121514 hypercoagulable actual thrombosis and DIC part

Question 1

what are coagulation control mechanisms?

Answer 1

blood flow-washes away activated factors

natural anticoagulant processing (antithrombin inactivating 2a and 10a, protein C system digesting cofactors 5 and 8)

Question 2

protein C is activated by

Answer 2

thrombin, which binds to thrombomodulin

Question 3

protein C does what?

Answer 3

degrades 8a and 5a

Question 4

primary hypercoagulable state

Answer 4

associated with venous thromboembolism

Question 5

primary hypercoagulable states–ex of conditions

Answer 5

deficiency of control proteins (antithrombin, protein C or protein S)

subtle changes causing control mechanisms (factor V Leiden-resistance to aPC)

increased coagulation factor levels (prothrombin gene variation G20210A)

Question 6

what percentage of familial thromboses are due to AT, proteinC, protein S deficiencies?

Answer 6

5-15%

Question 7

what tests can you order if you suspect AT, proteinC, or protein S deficiency?

Answer 7

functional AT, PC or PS assay

protein S free antigen

Question 8

what would you see for a disease with resistance to activated protein C on a PTT assay?

Answer 8

failure of PTT to prolong in response to addition of activated protein C

Question 9

factor V Leiden

Answer 9

arg 506 replaced by Gln

Question 10

factor V leiden is venous or arterial thrombotic risk factor?

Answer 10

venous

Question 11

prothrombin gene variation

Answer 11

RNA for prothrombin is more stable

associated with venous events (DVT, PE)

Question 12

antiphospholipid antibody syndrome

Answer 12

auto-Ig against phospholipid binding proteins (a lot of coagulation cascade proteins are phospholipid binding proteins)

Question 13

what symptoms do you see for antiphospholipid antibody syndrome?

Answer 13

venous and/or arterial thrombosis

recurrent fetal wastage

Question 14

lab signs for antiphospholipid antibody syndrome

Answer 14

evidence of antiphospholipid antibody:
lupus-like anticoagulant
positive antiphosphlipid serology

may have thrombocytopenia

Question 15

what is interesting about antiphospholipid antibody syndrome?

Answer 15

inhibits phosphlipid dependent in-VITRO coagulation assays

Question 16

sites of thrombosis-both arterial and venous-what would cause this?

Answer 16

antiphosphlipid syndrome

homocysteine

Question 17

syndromes associated with DIC

Answer 17

introduction of extrinsic clot promoting material

intravascular elaboration of procoagulants (heparin associated thrombocytopenia)

vascular injury (bacterial viral sepsis)

Question 18

DIC is not a disease: true or false

Answer 18

true–DIC is a manifestation of another disease

Question 19

purpura fulminans may be the presenting symptoms of

Answer 19

meningococcal sepsis
severe protein C deficiency in a newborn

can be associated with DIC

Question 20

clinical presentation of DIC

Answer 20

bleeding from venipunctures and other sites
purpura fulminans (microthrombosis in skin and elsewhere)

Question 21

D dimer

Answer 21

when plasmin cuts up clot, cuts up D dimers

Question 22

how is diagnosis of DIC made?

Answer 22

largely on clinical suspicion and appropriate clinical setting

Question 23

lab studies supportive of DIC

Answer 23

PT, PTT prolonged
fibrinogen reduced
platelets reduced
D-dimer elevated (not specific to DIC)

Question 24

differential diagnosis of DIC

Answer 24

DIC
liver failure
vit K deficiency
lupus anticoagulant