Thrombosis Flashcards
most important step in vivo coagulation
VII -> IX
antithombin
blocks II, IX, X, XI, XII amplified 1000x by heparin
common hypercoaguable states
factor V mutation prothrombin mutation 5.10 methylenetetrahydrofolate reductase mutation increased factor VIII, IX, XI, or fibrinogen
rare hypercoaguable states
antithrombin III deficiency protein C or S deficiency
very rare hypercoagulable states
fibrinolysis defects homozygous homocyteinuria
high risk for thrombosis
prolonged stasis MI atrial fibrillation tissue injury cnacer prosthetic cardiac valves DIC heparin induced thrombocytopenia antiphospholipid Ab syndrome
lower risk for thrombosis
cardiomyopahty nephrotic syndrome hyperestogenic states oral contraceptives sickle cell smoking
Things that block platelet coagulation
ADP Prostacyclin NO
HSPG
blocks IIa IXa Xa XIa XIIa
factor V leiden mutations
activated protein C resistance does not deactiate
prothrombin G20210 A mutation
increased prothrombin levels which are converted to working thrombin
heparin induced thrombocytopenia syndrome type II
unfractionated heparin induces autoAbs to molecular complex w/platelet factor 4 patients have thrombocytopenia and disseminated clots autoAb-heparin-platelet complexes cause endothelial injury, causing prothrombotic state
Antiphospholipid autoAbs
affinity for bound phospholipids on platelet surace that are combinded w/coagulation facotrs lupus anticoagulant detected during aPTT testing false positive VDRL test recurrent venous or arterial thrombosis and/or fetal loss
homocysteine
contributes to arterial and venous thrombosis and atherosclerosis marked elevations caused by homozygous deficiencies of CBS folic acid, pyridoxine, and/or vit B12 can reduce plasma homocysteine concentrations, but does not decrease risk ASCVD
types of shock
disruptive (septic, neurogenic,, anaphylactic) cardiogenic shock hypovolemic shock (hemorrhagic) obstructive shock (saddle PE)
inadequate production of platelets
leukemias aplastic anemia myelodysplaisa B12 or folate deficiency
splenic sequestration of platelets
cirrhosis congestive splenomegaly
increased platelet destruction or consumption
ITP DIC TTP HUS bleeding sepsis HIV
drug induced destruction
quinidine sulfa rarely heparin/HIT
increased platelets
platelet dysfunction bleeding
platelet dysfunction
bernard-soulier syndrome vWD glanzmann thrombbasthenia drug induces (aspirin, NSAIDs) systemic disorders (uremia
acquired coagulation disoreders
vit K deficiency liver disease anticoagulation w/warfain or heparin DIC
hereditary coagulation disorders
hemophilia A (VIII) hemophilia B (IX) hemophilia C (XI) vWD
acquired vascular disorders
collagen defects (scurvey, cushings) henoch-schonlein purpura amyloidosis
hereditary vascular disorders
CT (ehlers-danlos, osteogensis imperfecta, marfans) hereditary hemorrhagic telangiectasia
musculotaneous bleeding
petechiae, bruising, GI think disorders of platelets, vWD, or vasculature
spontaneous or excessive soft tissues, mm and joints, delayed surgical bleeding
think coagulation disorders
afibrognemia
umbilical cord stump bleeding coagulation defect
factor XIII deficiency
males, deep hematomas, hemarthroses, chronic joint abnormalities, umbilical cord stump bleeding coagulation defect
factor XIII deficency
poor wound healing, severe scar formation coagulation defect
chediak-higashi syndrome
oculocutaneous albinism, infections, neutrophil peroxidase + inclusions platelet dysfunction
wiskott aldrich syndomre
eczema, immunodeficiency thrombocytopenia
digeorge syndrome
cleft palate, cardiac defects, facial anomalies, learning disabilities thrombocytopenia
petechiae
<0.3 cm
purpura
.3-1cm
ecchymoses
>1cm
vWD I and III
quantity defect
vWD II
quality defect
hem A
negative for epistaxis, bruising, petechiae, GI bleeding, menorrhagia, postpartum bleeding positive for hematoma, hemarthrosis, post-procedure bleeding
vWD
positive for epistaxis, bruising, petechiae, GI bleeding, menorrhagia, hematoma (type 1), hemarthrosis (type 1), postpartum bleeding, post procedure bleeding
adhesion defects
vWD bernard-soulier disease
adhesion labs
ristocetin
aggregation defects
glanzmann thrombasthenia
aggregation labs
ADP/collage/epi/arachidonic acid
gray platelet syndrome
empty platelet alpha granules mild bleeding autosomal dominant or recessive
morphology of gray platelet syndrome
hypogranular platelets giant platelets thrombocytopenia myelofibrosis
diagnosis of gray platelet syndrome
variably abnormal platelet aggregation abnormal platelet appearance on blood smear electron microscopy shoeing absent alpha granules
uremia
defects in adhesion, granule secretion, and aggregation
acquired platelet storage defects
SLE cardiopulmonary bypass platelet activation
acute immune idiopathic thrombocytopenic purpura
ITP childhood disease w/acute onset (2 weeks post viral) self-limited (resolves w/in 6 months) autoAbs against platelet Ags
chronic immune (refractory) thrombocytoenic purpura of adults
20-49 years 3F:1M spontaneous remissions rare primary or secondary to SLE, HIV, Leukemias/lymphomas autoAbs against platelet Ags
Primary TTP
deficency of ADAMTS13
treated w/plasmaphoresis
waterhouse-friderichsen syndrome
massive adrenal hemorrhages
blue top
plasma
add anticoagulant
red top
serum
no anticoagulant, fluid that does not clot
vit K deficieny or warfarin
pronlonged PT
prolonged aPTT
platelet funx and platelet count unaffected
DIC
prlonged PT
prolonged aPTT
unaffected platelet function
decreased platelet count
vWD
unaffected PT and platelet count
prolonged aPTT
decreased platelet fnx
Haemophilia
unaffected PT, platelet count, platelet fnx
prolonged aPTT
Aspirin
unaffected PT, aPTT, platelet count
decreased platelet function
thrombocytopenia
unaffected PT and aPTT
decreased platelet count
early liver stage
prolonged PT
unaffected aPTT and platelet count
decteased platelet function
end-stage liver disease
prolonged PT and aPTT
decreased platelet count and function
ureima
decreased platelet fnx
congenital afibrogenemia
prolonged PT, aPTT
factor V deficicency
prolonged PT and aPTT
glanzmann’s thrombocytopenia
decreasd platelet fnx
bernard-soulier syndrome
decreased platelet function and count
