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HEMATOLOGY 2 > WEEK 10 - lab eval of fibrinolysis and anticoagulant therapy > Flashcards

WEEK 10 - lab eval of fibrinolysis and anticoagulant therapy Flashcards

1
Q

is the enzymatic breakdown of fibrin in blood clots.

A

fibrinolysis

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2
Q

star of fibrinolysis

A

plasmin

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3
Q

(including activators and inhibitors) cuts the fibrin mesh at various places, leading to the production of
circulating fragments that are cleared by other proteases.

A

plasmin

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4
Q

The endogenous plasmin-mediated process of dissolving a formed thrombus is denoted __

A

fibrinolysis

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5
Q

principle of whole blood clot lysis time

A

A clot is dissolved as a result of plasmin activity (no plasmin, no dissolution). Normally, this does not
occur in less than 72 hours because of the presence of plasma inhibitors which inactivate plasmin as it forms.

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6
Q

it assesses body’s ability to dissolve a blood clot and assess the fibrinolyutic system that is responsible in breaking clots

A

whole blood clot lysis time

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7
Q

if the lysis of clot occurs less than 72 hours it suggest that

A

our fibrinolytic system is enhanced due to certain conditions

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8
Q

conditions that enhance fibrinolytic activity of WBCLT

A

hyperfibrinolysis
liver disease
malignancy/cancer
systemic disorders

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9
Q

principle of diluted blood clot lysis time

A

plasmin inhibitors loose activity on dilution. In this method, whole blood is diluted with a buffer solution and clotted by the addition of thrombin. Then the clot is observed to lysis

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10
Q

Three buffer solutions that can be used in DCLT

A

o Phosphate buffer (PBS) – most common
o Sodium acetate
o Sodium chloride

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11
Q

purpose of diluted blood in DCLT

A

makes the blood more sensitive and the dilution reduces the concentration of clotting factors and inhibitors (plasmin inhibitors) to be observed readily ng

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12
Q

normal value of DCLT

A

should not lyse less than 6-10 hrs

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13
Q

shorten lysis suggests

A

increase fibrinolysis in DCLT observe in conditions such as

DIC - disseminated intravascular coagulation
liver disease
cancer

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14
Q

prolonged lysis time suggest in DCLT

A

defective fibrinolysis or excessive inhibitions seen in conditions where clot breakdown is impaired

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15
Q

Blood is collected in an anticoagulant, centrifuged and the plasma is recalcified, and checked for clot lysis

A

PLASMA CLOT LYSIS TIME (PCLT)

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16
Q

steps for plasma clot lysis time

A

collect blood
centri
recalcified plasma - adding calcium
check for clot formation
observe lysis
incubation

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17
Q

are proteins that can be precipitated when plasma is acidified by 1% acetic acid

A

euglobulin

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18
Q

fraction of plasma protein

A

eugloblulin

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19
Q

A screening procedure for the measurement of fibrinolytic activity (overall fibrinolysis).

A

EUGLOBULIN CLOT LYSIS TIME (ECLT)

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20
Q

euglobulins are fraction of plasma protein which is composed of

A

plasminogen, plasminogen activator and fibrinogen

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21
Q

normal value of whole blood clot lysis time

A

lysis after 24 hrs

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22
Q

this test is more sensitive than the clot lysis time

A

euglobulin clot lysis time

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23
Q

increase fibrinolytic activity of ECLT is seen in

A

associated with circulatory collapse
adrenalin injection
sudden death
pulmonary surgery
pyrogen reaction
obstetric complication
extreme stress

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24
Q

increased fibrinolytic activity is observed in euglobulin clot lysis time such as the condition associated with circulatory collapse, what are the conditions or example of scenario where it is observed?

A

shock
circulatory system fail

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25
Q

how adrenalin injection increase fibrinolytic activity

A

stimulates the release of tissue plasminogen activator which activates plasminogen to become plasmin

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26
Q

in sudden death, why fibrinolysis increased

A

sudden death - stress and physiologic changes trigger hyperfibrinolysis and is observed in postmortem whereby the body undergo uncontrolled processes

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27
Q

how pyrogen reaction increase fibrinolytic activity

A

induces systemic inflammation activating fibrinolysis

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28
Q

obstetric complication examples

A

placental abruption
amniotic embolism
post partum hemorrhage

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29
Q

how extreme stress increase fibrinolytic activity

A

-stress induces production of catecholamines (adrenalin)

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30
Q

principle of euglobulin clot lysis time

A

addition of 1% acetic acid to diluted plasma causes the euglobulin portion of the plasma to precipitate

after removing the supernatant, the euglobulin are dissolved in a buffer solution, thrombin is added to order to clot the euglobulins

the clot is incubated at 37*C and the time of complete lysis is noted

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31
Q

if the fibrinogen concentration is less than 80 mg/dl what will happen if we measure the fibrinolytic activity

A

it will be difficult to measure due to small clot

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32
Q

the test should be set up immediately after collection, plasma should be kept on ____

A

ice

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33
Q

why do we need to keep the plasma on ice?

A

the plasminogen activators are labile in RT thus will decrease their concentration

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34
Q

principle of protamine sulfate turbidity test

A

patient and control plasma are mixed with varying dilutions of protamine sulfate

each tube is incubated at room temp for 30 mns and observed for fibrin strand

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35
Q

a procedure used to detect the presence of fibrin monomerrs

A

PSTT - Protamine sulfate turbidity test

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36
Q

this FDP assay is not affected by therapeutic level of heparin, a blood thinner/anticoagulant

A

PSTT - protamine sulfate turbidity test

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37
Q

this test evaluates the FIBRIN DEGRADATION PRODUCTS

A

PSTT - Protamine sulfate turbidity test

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38
Q

the presence of fibrin degradation products means there’s an ongoing fibrin formation and dissolution, commonly seen in condition such as

A

disseminated intravascular coagulation

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39
Q

PSTT is a practical, specific, and sensitive blood test for the exclusion of __ and ____

A

venous thromboembolic disease
disseminated intravascular coagulation

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40
Q

aside from venous thromboembolic disease and DIC, the presence of fibrin monomers is also associated with conditions like

A

pulmonary embolism
cirrhosis of the liver

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41
Q

it measures a specific fragment arising from the degradation of crossed linked fibrin (d dimer )

A

latex d dimer assay

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42
Q

this test is superior in sensitivity and specificity as compared with the conventional FDP assay

A

latex d dimer assay

43
Q

this test is positive in early DIC and is specific for cross-linked D-Dimer fragment of fibrin

A

latex D-Dimer Assay

44
Q

a test to determine if there’s still ongoing or remaining clot in the individual

A

latex d dimer assay

45
Q

this test detects for residual clot for patients who had MI and stroke

A

latex d dimer assay

46
Q

latex d dimer assay also evaluates

A

abnormal clot formation and breakdown such as deep vein thrombosis, venous thromboembolism, pulmonary embolism

47
Q

specimen we can use for latex D-Dimer assay

A

fresh citrated/heparinized/edta plasma
Serum

48
Q

2 methods of assay for latex D dimer assay

A

enzyme immunoassay
latex bead

49
Q

a low and sensitive assay for latex d dimer assay

A

enzyme immunoassay

50
Q

a rapid, simple method of semi quantitative test for latex d dimer assay

A

latex bead

51
Q

ref range for latex d dimer

A

less than 200 ng/ml should be present

52
Q

conditions where they turn positive result in latex d dimer assay

A

DIC
pulmonary and cerebral embolism
phlebitis
thrombosis
sickle cell disease

53
Q

test that detects the presence and QUANTITY of FDP

A

fibrin degradation products immunoassay

54
Q

FDP immunoassay is used to evaluate conditions such as

A

blood clot formation and breakdown as seen in conditions associated with

DIC
thromboembolic disorder
post-surgical states

55
Q

plasma concentration of TPA ant9igen may be estimated by

A

enzyme immunoassay

56
Q

to measure TPA activity, a specified concentration of reagent ____ is added to the patient plasma

A

plasminogen

57
Q

TPA levels may indicate increased risk to what conditions

A

myocardial infarction
stroke
deep vein thrombosis

58
Q

used to measure PAI I

A

plasminogen activator inhibitor 1 assay

59
Q

PAI 1 will inhibts

A

TPA and urokinase

60
Q

plasminogen activaor inhibitor 1 assay is done by

A

collecting blood in acidified citrate tube
centrifuge immediately and create PPP
PPP is mixed with a measured amount of reagent TPA

61
Q

the methods for the assay of these fragments are based on red cell hemagglutination inhibitors, staphylococcal agglutination and immunodiffusion

A

quantitative assay of fibrin-fibrinogen degradation products

62
Q

a new assay that is sensitive biological marker of thrombin generation and X activity because generation of F12 precedes thrombus formation

A

prothrombin fragment 1.2 test

63
Q

small protein fragment produced when the prothrombin factor 2 is cleaved by the activated factor 10 during the conversion of prothrombin to thrombin

A

factor 1.2

64
Q

use of prothrombin fragment 1.2 test

A

detects hypercoagulable states
monitoring anticoagulant therapy (direct oral/heparin)
marker of thrombotic events

65
Q

the FDP present in the patient’s serum neutralized antifibrinogen antiserum, thereby preventing the antiserum from agglutinating fibrinogen-coated erythrocytes

A

tanned red cell hemagglutination inhibition immunoassay

66
Q

interpretation of result in tanned red cell hemagglutination inhibition immunoassay

A

with agglutination - no FDP
without agglutination - with FDP which neutralizes the antiserum

67
Q

antithrombin inactivates

A

thrombin and activated factor Xa

68
Q

natural inhibitor of coagulation/thrombin

A

antithrombin

69
Q

in the absence of ___ plasma antithrombin process is relatively slow

and it can act instantaneously inactivates thrombin, otherwise

A

heparin

70
Q

this activity test will detect abnormalities of both decreased levels of normal molecule/and or normal amounts of an abnormal molecule

A

plasma antithrombin test

71
Q

antithrombin protects ___

A

from clotting too much

72
Q

if antithrombin levels are low, a person will have a tendency to ___

A

clot more easily

73
Q

if antithrombin levels are too high, a person could, theoretically, have a

A

bleeding tendency

74
Q

it measures the availability of functional fibrinogen

A

plasma thrombin time

75
Q

a sensitive test in detecting heparin inhibition

A

plasma thrombin time

76
Q

prolonged thrombin time is observed in what conditions

A

hypofibrinogenemia or afibrinogenemia
DIC

77
Q

specimen for plasmathrombin time

A

citrated plasma stored at 2-8*C performed within 4 hrs

78
Q

a measured amount of thrombin is added to plasma. the length of time for a fibrin clot to form is recorded as

A

thrombin time

79
Q

whenever thrombin is used, ___ glassware and pipets should be employed

A

plastic or siliconized

80
Q

is a series of test ised t9 detect lupus anticoagilant in the blood

A

lupus anticoagulant

81
Q

autoantibodies that interfere with blood clotting mechanism

A

lupus anticoagulant

82
Q

lupus anticoagulant is commonly found in patient with

A

Antiphospholipid syndrome

83
Q

an autoimmune disorder causing abnormal clotting and pregnancy complication

A

Antiphospholipid syndrome

84
Q

when are we performing LA test

A

when there is an explained thrombosis in a vein or artery

and

if there is always a miscarriage

85
Q

a technique or method used in lupus anticoagulant test since it’s crucial and needs high risk therapy

A

schleider’s method

86
Q

helps in investigating the cause of a blood clot

A

LA test

87
Q

it evaluates a prolonged partial thromboplastin time and help determine the cause of recurrent miscarriages, or as part of an evaluation for antiphospholipid syndrome

A

LA test

88
Q

is LA test used to diagnose the chronic autoimmune disorder SLE

A

no po

89
Q

therapeutic anticoagulants

A

heparin
coumadin (warparin, dicoumarol)
aspirin

90
Q

works by enhancing the activity of antithrombin III

A

heparin

91
Q

heparin is administered throuh

A

intravenously

92
Q

causes immediate inhibition of blood clotting

A

heparin

93
Q

monitored using the PTT test

A

heparin

94
Q

accelerates the action of ATIII to inactiate thrombin

A

heparin

95
Q

used in MI and in surgery to prevent clotting

A

heparin

96
Q

coumadin (warfarin, dicoumarol) is administered through

A

orally

97
Q

takes couple of days for effects to show

A

coumadin

98
Q

inhibits production of vitamin K dependent and protein C and S

A

coumadin

99
Q

monitored using the PT test

A

coumadin

100
Q

for a long term prevention and treatment of clots

A

coumadin

101
Q

administration results in irreversible inhibition of PLT cyclooxygenase which is needed for proper PLT aggregation

A

aspirin

102
Q

affects last for the lifetime of the PLT at least seven days

A

aspirin

103
Q

patients taking aspirin must refrain from intake before test for at least how many days

A

7 days

104
Q
A

HEMATOLOGY 2 (18 decks)

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