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CV II > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

What is/makes up Virchow’s Triad?

A

Virchow’s triad are three things that lead to thrombosis

1) Endothelial injury
2) Abnormal blood flow
3) Hypercoagulability (Including heparin, oral contraceptives, hyperlipidemia, nephrotic syndrome, malignancy and lupus)

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2
Q

Which factor allows cross-linking?

A

Factor 13

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3
Q

What converts Plasminogen into Plasmin?

A

Tissue plasminogen activator
Urokinase
Factor XIIa

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4
Q

What is the role of plasmin?

A

Enzymatic degradation of fibrin and the clot

Breaks down into fibrin split products

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5
Q

What test could you run to see if there is degradation of a clot?

A

D-Dimer checks for fibrin split products

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6
Q

What does antithrombin do?

A

Inhibits coagulation via thrombin (IIa), IXa, Xa, XIa, XIIa, so if this was greatly increased due to heparin/warfarin then we could have a resultant bleeding disorder

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7
Q

Antithrombin’s binding is amplified by what?

A

Amplified 1000x by heparin

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8
Q

What does aPPT measure?

A

Intrinsic pathway

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9
Q

What does PT measure?

A

Extrinsic pathway

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10
Q

What does TT measure?

A

Common pathway

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11
Q

What does an arterial thrombus lead to?

A

Ischemia

Infarction

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12
Q

What does a venous thrombus lead to?

A

Vascular congestion and edema

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13
Q

A pt <50 presents with a DVT, what do you suspect?

A

Genetic hyper coagulability

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14
Q

Warfarin skin necrosis

A

Heterozygote carrier of Protein C deficiency to develop hemorrhagic skin necrosis when placed on warfarin
Causes cutaneous vessel thrombosis and concomitant skin necrosis

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15
Q

Causes of Protein C deficiency

A

Occurs with hereditary deficiency, surgery, trauma, pregnancy, liver or renal failure, DIC and warfarin (Coumadin)

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16
Q

You may have a false positive syphillis test (VDDRL) in which disorder?

A

Antiphospholipid autoantiboides hypercoagulability syndrome

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17
Q

What is another clinical feature of antiphospholipid autoantibodies?

A

Fetal loss can occur

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18
Q

Heparin-Induced Thrombocytopenia Syndrome (HIT) type II

A

Unfractionated heparin induced autoantibodies to molecular complex with platelet factor 4
The complex causes endothelial injury which leads to a prothrombotic state

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19
Q

Protrhombin G20210A mutation

A

Causes increased prothrombin levels which are converted to working thrombin

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20
Q

Factor V Leiden mutation

A

Activated Protein C Resistance

Mutant has decreased affinity to Activated Protein C and is not deactivated

21
Q

Homocysteine

A

Contributes to arterial/venous thrombosis and atherosclerosis with severe elevations
Increased risk of ASCVD with moderate elevations
Reducing homocysteine levels does not decrease ASCVD risk

22
Q

Thromboembolus

A

Thrombotic fragment moves through the venous system

23
Q

Systemic Emboli

A

Detached thrombotic fragments move from left heart through the arterial system
80% originate from mural thrombi

24
Q

How often are PE’s silent?

A

60-80% are clinically silent

25
Q

What is the leading cause of septic shock?

A

Gram negative bacteria

26
Q

Petechiae

A

<.3cm

27
Q

Purpura

A

0.3-1.0cm

28
Q

Ecchymoses

A

> 1cm

29
Q

Hemophilia A & B

A 
Factors VIII & IX
Joints in 80%
Muscles 
GI mucosa 
Hemarthroses and joint destruction
30
Q

Factor 1 Deficiency

A

Incopatible with life

31
Q

Factor 13 Deficiency

A

Umbilical stump
Later in life bleeding may be delayed and occurs in skin, muscles, oral cavity and brain
Females w/ recurrent abortions
Poor wound healing

32
Q

vWF Disease

A

Majority have mild deficiency, severe disease <.1%

Types 1,2,3

33
Q

Reduced quantity

A

Types 1 & 3

34
Q

Low circulating factor 8

A

Type 3

35
Q

Qualitative defect

A

Type 2

36
Q

Vitamin K deficiency

A

Required in factors II, VII, IX, X and Protein S, C and Z

37
Q

What does unfractionated heparin cause?

A

Causes Antithrombin III activation which leads to anticoagulation and bleeding disorder

38
Q

What does LMW Heparin cause?

A

Causes Antithrombin III activation only against factor Xa which leads to anticoagulation and bleeding disorder

39
Q

What does Warfarin cause?

A

Can cause Vit K dependent factor deficiency which leads to anticoagulation and bleeding disorder

40
Q

Which two factors are not synthesized in the liver?

A

VIII and vWF, so with hepatic failure we see a decrease in all factors except these

41
Q

Deficiency in Gp:Ib leads to what disorder?

A

Bernard-Soulier Syndrome

42
Q

Deficiency in Gp:IIb/IIIa leads to what defects and what disorder?

A

Glanzmann thrombasthenia and defects in aggregation

43
Q

Pathophys of Gray Platelet Syndrome

A

Empty platelet alpha granules

44
Q

Uremia leads to what types of defects?

A

Defects in adhesion, granule secretion and aggregation

45
Q

Acute Immune Idiopathic Thrombocytopenic Purpura (ITP)

A

Childhood disease with acute onset (2 weeks post virus)
Self-limited (resolves w/i 6 mo.)
AutoAb against platelet Ag (GpIIb-IIIa or Gp1b-IX)

46
Q

Chronic Immune Thrombocytopenic Purpura (ITP)

A

Adults disease occurring 20-40yrs with no history of antecedent infection
Spontaneous remissions are rare
Primary/Secondar
AutoAb against platelet Ag (GpIIb-IIIa or Gp1b-IX)

47
Q

Congenital and Idiopathic Thrombotic Thrombocytopenic purpura (TTP)

A

Defiency in ADAMTS13

48
Q

HELLP Syndrome

A

Occuring in pregnant women with HTN

Hemolysis, Elevated liver enzymes, low platelet count

CV II (5 decks)

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