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2 - Hematology Flashcards

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1
Q

Initial events for thrombus formation

A

Plt adhesion
Shape change
Granule release -> recruitment
Hemostatic plug at area of subendothelial collagen exposure

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2
Q

Three initial responses to vascular injury

A

Vascular vasoconstriction
Platelet adhesion
Thrombin generation

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3
Q

Activates factor XI

A

Exposed collagen + prekallikrein + HMW kininogen + factor XII

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4
Q

Activates factor IX

A

Activated XI

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5
Q

Activates factor X

A

Activated IX, add VIII

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6
Q

Convert prothrombin (factor II) to thrombin

A

Activate X, then add V

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7
Q

What does thrombin do?

A

Converts fibrinogen to fibrin

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8
Q

First step of extrinsic pathway

A

Tissue factor (injured cells) + factor VII

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9
Q

Second step of extrinsic pathway

A

Activate X, add V

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10
Q

Prothrombin complex

A

X, V, Ca, Platelet factor 3, prothrombin
Forms on platelets
Catalyzes thrombin formation

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11
Q

Tissue factor pathway inhibitor

A

Inhibits factor X

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12
Q

Fibrin activity

A

Links platelets together

Binds GpIIb/IIIa to form platelet plug -> hemostasis

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13
Q

Thrombin activity

A

Key to coagulation
Converts fibrinogen to fibrin and fibrin split products
Activates factors V and VIII
Activates platelets

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14
Q

Antithrombin III

A

Key to anticoagulation
Binds and inhibits thrombin
Inhibits factors IX, X, XI

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15
Q

Function of heparin

A

Activates AT-III (up to 1000x normal activity)

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16
Q

Protein C

A

Vitamin K-dependent
Degrades factors V and VIII
Degrades fibrinogen

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17
Q

Protein S

A

Vitamin K-dependent

Protein C cofactor

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18
Q

Fibrinolysis 1st step

A

Tissue plasminogen activator - released from endothelium and converts plasminogen to plasmin

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19
Q

Plasmin function

A

Degrades factors V and VIII, fibrinogen, and fibrin -> loss of platelet plug

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20
Q

Alpha-2 antiplasmin function

A

Natural plasmin inhibitor

Released from endothelium

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21
Q

Shortest factor half life

A

VII

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22
Q

Factors V and VIII - labile factors - stored activity?

A

Activity lost in stored blood

Activity not lost in FFP

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23
Q

Synthesis of factor VIII

A

Only factor not in liver

Synthesized in endothelium along with vWF

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24
Q

Vitamin K-dependent factors

A

II, VII, IX, X; protein C, S

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25
Effect time of IV vitamin K
12 hours
26
Effect time of FFP
Immediate
27
Blood cell half-life
RBC: 120 days Platelets: 7 days PMNs: 1-2 days
28
Prostacyclin (PGI2) source/function
From endothelium Decreases platelet aggregation, promotes vasodilation (antagonizes TXA2) Increases cAMP in platelets
29
Thromboxane A2 source/function
From platelets Increases platelet aggregation and promotes vasoconstriction Triggers Ca release in plts -> exposes GpIIB/IIIa receptor, causes platelet-platelet binding, platelet-to-collagen binding
30
Cryoprecipitate
Highest concentration of vWF-VIII Used in von Willebrand's disease and hemophilia A High levels of fibrinogen
31
FFP
High levels of all coagulation factors, protein C, protein S, AT-III
32
DDAVP/conjugated estrogens
Cause release of VIII and vWF from endothelium
33
Prothrombin time (PT)
Measures II, V, VII, X, fibrinogen | Best for liver synthetic function
34
Partial thromboplastin time (PTT)
Measures most factors except VII and XIII (does not pick up factor VII deficiency) Also measures fibrinogen
35
Goal PTT for routine anticoagulation
60-90seconds
36
ACT goal time
150-200 sec for routine anticoagulation | >480 sec for cardiopulmonary bypass
37
INR level relative contraindication to surgery
>1.5
38
INR >1.3
Relative contraindication to: CVL placement Perc needle biopsies Eye surgery
39
MCC surgical bleeding
Incomplete hemostasis
40
MC congenital bleeding disorder
von Willebrand's disease
41
MC Sx vWD
Epistaxis
42
Genetics of vWD
Types 1, 2 autosomal dominant | Type 3 autosomal recessive
43
Function of von Willebrand factor
Links GpIb receptor on plts to collagen
44
vWD Type I
Most common (70%), often only mild Reduced quantity of vWF Tx: recombinant VIII:vWF, DDAVP, cryo
45
vWD type II
Defect on vWF molecule itself, doesn't work well | Tx: recombinant VIII:vWF, cryoprecipitate, DDAVP
46
vWD Type III
Complete vWF deficiency (rare) Tx: recombinant VIII:vWF, cryoprecipitate DDAVP WILL NOT WORK
47
Hemophilia A
VIII deficiency, sex-linked recessive Prolonged PTT, normal PT (follow PTT q8h p surgery) Tx with recombinant factor VIII or cryo
48
Goal levels in hemophilia A
Need 100% pre-op | 80-100% for 10-14 days p surgery
49
Hemophilia B
IX deficiency, sex-linked recessive Prolonged PTT and normal PT Tx: recombinant factor IX or FFP
50
Goal levels in hemophilia B
Need 100% pre-op | Keep at 20-30% 2-3 days p surgery
51
Factor VII deficiency
Prolonged PT and normal PTT Bleeding tendency Tx: recombinant factor VII concentrate, FFP
52
Platelet disorder sx
Bruising, epistaxis, petechiae, purpura
53
Acquired thrombocytopenia
Can be caused by H2 blockers, heparin
54
Glanzmann's thrombocytopenia
GpIIb/IIIa receptor deficiency on platelets (fibrin normally links GpIIb/IIIa together) Tx: platelets
55
Bernard Soulier
GpIb receptor deficiency on platelets (can't bind collagen) (vWF normally links GpIb to collagen) Tx: platelets
56
Uremia (platelet disorder)
BUN>60-80 Inhibits plt function by inhibiting release of vWF Tx: hemodialysis, DDAVP for acute reversal, cryo for moderate/severe bleeding
57
HIT
Thrombocytopenia d/t anti-heparin Ab -> plt destruction Can also cause plt aggregation and thrombosis Dx: plts <100, drop in plts > 50% admission levels, thrombosis on heparin ELISA for heparin Abs, serotonin release assay Tx: STOP heparin, start argatroban, avoid giving plts (risk of thrombosis)
58
DIC
Decreased plts, low fibrinogen, high fibrin split products (high D-dimer) Prolonged PT and PTT Often initiated by tissue factor Treat underlying cause
59
ASA
Stop 7 days before surgery - prolonged bleeding time Inhibits cyclooxygenase in plts and decreases TXA2 Plts lack DNA, cannot resynthesize COX
60
Clopidogrel
Stop 7 days before surgery, ADP receptor antagonist | Tx for bleeding: platelets
61
Coronary stent and need to stop Plavix for elective surgery
Tx: bridge with Integrin (eptifibatide [GpIIb/IIIa inhibitor])
62
Coumadin
Stop 7 days a surgery, consider starting heparin while Coumadin wears off Tx for bleeding: Vit K and FFP
63
Plts goal for surgery
Want >50k before surgery | >20k p surgery
64
Prostate surgery and coagulation
Can release urokinase, activates plasminogen -> thrombolysis | Tx: aminocaproic acid (Amicar, inhibits fibrinolysis
65
Best way to predict bleeding risk
H&P

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