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HEME/ONC > hemostasis > Flashcards

hemostasis Flashcards

1
Q

what kind of bleeding do you see with primary d/o?

A

immediate small bleeds
its a platelet issue

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2
Q

list the primary hemostasis d/o (3)

A

platelet d/o
von willebrand dz
drug induced platelet dyfx
ITP

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3
Q

which meds can cause drug induced platelet dysfxn?

A

aspirin
NSAIDs
advil

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4
Q

what kind of bleeding do you see with secondary hemostasis d/o?

A

delayed, severe bleeding
platelets there; deficiencies or inhibitors in cascade

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5
Q

list the 4 secondary hemostasis d/o

A

hemophilias
acquired factor inhibitors
liver dz
DIC

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6
Q

what does DIC stand for

A

disseminated intravascular coagulation

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7
Q

what does ITP stand for

A

immune thrombocytopenic purpura

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8
Q

what is ITP?

A

a primary hemostasis d/o when antibodies attack platelets causing thrombocytopenia

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9
Q

what two glycoproteins are being attacked in ITP?

A

GP1B
GPIIB

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10
Q

what is drug induced platelet dysfunction?

A

a primary hemostasis d/o causing platelets to be either less functional or decreased in #

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11
Q

what is von willebrand’s disease

A

a primary hemostasis d/o of abnormal vWF (quantity or quality)
leads to mucocutaneous bleeding depending on type

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12
Q

what is hemophilia A and B?

A

a secondary hemostasis d/o
inherited decrease in factors 8 or 9

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13
Q

what is DIC?

A

a secondary hemostasis d/o
abnormal activation of clotting system in systemic illness; consumptive coagulopathy

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14
Q

labs that can screen for DIC

A

PT, PTT
platelet count
fibrinogen
D-dimers
FDP

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15
Q

expected PT and PTT and platelet count levels in DIC

A

high PT, PTT

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16
Q

expected platelet count and fibrinogen levels in DIC

A

both will be low

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17
Q

will D-dimers and FDP be present with DIC?

A

yes they both will

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18
Q

what are D-dimers and FDP?

A

D-dimers: product of blood clot
FDP: fibrinogen degradation products

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19
Q

5 scenarios to suspect a thrombophilia

A

unprovoked thrombosis at early age
familial tendency
thrombosis at odd site (artery, portal vein)
recurrent thrombosis
arterial vs venous thrombosis

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20
Q

what does Protein C & S depend on?

A

vitamin K
they are also reduced with warfarin

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21
Q

AT-III is lowered by what drug?

A

heparin

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22
Q

_____, _____, and ______ may be reduced w/ acute clotting

A

protein C
free protein S
AT-III

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23
Q

when should you test for hypercoaguable state?

A

before anticoagulants
2-3 wks after stopping anticoagulants

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24
Q

what is prothrombin time (PT/INR)

A

time it takes for factor VII to form complex with tissue factor and form a clot
monitors extrinsic pathway

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25
Q

what test do we use to monitor warfarin therapy?

A

prothrombin time

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26
Q

how does warfarin work in the body?

A

anticoagulant
vitamin K inhibitor to block factor 2,7,9,10

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27
Q

what do you give to reverse the effect of warfarin?

A

vitamin K

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28
Q

how do abx affect INR?

A

they increase it by decreasing the Vit K producing bacteria in the gut

29
Q

what is normal INR goal when starting warfarin?

A

2-3
if they have artificial valve or if for secondary MI prevention then 2.5-3

30
Q

why do you need to give a bridge when starting warfarin? what do you give as the bridge

A

pt is HYPERcoagulable for 5 days at start bc of long half life of prothrombin
protein C and S are blocked first and they normally do negative feedback
give heparin/LMWH bridge

31
Q

what test can see the severity of liver dz?

A

prothrombin time

32
Q

what test can screen for vitamin K deficiency?

A

prothrombin time

33
Q

what is INR?

A

a way of standardizing PT values from diff labs
you divide PT by control and raise it to ISI

34
Q

what is normal INR levels

A

0.9 to 1.2

35
Q

what is normal PT time?

A

11 to 14 seconds

36
Q

what should you give to a patient with INR > 9 w/o bleeding? how often should you recheck INR?

A

Vit K 2.5-5mg oral (no backup options)
recheck INR q 24hrs

37
Q

when should you NOT give PCC or FFP?

A

never give it to non-bleeding patients

38
Q

what to do in patient with INR 5-9 without bleeding (2 things)

A

maybe give 1-2.5mg vit K (don’t have to give if no major risk factors)
hold 1-2 doses of warfarin
recheck INR q 2-3 days

39
Q

what to do in patient w/ INR <5 without bleeding

A

check INR q 2-3 days
hold 1 dose of warfarin

40
Q

what is partial thromboplastin time (aPTT)

A

measures rate of the contact pathway (intrinsic pathway)
adding activator like clay to plasma

41
Q

5 things that can cause elevated PTT

A

factor deficiency (12,11,10,9,5,2)
antiphospholipid antibodies
acquired factor inibitors
heparin
lupus (if its high in unreasonable setting)

42
Q

what lab is used to monitor heparin?

A

aPTT
heparin anti-xa therapeutic (0.3 to 0.8)

43
Q

when are mixing studies done?

A

to see if they are deficient or if the factors are just being inhibited

44
Q

if you give mixing studies and it corrects, what does this mean?

A

it means they had a deficiency
if it did not correct then it’d mean the factors are being inhibited

45
Q

what is the normal range for aPTT

A

25-40 seconds

46
Q

how does heparin work? what’s the therapeutic range?

A

activates antithrombin III which inactivates IIA, VIIa-TF, IXa, Xa, XIa
therapeutic range is 40-70 secs

47
Q

what is the major risk with heparin therapy?

A

bleeding- it can be internal if dose is too high

48
Q

how do you reverse heparin? (what do you give?)

A

protamine sulfate!!!!

49
Q

unfractionated vs LMWH heparin

A

unfractionated is IV and monitored
LMWH is SQ, longer, wt based and no need to monitor

50
Q

what is heparin induced thrombocytopenia (HIT)

A

low platelet and thrombosis d/t antibodies to heparin/PF4 complex

51
Q

what should you suspect when theres a decrease in platelets by >50% or levels <100k?

A

HIT

52
Q

what should you do if someone has HIT? (4 things)

A

stop immediately and permanently
check antiPF5 antibody
confirm it
avoid platelet transfusion

53
Q

2 ways to confirm HIT?

A

serotonin release assay or P-selectin expression assay (PEA)

54
Q

what should you right after stopping heparin in patient with HIT? why?

A

a different anticoagulant like argatroban, fondaparinux, bivalirudin
bc heparin is still floating around in the body

55
Q

what disorder is HIT similar to? how are they a bit different?

A

DIC except its more clotting than bleeding and the clots are huge

56
Q

how does tPA work?

A

breaks down clot by cleaving plasminogen into plasmin and speeding up fibrinolysis

57
Q

name the antiplatelet drug that blocks platelet ACTIVATION

A

Clopidogrel

58
Q

name the antiplatelet drug that blocks platelet AGGREGATION

A

Aspirin

59
Q

most common type of von Willebrand dz?

A

type 1– low vWF and mild sx

60
Q

what type of von Willebrand dz is a qualitative issue?

A

type 2

61
Q

what type of von Willebrand dz can resemble hemophilia?

A

type 3

62
Q

4 initial testings for von Willebrand dz

A

vWF:Ag— its low
Ristocetin cofactor activity (vWF R:Co)– for activity measure
factor VIII activity
vWF multimers

63
Q

what is thrombin time (TT)

A

measures conversion of fibrinogen to fibrin

64
Q

3 things that elevate TT

A

hypo or dysfibrinogenemia
heparin
DIC

65
Q

what is normal fibrinogen range?

A

175-400

66
Q

2 things that cause decreased & increased Fibrinogen

A

decreased—DIC, liver dz
increased– inflammatory states, pregnancy

67
Q

when do you do FDP/D-dimer testing?

A

to screen for clotting including DIC

68
Q

when can you see FDP/D-dimer (6)

A

DIC
malignancy
liver dz
surgery
trauma
pregnancy

HEME/ONC (5 decks)

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