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(AA) Hemostasis > Section 8 > Flashcards

Section 8 Flashcards

1
Q

Reasons to do hemostasis testing

A

monitor therapy, ID “coag” defects

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2
Q

manual tilt method

A

trouble shooting method, not done anymore, hard to tell

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3
Q

Mechanical
two different types

A

electromagnetic clot detection:
coductivity between two probes
clot finishes circuit

magnetic
increases viscosity

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4
Q

Photooptical (turbometric)

A

measures change in OD of test sample light transmission
light transmitted

cloudy or turbid samples will change result

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5
Q

nephlemetric

A

light scatter also immunologic (90-180)

change in light that is scattered

cloudy or turbid will change results

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6
Q

Chromogenic

A

color producing substrate PNA (YELLOW)

proteins free pNA, color proportional to protease activity

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7
Q

Immunologic end point

A

latex particles w ab

ab-ag complex aggglutinate, absorb more light

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8
Q

PT Test

A

Prothrombin Time
Extrinsic path

VIII, X, V, II, I

PPP sodium citrate

neoplastine: heparin inhibitor
phospholipid PF3 substitute
CaCl2 to override sodium citrate

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9
Q

What can PT not test for

A

Can not test for TFIII, Ca++, PF3/XIII

used to monitor anticoags

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10
Q

Ref range for PT

A

11-13 seconds

pts on oral anticoags will have PT of 20-27 seconds

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11
Q

INR
international normalized ratio
what does this ratio do?

when on an anticoag….what happens to the magic 4?

protein induced……

A

“correction” standardizes results between labs

when on an anticoag, magic 4 are not decreased in concentration, they are produced in incomplete forms

Protein induced by VIT K absence PIVKA

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12
Q

PIVKA extras
refrence … given a …., futher from this number means?

A

refrence thromboplastin assigned a 1, the further the ISI is from 1 the less sensitive it is to PIVKAS

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13
Q

Ref range of INR

TR

A

.9-1.2 ref range

TR: 2-3

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14
Q

INR calculation

A

pt PT/normal PT to the power of ISI

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15
Q

APTT

A

intrinsic

XII, XI, IX, II, I ,V VIII, PK HMWK, X

2 rgnts:

Activator rgnt - contact activator (XI, XII, PK, HMWK)
PF3 sub

CaCl2

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16
Q

APTT cannot test?
used to monitor ….what are these values?

A

cannnot test PF3, Ca++ or XIII

used to monitor effects of heparin (these pts will have 1.5 -2.5x the normal value)

17
Q

APTT ref range

A

26-36 seconds

18
Q

PT normal APTT prolonged

A

upper part of intrinsic factor problem
XII, XI, IX, HMWK, PK, VIII

19
Q

PT prolonged APTT norm

A

VII

extrinsic path

20
Q

PT prolonged APTT prolonged

A

common path I, II, V X

21
Q

TT
thrombin time

tests adequacy of?

reagent?

ref range

A

tests adequacy of fibrinogen

time required for clot to form is thrombin time

reagent - dilute thrombin

Ref range: 14- 20 sec

22
Q

50:50 mix
if a test is prolonged, it is due to…..

mix what two things?

a deficiency result
a inhibitor result

A

if one test is prolonged, it is due to a factor deficiency or inhibitor

mix norm plasma and pt plasma 1:1

Factor deficiency: addition of norm plasma should cause a significant correctioon in prolonged result

Facotr inhibitor: test should remain prolonged

23
Q

Immunologic fibrinogen
measures?
quantitates….

A

measures Ag

quantitates total fibrinogen and dysfunctional

24
Q

Fibrinogen activity
quantitates?

most?

plasma is? for what reason?

plotted on a

A

quantitates only FUNCTIONAL fibrinogen

most commonly preformed fibrinogen assay

plasma diluted ot 1:10 minimize heparin

std curve

25
Q

FDPs

Fibrinogen degradation products

dont differentiate between…will be positive on both

A

semi quant measure of FDPs

will be pos in presence of FDP, Fibringen fibrin ..etc

dont differentiate 1 from 2 fibrinolysis, will be positive in both firbinogenolysis/fibrinolysis

26
Q

D-Dimer
only in
what is stabllizied

assays?

seen in cases of?

all assays use?

common?

A

only present in 2 fibrinolysis

(polymers stabilized by XIII form clot)

ELISA/EFA

SEEN IN CASES OF THROMBOSIS (DIC/DVT/PE)

all assays use monoclonal ab to D-dimer

latex aggl common

27
Q

Interpretation of D-Dimer

A

particles agglut if D-dumers are present and change OD, flourescne of visible agg on slide

Be aware of post zone (too much ag) in assay

28
Q

Factor Assay
using a specific….
if pt is deficient, what do results look like?

ref range

A

using specific factor def plasma (has everything but VIII) re-run APTT

If pt is def VIII, APTT will remain prolonged

if pt is deficient in some other factor, it will correct

Ref range: 60-150%

29
Q

Anti Xa assay
monitors what therapy?

1.)pt pl….
2.) add

increased color means?

A

to monitor therapy w LMWH, UFH or direct facotr Xa inhibitors

1.)pt plasma w rgnt that has constant Xa amount
2.) add chrom substrate

increased color means decreased LMWH,UFH Direct..etc

30
Q

RT
what does the snake venom do?
acts like?
NOT
what can inhibit it?
Differentiates?

Ref range

A

snake venm cleaves away fibrinopetpide A

TESTS FOR Factor 1

acts like thrombin on fibrinogen

NOT inhibited by thrombin inhibitors like heparin/autoab (FDPs can inhibit)

Differentiates lack of fibrinogen/inhibitor

Ref range: 16-22 sec

31
Q

TT prolonged, RT normal

A

thrombin inhibitor like heparin

32
Q

TT prolonged, RT prolonged

A

lack of fibrinogen/FDPs

33
Q

Urea clot lysis/solubility
adequacy of
what does the test contain?
ref range

A

Adequacy of XIII

if clot has been stabilized by XIII, clot will remain

If not stabilized it will dissolve

PRP, CA++, Glass tube

Ref range 60-150%

34
Q

Euglobulin clot lysis
measures

make sure pt isnt experiencing dangerous

monitor pts on

ref range

A

fibrinolytic capability

make sure pt isnt experiencing dangerous degree of fibrinogenolysis

monitor activity of pt on tPA, strep/urokinase

Euoglobulin fraction, buffer, thrombin/fibrinogen

REF RANGE: >1hr (<4hr)

increased fibrinolutic activity will make it faster

35
Q

Clotal

A

measures coag/fibrinolytic capacity

36
Q

ACT
activated clotting time

A

whole blood clotting time
POCT to monitor high heparin dose during cardiac surgery

37
Q

RVVT

A

Direct activator of X

mixing venom w ca++ and PPP tests the common path

Stypven time

20-30 seconds

(AA) Hemostasis (19 decks)

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