function

A

Bio identical to tPA used to convert plasminogen to plasmin to digest fibrin as a thrombolytic

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46
Q

General function of all leukocytes

A

Destroy or neutralize invading bacteria, fungi, or viruses

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47
Q

From a multipotential hematopoietic stem cell (hemocytoblast), what are the 2 offspring it can develop into

A
  • common myeloid progenitor
  • common lymphoid progenitor
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48
Q

From a common lymphoid progenitor, what 3 cells can arise from it?

A
  • Natural killer cell
  • T lymphocyte
  • B lymphocyte
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49
Q

From a common myeloid progenitor, what 4 cell types can arise from it?

A
  • megakaryocyte
  • erythroblast
  • mast cell
  • myeloblast
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50
Q

From a myeloblast, what4 cell types can arise from it?

A
  • basophil
  • neutrophil
  • eosinophil
  • monocyte
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51
Q

List the 4 phagocytes

A
  • neutrophils
  • monocytes (eventually macrophages and dendritic cells)
  • mast cells
  • B lymphocytes
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52
Q

Chemotaxis

A

Movement of an organism in response to chemical stimuli

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53
Q

3 steps of neutrophil recruitment

A
  • Margination (adherence to vessel wall)
  • Diapedesis (sliding out of vessel)
  • chemotaxis (follow the signals to the source)
54
Q

Walling off effect

A

Refers to clotting factors that block off areas where fluid has leaked to keep the pathogen from spreading to the rest of the body

55
Q

What cell type causes the body to produce IgE?

A

Basophils

56
Q

Langerhan cells of the skin are also known as ___

A

Histiocytes (macrophages)

57
Q

Granuloma

A

Capsuled “giant cell” formed from alveolar macrophages creating calcifications in the lungs that often appear as tubercles

58
Q

What surface molecule do natural killer cells recognize?

A

MHC to distinguish infected and tumor cells from normal and uninfected cells

59
Q

Common reasons for leukocytosis (5)

A 
Infection
Inflammation
Hereditary
Malignancy
Allergies
60
Q

Common reasons for Leukopenia (3)

A
  • Aplastic anemia or bone marrow suppression
  • chemotherapy
  • HIV/AIDS
61
Q

Left shift or bandemia definition

A

Appearance of high numbers of immature wbc’s in blood recognized by presents of “bands” on their surface, indicates wbc’s being released before they have time to mature sometimes indicating serious bacterial infection or blood loss

62
Q

Blood antigen definition

A

Groups of over 700 known Proteins, lipoproteins and carbohydrates that sit on the surface of RBC membranes with certain ones often being based on genetic expression of the individual, to which an antibody response can be mounted against

63
Q

Most blood antigens are ____ genetically

A

Co dominant (if the gene is present, the antigen will be expressed - think AB blood type)

64
Q

Naturally occurring antibodies/alloantibodies

A

Exceptions to the antibody formation rule that exposure to an antigen via pregnancy or transfusion is required to form an antibody, these can be formed from food or other object exposure over a life time

65
Q

Most common example of alloantibodies, what is the most common example of problematic alloantibodies?

A

ABO antibodies, Rh antibodies

66
Q

What type of hypersensitivity reaction is a blood transfusion hemolytic response?

A

A type 2

67
Q

Bombay type

A

An hh genotype resulting in lack of an H substance on RBC, very rare and result in only being able to receive blood from their own as they have a hemolytic reaction to H type

68
Q

H substance

A

A carbohydrate chain present on almost all human’s RBC unless they are rare hh type, allows for binding of A and B enzymes for blood typage

69
Q

If you are type O blood, you form antibodies against…

A

….The A and B antigens

70
Q

Group O cells are considered a universal ___, while group O plasma is considered a universal ____

A

Donor, recipient

71
Q

Group AB cells are considered a universal ___, while group AB plasma is considerred a universal ___

A

Recipient, donor

72
Q

Most Rh antibodies are produced by direct stimulation by these 2 mechanisms

A

1) pregnancy
2) transfusion

73
Q

The antigen most efficient at eliciting an immune response is the antigen designated ___, a major antigen of the ___ system

A

D, Rh

74
Q

Rarest ABO and Rh genetic setup

A

AB, Rh neg

75
Q

Because antiD is a ___ antibody, it is of concern during ___

A

IgG, pregnancy crossing the placenta and causing hemolysis of fetal RBC’s

76
Q

Rhogam mech of action

A
  • Immunize every Rh neg mom at 28 weeks pregnant (it lasts 12 weeks, so to term) with an then at birth get another immunization of it
  • This allows the anti-D antibody to destroy fetal cells that have leaked into mom’s circulation without crossing placenta and before mom mounts her own antigenic response
  • If amniocentesis occurs at 16 weeks then rhogam is given at 16 weeks and then 12 weeks later again and then at delivery again (3 times, unless baby and mom are Rh neg)
77
Q

During pregancy, what Rh type do you always assume the fetus is?

A

Rh positive

78
Q

Rhogam should be given even in the case of…

A

…miscarriage, stillbirth, natural or elective abortion

79
Q

Direct coomb’s test

A

A test for hemolytic anemia that checks for antibodies attached to the surface of red blood cells such as on a new born

80
Q

Indirect coombs test

A

A test for hemolytic anemia that checks for antibodies floating in serum, such as on a mother

81
Q

Protocol for a woman given rhogam is to…

why?

A

….carry a card that identifies this in case of an emergency
-because she will appear Rh positive even though she may be Rh negative

82
Q

Hemoglobin structure, how many o2 molecules can it carry?

A

4 chains a1 and 2, b1 and 2, each with a heme group containing an iron atom, it can carry 4 o2 molecules

83
Q

Hgb A vs Hgb F vs Hgb AS vs Hgb SS

A
  • A is 90% of normal human hemoglobin
  • F is fetal hemoglobin that has a higher carrying capacity than HgbA useful for fetal development, it drops drastically 3 months after birth
  • AS is sickle cell trait
  • SS is sickle cell disease
84
Q

A patient with acute active hemorrhage will have a ___ H&H

A

normal, serum and RBC’s are being lost together

85
Q

Thrombocytes are derived from this organ, while clotting factors are derived from this organ

A

Bone marrow, liver

86
Q

Name the 4 red cell indices

A

1) Mean corpuscular volume
2) Mean corpuscular hemoglobin
3) mean corpuscular hemoglobin conc.
4) red cell distribution width

87
Q

Mean corpuscular volume (MCV) function and reference range

A

Determines presence of macrocytic or microcytic anemia by measuring the avg size of an RBC, reference range being 80-100fL

88
Q

Common causes of macrocytosis (2)

A
  • folate or B12 deficiency
    • acoholism or liver disease
89
Q

Common causes of microcytosis (2)

A
  • Chronic iron deficiency
    • blood loss
90
Q

Mean corpuscular hemoglobin (MCH) function

A

Measures the weight of hemoglobin in avg RBC, correlates very closely with MCV andis redundant

91
Q

Mean corpuscular hemoglobin concentration (MCHC) function

A

Avg conc of hemoglobin in the average RBC, correlates with degree of chromasia (redness of RBC)

92
Q

Anisocytosis

A

Presence of RBC’s with varying sizes

93
Q

Polkiocytosis

A

Presence of RBC’s with varying shapes

94
Q

Red cell distribution width (RDW) function

A

Measure of variation in RBC size, with deficiency anemias tending to have higher RDW’s

95
Q

Reticulocyte count function, what do we want to see it look like on an anemic patient?

A

A measure of reticulocytes in the blood, indicative of functioning bone marrow
-If patient is anemic want to see high count to indicate bone marrow is working to replenish

96
Q

Serum ferritin test function, what is it most sensitive test for?

A

A measure of the intracellular protein that stores iron in the body to be mobilized in times of need, most sensitive test for iron deficiency

97
Q

Total Iron Binding Capacity test function, what does increased and decreased values indicate?

A

TIBC measures the blood capacity to bind iron with transferrin, if increased indicative of iron deficiency anemia, if normal or decreased could indicate hemolytic anemia or pernicious anemia

98
Q

Haptoglobin test function and what does a decrease or increase indicate?

A

Measures a blood glycoprotein that binds free hemoglobin, increased indicates inflammation or infection, decreased indicates hemolysis because the majority of it is bound to the free heme iron (it indirectly is measuring heme iron this way)

99
Q

Reticulocyte appearance under smear

A

Slightly larger than mature RBC and contain cytoplasmic remnants of RNA that stains blue

100
Q

A mean corpuscular volume (MCV) must be taken with consideration of presence of these 2 pathologies

A

Macro and microcytic anemias (avg out to normal appearing volume)

101
Q

Target, spherocyte, schistocyte, acanthocyte, echinocyte definitions

A

Target - dark center light colored ring dark periphery
Spherocytes - thickened rounded, microcytic hyperchromatic
Schistocytes - irregular RBC fragments
Acanthocytes - multiple spike like projections
Echinocytes - multiple smaller spiked projections

102
Q

Anemia of chronic disease (ACD) definition

A

Most common type of normocytic anemia, derived from autoimmune disorders, cancer, CKD, lliver disease, or other infections

103
Q

Anemia of renal disease often has ___ cells appear on a smear

A

Burr

104
Q

4 sources of pathophysiology of normocytic and hemolytic anemia and some examples

A

1) decreased RBC production (autoimmune, cancer, renal failure, aplastic bone marrow)
2) destruction or loss of RBC’s (bleeding, hemolysis)
3) uncompensated increase in plasma volume (overhydration, pregnancy)
4) mixed micro/macrocytic anemia (look for elevated RDW because MCV gonna be normal!)

105
Q

Iron is metabolized to ___

A

Bilirubin

106
Q

Unconjugated bilirubin nickname and definition

A

AKA indirect, goes to liver

107
Q

Conjugated bilirubin nickname and defintion

A

AKA direct bilirubin, occurs in the liver

108
Q

Very high levels of bilirubin can harm the brain, in a disease state called

A

Kernicterus

109
Q

Sickle cell crisis

A

Acute painful attack of the back abodmen and joints that results in fever, dehydration and pulmonary distress due to sickling cells claudicating

110
Q

G6PD deficiency definition

A

An enzyme that protects the RBC from oxidative damage, a deficiency in G6PD can result in hemolysis in sudden episodic periods despite normal health between episodes

111
Q

3 triggers for G6PD deficiency episode

A

Sulfonamides
febrile illness
Fava beans

112
Q

G6PD deficiency appearance on peripheral smear

A

Heinz bodies (small blue dots) of denatured hemoglobin in the cells and bite cells due to macrophages removing heinz bodies

113
Q

Sickle cell mutations are a result of…

A

…mutations on the B chain of the 6th amino acid

114
Q

Hemoglobin transports these 3 compounds

A
  • O2
  • CO2
  • NO (vasodilator)
115
Q

Hemoglobinopathies definition

A

Genetic defects that result in abnormal structure of one of the globin chains of hemoglobin

116
Q

Thalassemias definition

A

Reduced or absent production of one or more globin chains in hemoglobin molecule (e.g. Beta thalassemia)

117
Q

Sickle cell trait definition

A

A benign condition in which an individual has one of the sickle cell genes, they live a normal life but can rarely have sickling under extreme conditions (such as sports) and thus should be accommodated appropriately

118
Q

The biconcave shape of RBC allow for it to ___, sickle cells cannot and thus results in ____

A

pass thru capillaries, ischemia or claudication

119
Q

Sickle cell pathophysiology

A

Molecule is less soluble, B molecule binds other B molecules creating chains of HgB and changing the shape to a sickle

120
Q

Sickle cell rarely affects patients below 4 months of age because…

A

….they use hemoglobin F

121
Q

Estimated age of death in sickle cell patients

A

42-48 years

122
Q

Priapism or stroke in young individuals might indicate…

A

…sickle cell disease

123
Q

Hydroxyurea use in sickle cell disease pain management

A

It reactivates fetal hemoglobin production which has higher affinity for O2 helping alleviate frequency of pain episodes from sickle cell

124
Q

Dactylitis and what disease is it a hallmark of?

A

Sausage digits, occurs in children less than 7 years in the phalanges of hands and feet causing swelling, infarction causees premature fusion shortening affected digits, its a hallmark of sickle cell disease

125
Q

Pulmonary fat embolism definition

A

When fat from bone marrow gets into circulataion and becomes and emboli, can be fatal pulmonary emboli similar to a clot

126
Q

Aplastic crisis definition

A

Transient arrest of erythropoiesis in patients with sickle cell, abrupt reduction in hemoglobin conc. most often seen in children following infection with Human parvovirus B19 (fifth’s disease, think of the slapped cheek), results in a large infarct of portion of bone marrow

127
Q

Avascular necrosis of bone definition

A

Seen most often in femoral heads or humeral heads in both appendages, causes intense pain till infarct kills tissue then feel better, tissue becomes weak and collapses

128
Q

Acute chest syndrome definition and what is it the leading cause of in sickle cell patients?

A
  • Appearance of infiltrate with pulmonary symptoms in patient with sickel cell anemia,
  • leading cause of death
129
Q

Only sickle cell cure available

A

Hematopoietic stem cell transplant from match, and destruction of patient’s current bone marrow

130
Q

What disease started the blood borne pathogens standard? What is the disease that is most likely to be transmitted via needle stick?

A
  • HIV
  • hepC

Professional Development (28 decks)

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