Anemia

Question 1

Hemostasis

Answer 1

Prevents prolonged hemorrhage spontaneous thrombosis

Question 2

Pro thrombotic factors

Answer 2

Platelet activators, procoagulants, vasoconstrictors, fibrinolytic inhibitors

Question 3

Anti thrombotic factors

Answer 3

Platelet inhibitors, anticoagulants, vasodilators, fibrinolytic activators

Question 4

Steps of homeostasis

Answer 4

Vasoconstriction, platelet response, coagulation phase, fibrinolysis

Question 5

Vasoconstriction step

Answer 5

Immediate restriction of blood flow; sympathetic and local factors like thromboxane and endothelin

Question 6

Platelet response step

Answer 6

Forms initial plug within seconds; platelets stick to exposed collagen and each other, then release thromboxane and ADP to promote vasoconstriction, get more platelets, and start coagulation

Question 7

Coagulation phase

Answer 7

Activation of serine proteases through extrinsic or intrinsic pathways to cause production of fibrin and form the clot proper

Question 8

Fibrinolysis

Answer 8

Dissolution of the clot for wound healing and restoring blood flow

Question 9

Plasmin

Answer 9

Active form of plasminogen that incorporates into clots and degrades fibrin polymers

Question 10

TPA

Answer 10

Enzyme that activates plasmin

Question 11

Plasminogen activator inhibitor 1 or 2 and alpha 2 antiplasmin

Answer 11

Bind and inhibit TPA or plasmin

Question 12

Causes of excessive bleeding

Answer 12

Thrombocytopenia, von willebrand’s, hemophilia, vitamin k deficiency, fibrinolytic hyperactivity

Question 13

Treatments for hemorrhage

Answer 13

Vitamin k, anti-fibrinolytic agents, replacement factors from blood

Question 14

Forms of vitamin K

Answer 14

Phytonadione (k1), menaquinone (k2)

Question 15

Mechanism of action of vitamin K

Answer 15

Confers activity to factors II, VII, IX, X

Question 16

Vitamin k epoxide reductase

Answer 16

Reduces vitamin k so it is active again

Question 17

Routes of admin for vitamin K

Answer 17

Iv (slowly), subcutaneous (preferred), has to be given with bile salts for intestinal absorption

Question 18

Side effects of vitamin k

Answer 18

Generally very safe

Question 19

Uses for vitamin k

Answer 19

Anticoagulant toxicity, vitamin k deficiency, preventing hemorrhage in newborns

Question 20

Fibrinolytic inhibitors

Answer 20

Aminocaproic acid

Question 21

Mechanism of fibrinolytic inhibitors

Answer 21

Competitively inhibit plasmin’s action on fibrin

Question 22

Effect of too much aminocaproic acid

Answer 22

Thrombosis

Question 23

Uses for aminocaproic acid

Answer 23

Bleeding from fibrinolytic therapy, hemophilia

Question 24

Plasma fractions

Answer 24

Use for deficiencies in plasma factors

Question 25

Hemophilia A

Answer 25

Factor VIII deficiency

Question 26

Hemophilia B

Answer 26

Factor IX deficiency

Question 27

Desmopressin acetate

Answer 27

Increases factor VIII in hemophilia or VW; have tablets, injectable, or nasal spray

Question 28

Protamine sulfate

Answer 28

Cationic protein that neutralizes heparin (more effective against high MW); have to give slowly

Question 29

Aim of anemic therapy

Answer 29

Form RBCs and hemoglobin

Question 30

Nutrients for anemia

Answer 30

Iron, folic acid, vitamin B12

Question 31

Iron for anemia

Answer 31

Oral as ferrous salts, injected as colloidal suspension of iron

Question 32

Erythropoietin

Answer 32

Recombinant version used in chronic anemia, increases hematocrit and hemoglobin in 2-6 weeks; should take with iron

Question 33

Adverse effects of EPO

Answer 33

Hypertension and thrombosis

Question 34

Route of admin of EPO

Answer 34

Injection

Question 35

Filgastrim

Answer 35

rHuG-CSF to stimulate neutrophils, important during transplants after chemo and with neutropenia

Question 36

Oprelvekin

Answer 36

IL-11 to stimulate all cell lineages; used for thrombocytopenia