PR3154 CA Recap

Question 1

what is the difference between plasma and serum

Answer 1

plasma has fibrinogen (sample will not clot); serum does not have fibrinogen (sample will clot)

Question 2

what are granulocyte? describe how they look like.

Answer 2

basophil (blue, allergies, bilobed nucleus), eosinophil (red, parasitic inf, bilobed nucleus), neutrophil (bigger than rbc, most abundant wbc, usually first to arrive at site of inf)

Question 3

what are agranulocytes?

Answer 3

monocyte and lymphocyte (M bigger than L but both bigger than RBC)

Question 4

what is the fn of blood?

Answer 4

regulate, protect, transport

Question 5

what are the components of blood

Answer 5

wbc, rbc, platelet, plasma

Question 6

what makes up the plasma

Answer 6

water, soluble things, protein

Question 7

what makes up the buffy coat?

Answer 7

wbc, platelets

Question 8

what are some proteins found in plasma?

Answer 8

Ig, fibrinogen, albumin

Question 9

define hematocrit and state the normal levels found in males and females

Answer 9

avg vol of rbc relative to vol of blood
males 46%
females 42%

Question 10

where does erythropoiesis occur with age?

Answer 10

fetus: yolk sac then liver, spleen, lymph node
<5: all bone marrow
5-20: bone marrow of rib, sternum, vertebrae, prox end of long bone
>20: minus prox end of long bones

they eventually become fat

Question 11

what conditions are required for erythropoiesis?

Answer 11

oxygen and erythropoeitin

Question 12

identify some reasons for an incr in erythropoietin release?

Answer 12

any factors that result in more O2 needed to be generated (either incr O2 DD or decr O2 SS)
or any factors that result in more RBC needed (eg. anemia, reduced blood flow, blood donation)

Question 13

explain how new RBC is made (the process of erythropoiesis)

Answer 13

erythroblast (ribo syn) –> late erythroblast (hb accum inside) –> normoblast (nucleus ejected) –> reticulocyte –> RBC

Question 14

recall what it is called when there is too much/little rbc and wbc

Answer 14

too much rbc - polycythemia/erythemia
too much wbc - leukocytosis
too few wbc - leukopenia

Question 15

explain the process of blood clotting

Answer 15

when platelet plug forms –> vwf secr by platelet binds to collagen –> GP on platelet binds to vwf –> platelet activation and platelet agonist released –>&raquo_space;» platelet –> joined via fibrinogen (weak) –> thrombin convert fibrinogen to fibrin –> stronger cross link –> stabilised using fibrin stabilising factor, factor 13 which is activated by thrombin too

can tell that thrombin is an impt key player hence, to keep thrombin supply, PF3 is impt (factor 3) which is incr when there is platelet aggregation! also need factor 10a to convert prothrombin to thrombin

this whole thing is a +ive feedback loop

Question 16

name the factors involved in the ext and int pathway

also name the factors involved in the common pathway

Answer 16

ext: 3 - 7 - 10 - thrombin - fibrin - meshwork
int: 12 - 11 - 9 - 10 - thrombin - fibrin - meshwork

common: 10 - fibrin - meshwork

factor 3 is not usually found in blood and is only pr when there damaged tissue hence it belongs to (and starts) ext pathway

Question 17

what coagulation pathways (what factors) does each OAC work on

Answer 17

apix rivarox edoxaban - 10 (common)
enoxaparin - 10 (common)
warfarin - 2 7 9 10 (int and ext)
heparin - 2 10 (common)

recall ext path 3 7 10 and int path 12 11 9 10

Question 18

what kind of inhibitors are dabi and riva

Answer 18

competitive and reversible

Question 19

compare dabi to riva

Answer 19

riva has shorter t1/2 (effect reverse more quick)
riva need to be wary of cyp3a4 and pgp inhib/inducer
dabi has low bioF (give enteric coated)
dabi will cause more GI sx

Question 20

what is an adv the -teplases have over urokinase/streptokinase?

Answer 20

teplases are better because they BIND PREFERENTIALLY TO CLOT ASSOCIATED PLASMINOGEN hence activating plasmin in clots

Question 21

what should not be taken with fibrinolytics?

Answer 21

NO (may decr alteplase conc)
other apt/oac

Question 22

what is the dose to be used for dabi and edoxaban for VTET

Answer 22

dabi - 150mg bd
edox - 60mg od

Question 23

which pt population should not be started on edoxaban?

Answer 23

crcl > 95; high likelihood of tx failure

Question 24

what are the 3 sides of the virchows triad

Answer 24

blood stasis
hypercoagulability
vasc injury

Question 25

how does afib cause stroke?

Answer 25

uncontrolled contraction at left atrium - blood pool and conc of clotting factors at left atrium - clot break off and go to left vent then aorta then cerebral circ blocked

Question 26

what is mcha2ds2vasc

Answer 26

used to determine is oac shld be started
cong HF; HTN; =>75; DM; hx of stroke; vasc disease; 65-74

Question 27

what are some impt counselling points for sdm with pts when starting oac for spaf

Answer 27

• highlight stroke risk using mchadsvasc
• describe what can happen if not anticoaged
• talk about se of oac and bleed risk, then look at HASBLED to see if modifiable bleed risk
• compare between doacs and vka to do sdm

Question 28

recall SPAF dosing

Answer 28

apix 5 bd 2.5 bd (ABS)
riva 20 od 15 od (crcl)
dabi 150 bd 110 bd (age)
edox 60 od 30 od (crcl & bw)

Question 29

list the ddi with doacs

Answer 29

dual inhib of 3a4 and pgp
- rito, azole, clarith
dual inducer of 3a4 and pgp
- rifam, sjw
antiseizures
- valpro, cbz, pht

Question 30

list the ddi with warfarin

Answer 30

2c9 inhib
- amiodarone, bactrim, flucanazole, metronidazole, erythromycin
2c9 inducer
- rifam, sjw, cbz
no need dose adj
- amox clav, doxy, macrolides

Question 31

explain how different lifestyle factors might derange inr

Answer 31

inhib 2c9, decr met, incr warf, incr inr = alc binding
induce 2c9, incr met, decr warf, decr inr = chronic alc, smoke, sudden incr exercise

Question 32

provide impt warfarin counselling points

Answer 32

maintain diet, missed dose, when to go a&e, interchanging of meds, let dr/dentist know of warf tx

Question 33

recall ami dosing

Answer 33

load asp 100mg 300mg
load tica / clopi 180mg 600mg
tica 90 bd (12m) acs
clopi 75 od (6m) ccs
but if high bleed risk –> 3m

Question 34

when can thrombolytics be used in ais/ami

Answer 34

ami: when pci cnt be done
ais: within 4.5h, bp < 185/110 BG > 2.8, change in CT, disabling stroke

Question 35

describe the components of abcd2 for tia risk

Answer 35

age - 60-64 (0) vs 65 abv (1)
bp - htn (1) vs normal (0)
clinical sx - unilat weak (2), speech (1), others (0)
duration of tia - 60min abv (2), 10-59 (1), <10 (0)
dm - yes (1) vs no (0)

high risk tia is 4 and abv