Hemostasis - Unit 3

Question 1

What is hemostasis?

Answer 1

Blood stagnation/the process of clot formation.

Question 2

In simple terms, how does this work?

Answer 2

Tissue injury —> Platelet Plug —> Biochemistry –> Clot

Question 3

When an injury occurs, what factor affects the common pathway?

Answer 3

Factor 10

Question 4

Factor 10 (X) - what happens after this?

Answer 4

Prothrombin –> Thrombin –> Fibrinogen –> Fibrin –> Clot

Question 5

Why does the coagulation process matter?

Answer 5

Because lots of drugs we give affect this!

Question 6

Bleeding & Clotting Disorders - Platelet Issue or Factor Issue - T/F?

Answer 6

True!

Question 7

What are the platelets? How do they act in a bleed?

Answer 7

First responders, unstable platelet plug, they trigger clot formation, and repair microvascular injuries.

Question 8

Is a platelet plug very stable?

Answer 8

Not at all - it tends to go away within an hour. It’s easy to break away - it does this because it signals the body to create a clot.

Question 9

Thrombocytopenia - def

Answer 9

Low Platelet

Question 10

Thrombocytosis/thrombocythemia - def

Answer 10

high platelet count - not general symptomatic.

Question 11

Von Willebrand Factor (vWF) deficiency - what is it?

Answer 11

A platelet or factor problem.

Question 12

What is Von Willebrand disease?

Answer 12

Typically, it gets platelets to adhere to site of injury. It activate them.

In this disease, inadequate/ineffective vWF reduces platelet adhesion, activation and aggregation.

Question 13

What are some signs and symptoms of platelet problems?

Answer 13

Nosebleeds (epistaxis), Bleeding gums, Heavy menstrual bleeding, bruising, melena (black/bloody stool), symptoms of anemia.

Question 14

What are some treatments for Thrombocytopenia/VWD?

Answer 14

SAFETY FIRST!!!

Prevent blood loss. We might need to do a transufsion, DDAVP, immunosuppresant drugs, plasmapheresis.

Question 15

What does DDAVP (Desmopressin) do for blood?

At what level do we usually transfuse? Are we careful with it?

Answer 15

If you have any VWF, it releases it!

Question 16

How do we treat thrombocytosis?

Answer 16

Platelet aggregation inhibitors - usually there isn’t even a need for treatment, though.

Question 17

Factor issues - are they more or less severe than platelet issues?

Answer 17

More severe!

Question 18

What’s Factor V Leiden?

Answer 18

Doesn’t degrade - so we have a prolonged clot.

Question 19

The liver - what does it do for blood?

Answer 19

Filters/produces many clotting factors. It also clears TPA and urokinase

Question 20

What are some signs and symptoms of factor problems?

Answer 20

Platelet-type bleeding plus excessive bleeding from minor injuries, muscle and joint bleeding, prolonged hemorrhage, prolonged bleeding

Question 21

How do we treat factor issues?

Answer 21

Factor concentrates - but these are expensive.
Only one good concentrate exists, but it works for factor 8 only.
Desmopressin, Platelet transfusion, plasma transfusion (FFP), Vitamin K

Question 22

What should a normal platelet count be?

Answer 22

150,000-420,000

Question 23

What do the PT, INR & PTT do?

Answer 23

Measure time from platelet activation to clot formation/how long it takes body to recognize need for formation.

Question 24

PTT - which drug? Normal levels?

Answer 24

Heparin - normally 25-35 seconds, but should be 1.5-2.5 times faster when on heparin.

Question 25

PT/INR - Drug? Normal Levels?

Answer 25

Coumadin. Should normally be 11-14 seconds (PT) and .8-1.2 for INR. With coumadin, INR should be about 2.5-3.5

Question 26

Do we usually start Coumadin before stopping heparin?

Answer 26

Yes!

Question 27

What does antithrombin do?

Answer 27

It prevents thrombin doing its work.

Question 28

What does fibrinolysis do?

Answer 28

Deals with plasminogen - binds to fibrinogen and the clot. It regulates.

Question 29

What is HIT?

Answer 29

Heparin Induced Thrombocytopenia - starts about 5-14 days after receiving heparin. It reduces the platelet count because antibodies attack the platelets. We need to stop heparin and give another anti-coagulant, because there will be both clotting and bleeding with this condition.

Question 30

What is DIC?

Answer 30

It is serious - it’s called Disseminated Intravascular Coagulation - it’s overactive clotting. Also causes depletion of platelets and clotting factors. Give clotting factors and transfuse.