Unit IV

Question 1

Factor XIII is a ___ that forms ___ bonds between ___ and ____ residues

Answer 1

transglutaminase
amide
lysine and glutamine

Question 2

TF is expressed by

Answer 2

fibroblasts and smooth muscle cells surrounding blood vessels

Question 3

Structure of fibrinogen

Answer 3

3 pairs of polypeptide chains (2
Aα-chains, 2 Bβ-chains, and 2 γ-chains)
arranged into identical half molecules in an
elongated polypeptide composed of three
globules: a central globule (labelled the E
domain) containing the N-terminal domain
of all of the polypeptides, and globules on
each end of the molecule, designated D
domains

Question 4

Factor XIII cross links ___ domains

Answer 4

D

Question 5

What happens to the phospholipid membrane during platelet activation?

Answer 5

anionic phospholipid phosphatidylserine translocated from inner to outer leaflet

Question 6

Abnormal test in thrombocytopenia

Answer 6

platelet count

Question 7

abnormal test in platelet dysfunction

Answer 7

bleeding time

Question 8

abnormal test in hemophilia

Answer 8

APTT

Question 9

abnormal test in factor VII def

Answer 9

APTT

Question 10

abnormal test in dysfibrinogenemia

Answer 10

Thrombin clotting time (TCT)- fibrinogen defects

Question 11

abnormal test in hypofibrinogenemia

Answer 11

fibrinogen

Question 12

Only vitamin K dependent factor that is not a serine protease

Answer 12

Protein S

Question 13

Homozygous protein C deficiency

Answer 13

fatal in neonates

neonatal purpuea fulminans

Question 14

Tissue factor pathway inhibitor expressed by

Answer 14

constitutively by endothelial cells

Question 15

Plasmin cleaves

Answer 15

both fibrionogen and fibrin

Question 16

t-PA is a poor activator of plasmin in the absence of ____

Answer 16

fibrin

Question 17

Thrombin-activatable fibrinolysis inhibitor mechanism

Answer 17

• factor XIII covalently attaches it to fibrin
• cleaved to active form by thrombin-thrombomodulin complex
• removes C terminal of fibrin polecules and FDPs
• reduces plasminogen binding sites on fibrin

Question 18

Plasminogen activator inhibitor-q (PAI-1) is present in

Answer 18

alpha granules of platelets

Question 19

Deficiency in alpha 2 antiplasmin causes

Answer 19

bleeding disorder

Question 20

two things that cause abnormal bleeding times

Answer 20

1. decrease in platelet count

2. VW disease

Question 21

Post operative hemorrhage in Ashkenazi Jew or middle eastern, possibly after prostectomy

Answer 21

Factor XI deficiency

Question 22

Most common acquired factor inhibitor

Answer 22

factor VIII

- antibody to it

Question 23

In a lab test of Factor VIII, the ___ will be abnormal. When you do a mixing study what will happen?

Answer 23

PTT

It will not correct

Question 24

Prognosis of Factor VII def

Answer 24

excellent long term

Question 25

Most significant lab findings of DIC

Answer 25

- fibrinogen level has decreased markedly and the platelet count is low

Question 26

Syndrome caused by lupus anticoagulant

Answer 26

antiphospholipid antibody syndrome

Question 27

The lupus anticoagulant prolongs the ___. Why?

Answer 27

PTT | IgG antibody binds the phospholipid that is added to test tube to start the reaction

Question 28

Normal plasma mixed with plasma from patient with lupus anticoagulant->

Answer 28

PTT does not correct

Question 29

Lupus coag + phospholipid and repeat PTT

Answer 29

partial correction

Question 30

Other method of detecting lupus anticoagulant

Answer 30

dilute Russell's Viper Venom Test

Question 31

Why should you not give whole blood Group O even though it is the universal donor?

Answer 31

Contains anti-B and A antibodies

Question 32

Antibody to mono reacts to

Answer 32

horse red blood cells

Question 33

antibody to syphilis reacts to

Answer 33

phosphodiester group in bacterium Treponema pallidum | and cardiolipin from beef heart

Question 34

AIDS is diagnosed when CD4 levels fall below

Answer 34

200/microliter

Question 35

Least likely infections in HIV

Answer 35

High grade extracellular pathogens | - maintained ability to make Tfh independent antibody responses

Question 36

Standard antiretroviral therapy uses 2 _ and

Answer 36

NRTIs and a third drug from a different class

Question 37

Postthrombotic syndrome following DVT

Answer 37

- chronic venous insufficiency and chronic venostasis | - extremities become chronically wollen and show dark skin discoloration

Question 38

DVT restricted to calf veins

Answer 38

clinically insignificant

Question 39

DVT of popliteal of more proximal veins

Answer 39

stongly associated with PE

Question 40

Common studies for PE

Answer 40

CT and V/Q scan

Question 41

Arterial thrombi treatment

Answer 41

- heparin (further prevent clot formation) | - fibrinolytic agent (to lyse existing clot)

Question 42

Treatment of venous thrombi

Answer 42

since activation of the coagulation cascade and formation of a fibrin clot is the main pathophysiologic mechanism, agents that inhibit coagulation are indicated

Question 43

With arterial thrombi the | pathophysiology of thrombus formation is primarily related to

Answer 43

platelet activation and aggravation ** therefore treat with antiplatelet in long term setting

Question 44

Dabigatran etexilate

Answer 44

Pradaxa | - direct inhibitor of thrombin

Question 45

Apixaban and rivaroxaban

Answer 45

(Eliquis and Xarelto_ | - directly inhibit factor Xa

Question 46

Antiplatelet drugs are used to treat

Answer 46

acute coronary syndrome

Question 47

3 general classes of anti-platelet drugs

Answer 47

1. platelet products (aspirin) 2. prevent activation/aggregation (ADP receptor antagonists) 3. Block adhesion proteins (glycoprotein IIb/IIIa inhibitors)

Question 48

Thienopyridines (3)

Answer 48

ADP receptor antagonists 1. clopidogrel 2. ticlopine 3. prasugrel

Question 49

Onset of action thienopyridines

Answer 49

slow onset of action

Question 50

Onset of action ticagrelor

Answer 50

more rapid action than thienopyridines

Question 51

3 GPIIb/IIIa

Answer 51

1. abciximab- Monoclonal Ab, given IV 2. Eptifibatide 3. Tirofiban

Question 52

Indications for cryoprecipitate use

Answer 52

low or absent fibrinogen

Question 53

Transfuse PRBCs

Answer 53

4 hours

Question 54

Problem with using cryoprecipitate

Answer 54

IgM isoagglutinins can also be concentrated and cause hemolysis

Question 55

Delayed hemolytic reactions due to

Answer 55

alloantibody production

Question 56

Acute lung injury within 6 hours of infusion->

Answer 56

Transfusion related lung injury

Question 57

Transfusion associated circulatory overload (TACO)

Answer 57

fluid overload related to excessive amounts of products and or/ cardiac dysfunction

Question 58

Drug used in treatment of Philadeplephia chrom neg ALL that uses BiTE

Answer 58

blinatumomab

Question 59

mABs in transplant are directed to ___ and ____

Answer 59

CD3 and IL-2 receptor