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Fundamental 2 > Hematology > Flashcards

Hematology Flashcards

1
Q

Which endothelial layer acts as the lining separating flowing blood from the vessel and is made of endothelial cells?

A

Tunica Intima

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2
Q

Which endothelial layer forms a barrier separating fluid contents within the blood vessel from the highly thrombogenic material?

A

Tunica Intima

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3
Q

Which endothelial layer contains the highly thrombogenic material?

A

Tunica Media

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4
Q

What activates the clotting cascade pathway when injury to the vessel occurs?

A

Tissue factor

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5
Q

Which cofactor is necessary for adherence of platelets to the subendothelial layer?

A

Von Willebrand Factor (vWF)

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6
Q

What two substances can be released from endothelial cells that produce vasoconstriction?

A
  1. Thromboxane A2

2. Adenosine Diphosphate (ADP).

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7
Q

What two substances can be released from the endothelial cells that produce vasodilation?

A
  1. Nitric oxide

2. Prostacyclin

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8
Q

What can be released from the endothelial cells that is a coagulation inhibitor?

A

Tissue Factor Pathway Inhibitor.

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9
Q

What two substances can be released from the subendothelial layer?

A
  1. Collagen

2. Fibronectin

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10
Q

Where are platelets formed?

A

Bone marrow

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11
Q

How long do platelets live?

A

8-12days

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12
Q

What is the main role of the Tunica Adventitia layer?

A

Control of blood flow by influencing the vessel’s degree of contraction

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13
Q

What is the average concentration of platelets in the blood?

A

150,000-300,000/mm3

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14
Q

T/F: Platelet cells do not contain mitochondria, RNA, DNA, and do not reproduce?

A

False; platelets do contain mitochondria

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15
Q

What is thrombin’s 2 roles inside of the platelet?

A
  1. Activate coagulation factors

2. Influence recruitment of platelets

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16
Q

What are the five steps following vessel injury that cause clot formation?

A
  1. Disruption of endothelial lining
  2. Vessel wall contraction
  3. Adhesion
  4. Activation
  5. Aggregation
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17
Q

Does the vessel wall constrict or relax immediately following a vessel injury and why?

A

Constricts via 1. ANS reflex

  1. Thromboxane A2
  2. ADP
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18
Q

What factor begins the adhesion step of forming the primary plug?

A

von Willebrand Factor (vWF).

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19
Q

What does vWF attach to on the platelet cell?

A

Glycoprotein Ib (GpIb

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20
Q

What substance causes the platelet to undergo conformational change and become “activated”?

A

Tissue Factor

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21
Q

What does GpIIb and GpIIIb receptors complex do?

A

Links activated platelets together (called aggregation).

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22
Q

What does the platelet release into the blood once “activated”?

A
  1. Alpha granules
  2. Dense granules
  3. Thrombin
  4. Procoagulant mediators
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23
Q

What is another name for activation of cofactors?

A

Zymogens

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24
Q

What two factors are associated with the extrinsic pathway?

A

III and VII

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25
Q

All coagulation factors are synthesized where (except for 3 factors)?

A

The liver

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26
Q

Where are the other coagulation factors synsthesized?

A

III=Vascular wall,
IV=Ca++ in diet
vWF=Endothelial cells

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27
Q

How is the extrinsic pathway activated?

A

Tissue factor that happens outside the tissue wall

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28
Q

What are examples of injuries that activate the extrinsic pathway?

A
  1. Organ trauma

2. Crushing injury

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29
Q

Which factor is tissue factor?

A

Factor III

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30
Q

Which factor is Proconvertin?

A

Factor VII

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31
Q

What initiates the intrinsic pathway?

A

Initiated when damage occurs to blood vessel itself

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32
Q

Which factors are involved in the intrinsic pathway?

A

Factor XII, XI, IX, VIII

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33
Q

What is the progression of factors in the intrinsic pathway?

A

XII, XIIa, XI, XIa, IX, IXa, VIII, VIIIa

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34
Q

When the intrinsic and extrinsic pathways meet, what is formed?

A

XV (Prothrombinase Complex). Combination of Factor X and Factor V

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35
Q

What is the name of inactivated Factor II?

A

Prothrombin

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36
Q

What is the name of activated Factor II (Factor IIa)?

A

Thrombin

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37
Q

What is the name of inactive Factor I?

A

Fibrinogen

38
Q

What is the name of activated Factor I (Factor Ia)?

A

Fibrin

39
Q

Lastly, what factor acts on Fibrin to produce Fibrin Stabilization?

A

Factor XIII

40
Q

Once fibrin stabilization has occurred, it is considered a stable or unstable clot?

A

Stable Clot

41
Q

What is the name of Factor IV? IX?

A

IV=Calcium

IX=Christmas

42
Q

Which reaction is important step for both intrinsic and extrinsic pathways?

A

Conversion of Prothrombin to Thrombin

43
Q

What is thrombin’s role?

A
  1. Activates Factors V, VIII, I, and XIII

2. Recruitment of Platelets to injured area

44
Q

T/F: Thrombin can only produce coagulation factors and helps only with coagulation?

A

False; it can act as anti-coagulation as well

45
Q

How does thrombin produce anticoagulation?

A
  1. Release tPA
  2. Stimulates Protein C and Protein S
  3. Interferes with coagulation by forming relationship with Factor III
46
Q

Which factors are Vitamin K Dependent?

A

II, VII, IX, and X

47
Q

What are the three phases of hemostasis described by cell-based theory of coagulation?

A
  1. Initiation
  2. Amplification
  3. Propagation
48
Q

According to the cell based theory, what is activated by TF/VII complex?

A

Factor X (common) and IX (intrinsic)

49
Q

Why does the fibrinolytic system exist?

A

To degrade fibrin

50
Q

What is the first step in the fibrinolytic system?

A

Increased blood flow to site of injury to remove procoagulant mediators (ADP and Thromboxane)

51
Q

How does antithrombin III interfere with coagulation?

A

By removing clotting factors from the clotting cascade (XII, XI, X, IX)

52
Q

Three main ways fibrinolytic system works?

A
  1. Tissue factor pathway inhibitor
  2. Protein C and S
  3. Antithrombin III
53
Q

What substance ultimately degrades fibrin into fibrin degradation products?

A

Plasmin

54
Q

What stops the fibrinolytic process?

A

Fibrinolytic mediators called Alpha-Antiplasmin and tissue plasminogen activator inhibitor (tPA inhibitor)

55
Q

What are three herbal medications that influence coagulation?

A

Gingko, Ginger, Garlic

56
Q

What surgeries are examples of high bleeding risk?

A

Cardiac surgery, AAA repair, neurosurgery, cancer surgery, TURP, Kidney biopsy, Bilat Knee replacement

57
Q

What surgeries are considered intermediate bleeding risk?

A

Abd surgery, orthopedic surgery, endarterectomy or carotid bypass, non-cataract eye surgery, extensive dental surgery, cardiac defibrillator insertion,

58
Q

How many days before high, intermediate, or low risk surgeries would you stop warfarin use?

A

5 days before surgery

59
Q

What is normal PT?

A

12-14 sec

60
Q

What is normal aPTT?

A

25-32 seconds

61
Q

What is normal ACT?

A

80-150 seconds

62
Q

Which laboratory test is altered by coumadin?

A

Prothrombin Time

63
Q

Which laboratory test is altered by ASA and NSAIDS?

A

Bleeding time

64
Q

What laboratory test is altered by heparin or lovenox?

A

aPTT (activated partial thromboplastin time)

65
Q

What is treatment of von Willebrand Disease?

A

DDAVP and cryoprecipitate

66
Q

What is platelet count is considered thrombocytopenic?

A

<100,000/mm3

67
Q

Should expect bleeding below what platelet count?

A

<50,000/mm3

68
Q

Should expect SPONTANEOUS bleeding below what platelet count?

A

<20,000/mm3

69
Q

Prothrombin time (PT) measures the efficiency of what pathway(s)?

A

Extrinsic and common pathways

70
Q

Activated partial thromboplastin time (aPTT) measures the efficiency of what pathway(s)?

A

Intrinsic and common pathways

71
Q

Which laboratory value would you check if patient on coumadin therapy?

A

Prothrombin time

72
Q

What is the most common inherited coagulation disorder?

A

von Willebrand Disease

73
Q

Where is vWF synthesized?

A
  1. Endothelial cells

2. Megakaryocytes

74
Q

Which factor is deficient in Hemophilia Type A?

A

Factor VIII

75
Q

Which factor is deficient in Hemophilia Type B?

A

Factor IX

76
Q

What is the most common surgical procedure for patient with Sickle Cell disease?

A

Cholecystectomy

77
Q

What is intraoperative management of patient with Sickle Cell Disease?

A
  1. Maintain normothermia
  2. Maintain spO2>95%
  3. Aggressive fluid hydration
  4. Transfuse only if necessary and do not elevate Hgb>11
78
Q

What is the mnemonic for memorizing the clotting factors in order?

A

Foolish People Try Climbing Long Slopes After Christmas, Some People Have Fallen

79
Q

Names the factors in order I-XIII

A

Fibrinogen, Prothrombin, Tissue Factor, Calcium, Labile Factor, Stable Factor, Antihemophilic Factor, Christmas, Stuart-Prower Factor, Plasma Thromboplastin Antecedent, Hageman factor, Fibrin stabilizing factor

80
Q

Warfarin inhibits what?

A

All vitamin K dependent factors (II, VII, IX, X) and Proteins C and S

81
Q

What does heparin bind to to produce anticoagulant effects?

A

Antithrombin (AT) and creates Heparin-AT complex

82
Q

What does Heparin AT Complex neutralize?

A

Neutralizes Thrombin and Factors XII, XI, X, and IX (and inhibits platelet function)

83
Q

What is pretreatment before surgery for patient with vWD Type III?

A

Purified VIII and vWF concentrate

84
Q

What is pretreatment before surgery for patient with vWD Type I?

A

Desmopressin (DDAVP)

85
Q

Why is DDAVP not ideal for vWD Type III?

A

Because these patients do not produce any vWF

86
Q

What two coagulopathies would cause abnormal aPTT and normal PT?

A

Hemophilia type A and Hemophilia type B

87
Q

What factor deficiencies would cause a prolonged PTT AND PT?

A

Deficiency of factors II and X

88
Q

What are four lab abnormalities that characterize DIC?

A
  1. Increased PT/PTT
  2. Increased d-Dimer
  3. Decreased platelets
  4. Decreased fibrinogen
89
Q

What are 5 triggers for Sickle Cell Crisis?

A
  1. Pain
  2. Dehydration
  3. Hypoxia
  4. Acidosis
  5. Hypothermia
90
Q

What are two common comorbidities associated with Sickle Cell disease?

A
  1. Asthma (50%)

2. Pulmonary HTN (10%)

Fundamental 2 (7 decks)

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