5-REVISED SECONDARY HEMOSTASIS Flashcards
1
Q
What is the primary goal of secondary hemostasis
A
Formation of a stabilized fibrin clot
2
Q
What are the main components of secondary hemostasis
A
Coagulation factors
3
Q
What two processes occur during secondary hemostasis
A
Coagulation factors interact on platelet surfaces to produce fibrin+Fibrin stabilization by Factor XIII
4
Q
What is Factor I called
A
Fibrinogen
5
Q
What is Factor II called
A
Prothrombin (Prethrombin)
6
Q
What is Factor III called
A
Tissue factor (Tissue thromboplastin)
7
Q
What is Factor IV called
A
Calcium
8
Q
What is Factor V called
A
Proaccelerin (Labile factor+Accelerator globulin)
9
Q
What is Factor VII called
A
Proconvertin (Stable Factor+SPCA)
10
Q
What is Factor VIII called
A
Antihemophilic factor (AHF-A+Platelet cofactor 1)
11
Q
What is Factor IX called
A
Plasma thromboplastin component (Christmas factor+AHF-B+Platelet cofactor 2)
12
Q
What is Factor X called
A
Stuart-Prower factor (Autoprothrombin III)
13
Q
What is Factor XI called
A
Plasma thromboplastin antecedent (AHF-C)
14
Q
What is Factor XII called
A
Hageman factor (Glass factor+Contact factor)
15
Q
What is Factor XIII called
A
Fibrin stabilizing factor (Laki-Lorand Factor+Fibrinase+Plasma transglutamase)
16
Q
What is Prekallikrein called
A
Fletcher factor
17
Q
What is HMWK called
A
Fritzgerald factor (Contact activation cofactor+Williams factor+Flaujeac factor)
18
Q
What are the four classifications of blood factors
A
Substrate+Zymogen+Cofactor+Calcium
19
Q
What is a substrate in coagulation
A
Substance on which enzymes act (e.g.
20
Q
What is a zymogen in coagulation
A
Enzyme precursor with no biologic activity (e.g.
21
Q
What converts zymogens to active enzymes
A
Serine proteases
22
Q
What is a cofactor in coagulation
A
Component aiding zymogen activation (e.g.
23
Q
Which factor stabilizes fibrin clots
A
Factor XIII (Fibrin stabilizing factor)
24
Q
What vitamin is required for Factors II, VII, IX, and X,
A
Vitamin K
25
Which factors participate in the common pathway
Factors I, II, V, X, XI, XII, XIII
26
Which factors participate in the extrinsic pathway
Factor VII
27
Which factors participate in the intrinsic pathway
Factors VIII, IX, XI, XII, Prekallikrein, HMWK
28
Which factors have short plasma half-lives (5-12 hours)
Factors V, VII, VIII
29
What is required for fibrin cross-linking
Factor XIIIa (activated form)
30
What initiates fibrin formation
Thrombin (Factor IIa) cleaving fibrinogen
31
What is the substrate for thrombin
Fibrinogen (Factor I)
32
Which coagulation factors are NOT serine proteases
Factor I (fibrin clot)+Factor V (cofactor)+Factor VIII (cofactor)+Factor XIII (transglutaminase)
33
What is the active form of most coagulation factors
Serine protease
34
Which factors act as cofactors
Factor V+Factor VIII
35
What type of enzyme is Factor XIII
Transglutaminase
36
What does Factor I form
Fibrin clot
37
Where are coagulation factors produced
Liver (except VIII:vWF
38
In what form do coagulation factors circulate
Inactive precursors (zymogens)
39
Which factors are serine proteases
II+VII+IX+X+XI+XII+prekallikrein+HMWK
40
Which factors belong to the extrinsic pathway
III+VII
41
Which factors belong to the intrinsic pathway
XII+XI+IX+VIII
42
Which factors belong to the common pathway
X+V+II+I
43
Which factors comprise the fibrinogen group
I+V+VIII+XIII
44
What defines the fibrinogen group
Vitamin K independent+calcium dependent+fully consumed during clotting+absent in serum
45
Which factors comprise the prothrombin group
II+VII+IX+X+protein C+protein S
46
What defines the prothrombin group
Vitamin K dependent+calcium dependent+adsorbable by BaSO4/Al(OH)3+absent in adsorbed plasma
47
Which factors comprise the contact group
XII+XI+prekallikrein+HMWK
48
What defines the contact group
Vitamin K independent+calcium independent+activate Factor XII
49
Which test evaluates intrinsic/common pathways
APTT (activated partial thromboplastin time)
50
Which factors does APTT assess
XII+XI+X+IX+VIII+V+II+I
51
Which therapy does APTT monitor
Heparin therapy
52
Which test evaluates the extrinsic pathway
PT (prothrombin time)
53
Which factors does PT assess
VII+X+V+II+I
54
Which therapy does PT monitor
Coumadin (warfarin) therapy
55
What is the half-life order of prothrombin group factors
VII
56
What is the most concentrated coagulation factor
Fibrinogen (Factor I)
57
What are the components of Factor VIII complex
VIII:C (coagulant)+VIII:vWF
58
Where is VIII:vWF produced
Megakaryocytes and endothelial cells
59
What are the three stages of secondary hemostasis (per Fig 5.2)
1. Generation of thromboplastin+2. Conversion of prothrombin to thrombin+3. Conversion of fibrinogen to fibrin
60
Where does the major site of coagulation inhibition occur
Endothelium and platelet
61
What are the four major coagulation inhibitors (per Table 5.6)
Antithrombin+Protein C+Protein S+Tissue Factor Pathway Inhibitor (TFPI)
62
What does the coagulation or clotting time measure
Period required for blood to clot after removal from the body
63
What does the coagulation or clotting time detect
Coagulation factor deficiency
64
What are the two methods to measure coagulation time
Capillary blood method+Whole Blood/Lee and White
65
What is the normal value for the capillary blood method
2-4 minutes
66
What is the normal value for the Whole Blood/Lee and White method
7-15 minutes
67
Where can the Whole Blood/Lee and White method be performed
Bedside
68
What type of specimen is used for Prothrombin Time (PT) testing
Platelet Poor Plasma
69
What reagent is added to the Platelet Poor Plasma for PT testing
Thromboplastin+Calcium Chloride
70
How does the PT test start
Mix platelet poor plasma+thromboplastin+start timer upon the addition of calcium chloride
71
What is the normal value for PT
12-14 seconds (some sources 10-12 seconds)
72
What therapy is monitored by PT
Coumadin Therapy
73
What is the action of Coumadin
Vitamin K Antagonist
74
Name the several compounds of coumadin
Dicumarol+Indanedione+Warfarin (4-oxycoumarin)
75
Which compound of coumadin is most commonly used
Warfarin (4-oxycoumarin)
76
How is Coumadin neutralized
Vitamin K supplement or FFP (Fresh Frozen Plasma)
77
What is the principle of the PT test
Clot formation in citrated plasma measured in seconds after addition of thromboplastin and calcium
78
Which coagulation factors does PT monitor
Extrinsic and common pathways
79
What tissue is used to derived tissue thromboplastin
Rabbit brain or lung tissue
80
What is the most sensitive PT reagent
Manchester Reagent
81
What tissue is used to derived Manchester Reagent
Human brain thromboplastin
82
What is INR
International Normalized Ratio
83
What is the purpose of INR
Standardized way of reporting PT results
84
What INR should be achieved for most indications (DVT
MI)
85
What INR is recommended for patients with prosthetic heart valves
2.5-3.5
86
What INR is the target for pulmonary embolism treatment
3
87
What is ISI
International Sensitivity Index
88
Where can ISI be found
PT reagent bottle
89
Who assigns the ISI
Manufacturers
90
What is an ISI of less than 1.0 mean
More sensitive thromboplastin
91
Why is the ISI value critical
For calculation of INR
92
What is the normal value for APTT/aPTT/PTT
35-45 seconds (some sources 25-35 seconds)
93
What therapy is monitored by APTT/aPTT/PTT
Heparin Therapy
94
What is the action of Heparin
Antithrombin
95
How is Heparin overdose neutralized
Protamine Sulfate
96
What is the principle of the APTT/aPTT/PTT
Clot formation in citrated plasma measured in seconds after addition of partial thromboplastin reagent and calcium chloride
97
Which coagulation factors are monitored by APTT/aPTT/PTT
Intrinsic and common pathways
98
What is the activator for APTT reagent
Kaolin+ellagic acid+celite
99
What factor does Kaolin+ellagic acid+celite activates
Factor XII
100
What is the purpose of phospholipid in APTT reagent
Substance for platelet factor 3
101
What type of specimen is used for Stypven Time or Russell Viper Venom Time testing
Platelet poor plasma + Stypven reagent (platelin – CaCl2)
102
Which factor deficiency is detected using Stypven Time or Russell Viper Venom Time testing
Factor deficiency in the common pathway
103
Where is the source for Stypven reagent
East Indian Viper (Vipera russelli) venom
104
Which factor is directly activated by Stypven reagent
Factor X
105
What is the normal value for Stypven Time or Russell Viper Venom Time testing
6-10 seconds
106
What does Thrombin Time measure
Rate of thrombin-induced cleavage of fibrinogen to fibrin monomers & subsequent polymerization to form insoluble fibrin clot
107
What formation does the Thrombin Time evaluate
Thrombin
108
What is the normal value for Thrombin Time
10 to 14 seconds or <20 seconds
109
What are the conditions for Prolonged Thrombin Time
Fibrinogen deficiency (<100 mg/dl)+Presence of FDP/FSP+Thrombolytic agent (Streptokinase)+High concentrations of immunoglobulins+Heparin Therapy
110
What are the multiple roles of Thrombin
Promotes wound healing and tissue repair+Stimulates platelet aggregation+Converts Fibrinogen to fibrin+Converts Plasminogen to plasmin+Converts Protein C to APC (Activated Protein C)
111
What is Reptilase
Enzymes found in the venom of Bothrops atrox snake
112
What is Reptilase thrombin-like in nature
Enzymes found in the venom of Bothrops atrox snake
113
What is the normal value for Reptilase Time
10 to 15 seconds
114
What conditions result in a prolonged Reptilase Time
Dysfibrinogenemia+Fibrinogen deficiency+Presence of FDP/FSP+Thrombolytic agent (streptokinase)
115
What is the effect of heparin therapy on Reptilase Time
Unaffected
116
What does the Urea Solubility Test or Duckert’s Test or Factor XIII Assay detect
Factor XIII deficiency
117
What reagent is used in Urea Solubility Test
5 M Urea
118
What reagents can substitute
1% monocloroacetic acid or 2 % acetic acid
119
What is the normal result in the Urea Solubility Test
Insoluble to urea (24°C)
120
What does the Prothrombin Consumption Test detect
Detect for thrombogenesis capability
121
What is the result of the PT test in Factor I Deficiency
Prolonged
122
What is the result of the APTT test in Factor I Deficiency
Prolonged
123
What is the result of the PT test in Factor II Deficiency
Prolonged
124
What is the result of the APTT test in Factor II Deficiency
Prolonged
125
What is the result of the PT test in Factor V Deficiency
Prolonged
126
What is the result of the APTT test in Factor V Deficiency
Prolonged
127
What is the result of the PT test in Factor VII Deficiency
Prolonged
128
What is the result of the APTT test in Factor VII Deficiency
Normal
129
What is the result of the PT test in Factor VIII Deficiency
Normal
130
What is the result of the APTT test in Factor VIII Deficiency
Prolonged
131
What is the result of the PT test in Factor IX Deficiency
Normal
132
What is the result of the APTT test in Factor IX Deficiency
Prolonged
133
What is the result of the PT test in Factor X Deficiency
Prolonged
134
What is the result of the APTT test in Factor X Deficiency
Prolonged
135
What is the result of the PT test in Factor XI Deficiency
Normal
136
What is the result of the APTT test in Factor XI Deficiency
Prolonged
137
What is the result of the PT test in Factor XII Deficiency
Normal
138
What is the result of the APTT test in Factor XII Deficiency
Prolonged
139
What factors are defective if there is abnormal APTT only
VIII+IX+XI+XII defect
140
What factor is defective if there is abnormal PT only
VII defect
141
What factors are defective if there is abnormal APTT and PT
X+V+II+I defects
142
What other medical conditions can cause abnormal APTT and PT
DIC+Liver disease+Vitamin K deficiency+Massive transfusion
143
What is the purpose of Substitution Tests/Mixing Studies
To detect what coagulation factor is deficient in a certain patient+to determine if prolonged PT or PTT is due to a factor deficiency or an inhibitor
144
If PT/APTT/TT are abnormal+and normal plasma corrects+what is the possible deficient factor
I
145
If PT/APTT are abnormal+and normal plasma corrects+what is the possible deficient factor
II
146
If PT/APTT are abnormal+and normal plasma corrects+what is the possible deficient factor
V
147
If PT is abnormal+and normal plasma corrects+what is the possible deficient factor
VII
148
If APTT is abnormal+and normal plasma corrects+what is the possible deficient factor
VIII
149
If APTT is abnormal+and normal plasma corrects+what is the possible deficient factor
IX
150
If PT/APTT are abnormal+and normal plasma corrects+what is the possible deficient factor
X
151
If APTT is abnormal+and normal plasma corrects+what is the possible deficient factor
XI or XII
152
What do circulating anticoagulants typically prolong
APTT (or PT)
153
How do circulating anticoagulants affect normal plasma
Prolongation of the APTT (or PT) test is not corrected by the addition of normal plasma
154
What are the actions of circulating anticoagulants
Inactivate an activated coagulation factor+block interaction between coagulation factors and platelets
155
Name the examples of circulating anticoagulants
Lupus inhibitor+Nonspecific anticoagulant+IgG+IgM+IgA which interfere with phospholipid portion of the prothrombinase complex+Xa-Va-calcium-platelet-phospholipid
156
Which procedure is used to identify circulating anticoagulants
Platelet neutralization procedure+Dilute Russel Viper Venom time
157
What are examples of circulating anticoagulants
Lupus inhibitor+Nonspecific anticoagulant+IgG
158
What procedures are used to identify circulating anticoagulants
Platelet neutralization procedure+Dilute Russel Viper Venom time
159
What is the BT in Disorder of 1° hemostasis
Increased
160
What is the CT in Disorder of 1° hemostasis
Normal
161
What is the PT in Disorder of 1° hemostasis
Normal
162
What is the APTT in Disorder of 1° hemostasis
Normal
163
What is the Stypven in Disorder of 1° hemostasis
Normal
164
What is the TT in Disorder of 1° hemostasis
Normal
165
What is the Duckert's in Disorder of 1° hemostasis
Normal
166
What is the BT in Fibrinogen deficiency
Normal
167
What is the CT in Fibrinogen deficiency
Increased
168
What is the PT in Fibrinogen deficiency
Increased
169
What is the APTT in Fibrinogen deficiency
Increased
170
What is the Stypven in Fibrinogen deficiency
Increased
171
What is the TT in Fibrinogen deficiency
Increased
172
What is the Duckert's in Fibrinogen deficiency
Normal
173
What is the BT in Prothrombin deficiency
Normal
174
What is the CT in Prothrombin deficiency
Increased
175
What is the PT in Prothrombin deficiency
Increased
176
What is the APTT in Prothrombin deficiency
Increased
177
What is the Stypven in Prothrombin deficiency
Increased
178
What is the TT in Prothrombin deficiency
Normal
179
What is the Duckert's in Prothrombin deficiency
Normal
180
What is the BT in Parahemophilia
Normal
181
What is the CT in Parahemophilia
Increased
182
What is the PT in Parahemophilia
Increased
183
What is the APTT in Parahemophilia
Increased
184
What is the Stypven in Parahemophilia
Increased
185
What is the TT in Parahemophilia
Normal
186
What is the Duckert's in Parahemophilia
Normal
187
What is the BT in Factor VII deficiency
Normal
188
What is the CT in Factor VII deficiency
Increased
189
What is the PT in Factor VII deficiency
Increased
190
What is the APTT in Factor VII deficiency
Normal
191
What is the Stypven in Factor VII deficiency
Normal
192
What is the TT in Factor VII deficiency
Normal
193
What is the Duckert's in Factor VII deficiency
Normal
194
What is the BT in Hemophilia A (classic)
Normal
195
What is the CT in Hemophilia A (classic)
Increased
196
What is the PT in Hemophilia A (classic)
Normal
197
What is the APTT in Hemophilia A (classic)
Increased
198
What is the Stypven in Hemophilia A (classic)
Normal
199
What is the TT in Hemophilia A (classic)
Normal
200
What is the Duckert's in Hemophilia A (classic)
Normal
201
What is the BT in Von Willebrand disease
Increased
202
What is the CT in Von Willebrand disease
Increased
203
What is the PT in Von Willebrand disease
Normal
204
What is the APTT in Von Willebrand disease
Increased
205
What is the Stypven in Von Willebrand disease
Normal
206
What is the TT in Von Willebrand disease
Normal
207
What is the Duckert's in Von Willebrand disease
Normal
208
What is the BT in Hemophilia B
Normal
209
What is the CT in Hemophilia B
Increased
210
What is the PT in Hemophilia B
Normal
211
What is the APTT in Hemophilia B
Increased
212
What is the Stypven in Hemophilia B
Normal
213
What is the TT in Hemophilia B
Normal
214
What is the Duckert's in Hemophilia B
Normal
215
What is the BT in Factor X deficiency
Normal
216
What is the CT in Factor X deficiency
Increased
217
What is the PT in Factor X deficiency
Increased
218
What is the APTT in Factor X deficiency
Increased
219
What is the Stypven in Factor X deficiency
Increased
220
What is the TT in Factor X deficiency
Normal
221
What is the Duckert's in Factor X deficiency
Normal
222
What is the BT in Hemophilia C
Normal
223
What is the CT in Hemophilia C
Increased
224
What is the PT in Hemophilia C
Normal
225
What is the APTT in Hemophilia C
Increased
226
What is the Stypven in Hemophilia C
Normal
227
What is the TT in Hemophilia C
Normal
228
What is the Duckert's in Hemophilia C
Normal
229
What is the BT in Factor XII deficiency
Normal
230
What is the CT in Factor XII deficiency
Increased
231
What is the PT in Factor XII deficiency
Increased
232
What is the APTT in Factor XII deficiency
Normal
233
What is the Stypven in Factor XII deficiency
Normal
234
What is the TT in Factor XII deficiency
Normal
235
What is the Duckert's in Factor XII deficiency
Normal
236
What is the BT in Factor XIII deficiency
Normal
237
What is the CT in Factor XIII deficiency
Normal
238
What is the PT in Factor XIII deficiency
Normal
239
What is the APTT in Factor XIII deficiency
Normal
240
What is the Stypven in Factor XIII deficiency
Normal
241
What is the TT in Factor XIII deficiency
Normal
242
What is the Duckert's in Factor XIII deficiency
Abnormal
243
What is the BT in DIC
Increased
244
What is the CT in DIC
Increased
245
What is the PT in DIC
Increased
246
What is the APTT in DIC
Increased
247
What is the Stypven in DIC
Increased
248
What is the TT in DIC
Increased
249
What is the Duckert's in DIC
Normal
250
What is Factor XI deficiency also known as
Hemophilia C or Rosenthal`s Syndrome
251
What is the cause of Factor XI deficiency
Usually due to decreased synthesis
252
What type of bleeding syndrome is usually caused by Factor XI deficiency
Mild bleeding syndrome usually due to trauma
253
What are symptoms of Factor XI deficiency
Epistaxis
254
What are the results of a prolonged APTT in Factor XI deficiency
Corrected by absorbed plasma and aged serum
255
What are the treatments of Factor XI deficiency
Fresh Whole Blood+Fresh Frozen Plasma
256
What is Factor VIII: C Deficiency also known as
Classic Hemophilia or Hemophilia A
257
What type of inheritance does Factor VIII: C Deficiency have
Sex-linked or X-linked
258
What is the cause of Factor VIII: C Deficiency
Due to deficient or defective Factor VIII: C
259
What is the bleeding tendency of Factor VIII: C Deficiency
Bleeding diathesis
260
What are the symptoms of Factor VIII: C Deficiency
Hematomas+hemarthroses+epistaxis+hematuria+G.I. bleeding+intracranial hemorrhage+post-operative bleeding
261
What are the results of a prolonged APTT in Factor VIII: C Deficiency
Corrected by absorbed plasma but not by aged serum
262
What are the treatments for Factor VIII: C Deficiency
Cryoprecipitate+DDAVP (1-desamino-8-d-arginine-vasopressin)
263
What is the function of DDAVP
Increases plasma Factor VIII: C by causing its release from endogenous stores
264
What is Desmopressin
An analogue of ADH that maybe substituted for blood components
265
What do Prothrombin Complex Concentrates contain
Factors II+VII+IX+X as well as protein C and S
266
When are Prothrombin Complex Concentrates reserved for
Life threatening situations
267
What is Factor IX Deficiency also known as
Hemophilia B or Christmas Disease
268
What type of inheritance does Factor IX Deficiency have
Sex-linked recessive
269
Is Factor IX Deficiency generally milder or more severe than Hemophilia A
Generally milder than Hemophilia A
270
What are the results of a prolonged APTT in Factor IX Deficiency
Corrected by aged serum but not absorbed plasma
271
What are the treatments for Factor IX Deficiency
Fresh Frozen Plasma+Factor IX Concentrate
272
What is Von Willebrand`s Disease
Autosomal trait
273
What are symptoms of Von Willebrand`s Disease
Bruising+epistaxis+menorrhagia+hemorrhage from tooth extractions
274
What is deficient in Von Willebrand`s Disease
Both Factor VIII:C and Von Willebrand Factor
275
What is the effect of Ristocetin on platelets in Von Willebrand`s Disease
Platelets don’t aggregate with ristocetin
276
How frequent is Von Willebrand`s Disease
Most frequent inherited coagulopathy
277
What are the prolonged laboratory results of Von Willebrand`s Disease
Prolonged bleeding time
278
What cryoprecipitate contains
The only component that contains all the elements of the Factor VIII complex
279
What type of inheritance does Factor VII Deficiency have
Autosomal recessive
280
What symptoms may occur in children with Factor VII Deficiency
Mucous membrane and soft tissue hemorrhage
281
What does a prolonged PT correct with in Factor VII Deficiency
Corrected by normal aged serum but not by adsorbed plasma
282
What inheritance does Factor X (Stuart Prower Factor) Deficiency have
Autosomal incompletely recessive
283
What bleeding symptoms characterize Factor X (Stuart Prower Factor) Deficiency
Bruising+soft tissue bleeding+post traumatic or postoperative bleeding
284
What test results are corrected by serum but not adsorbed plasma in Factor X (Stuart Prower Factor) Deficiency
Prolonged PT and APTT
285
What other test results are prolonged in Factor X (Stuart Prower Factor) Deficiency
Prolonged Stypven Time and PT Conversion Time
286
What treatments for Factor X (Stuart Prower Factor) Deficiency
Fresh Frozen Plasma+PT Complex Concentrate
287
What is Factor V Deficiency also known as
Owren`s Disease or Labile Factor Deficiency
288
What type of inheritance does Factor V Deficiency have
Autosomal recessive
289
What form can Factor V Deficiency be in
Acquired form due to antibody production
290
What bleeding tendencies characterize Factor V Deficiency
Hemorrhagic diathesis
291
What test results are corrected by adsorbed plasma in Factor V Deficiency
Prolonged PT and APTT
292
What treatment for Factor V Deficiency
Fresh Frozen Plasma
293
What is Factor II Deficiency also known as
Hypoprothrombinemia
294
What type of inheritance does Factor II Deficiency have
Autosomal recessive trait
295
What bleeding tendencies characterize Factor II Deficiency
Mild bleeding tendencies
296
What results are prolonged in Factor II Deficiency
Prolonged PT and APTT
297
What results are normal in Factor II Deficiency
Normal Thrombin Clotting Time
298
What conditions should be ruled out with Factor II Deficiency
Vitamin K deficiency+liver disease+multifactor deficiency
299
What treatment for Factor II Deficiency
Fresh Frozen Plasma
300
What are three classifications of Factor I Deficiency
Afibrinogenemia+hypofibrinogenemia+dysfibrigenemia
301
What general defect is seen in Factor I Deficiency
Defect in fibrin formation
302
What type of inheritance does Factor I Deficiency have
Autosomal trait
303
What are characteristics of afibrinogenemia
Recessive and clinically severe
304
What are characteristics of hypofibrinogenemia and dysfibrigenemia
Dominant but bleeding episodes are less severe
305
Which test results are prolonged in both hypofibrinogenemia and dysfibrinogenemia
Thrombin time
306
Which test result is prolonged only in dysfibrinogenemia
Reptilase time
307
What is the reference range for Factor I
200-400 mg/dl
308
What is the inheritance of Factor XIII Deficiency
Autosomal recessive
309
What is required to express Factor XIII Deficiency
Only homozygotes
310
What are symptoms of Factor XIII Deficiency
Spontaneous bleeding with poor wound healing
311
What is used to treat Factor XIII Deficiency
Unstable commercially purified
312
Why does hepatic disease affect coagulation
Since the liver is the primary site of procoagulant
313
Why does Vitamin K Deficiency occur
Decreased dietary intake or increased destruction or absence of normal bacterial flora in the gut
314
Where are Vitamin K dependent factors synthesized
Synthesized in the liver
315
What factors are Vitamin K dependent
II+VII+IX+X+Protein C+Protein S
