Chapter 8: The Clotting Cycle & Bleeding disorders

Question 1

MCC of venous clots

Answer 1

stasis

Question 2

MCC of arterial clots?

Answer 2

endothelial injury (exposure of BM)

Question 3

MCC of genetic venous clots

Answer 3

Factor V Leiden defect

Question 4

What is the normal PLT count?

Answer 4

150,000–350,000

Question 5

All cells have MHC 1 on surface except which cells?

Answer 5

RBCs and PLTs (so they can set off immune system)

Question 6

What is thrombocythemia?

Answer 6

When PLT count is 2 standard deviations above normal

Question 7

What could cause secondary throbocytosis?

Answer 7

anemia, neoplasm, autoimmune disease, inflammation, infection

Question 8

What could cause secondary thrombocytosis?

Answer 8

anemia, neoplasm, autoimmune disease, inflammation, infection

Question 9

What is thrombotic thrombocytopenia purpura?

Answer 9

thrombotic microangiopathy due to vWF-esterase deficiency (ADAM TS 13); similar to DIC

Question 10

What is microangiopathic Hemolytic Anemia (MAHA)?

Answer 10

When blood vessels have micro thrombus and causes passing RBCs to lyse

Question 11

MCC of thrombocytopenia?

Answer 11

1)virus 2)drugs

Question 12

What is immune thrombocytopenia?

Answer 12

When antibodies are made against PLTs; also called idiopathic thrombocytopenia purpura, immune thrombocytopenia purpura, and autoimmune thrombocytopenia purpura

Question 13

What kinds of infection could cause thrombocytopenia?

Answer 13

Parvovirus B19; Hep C, Hep E

Question 14

Do we transfuse for destructive process of PLTs?

Answer 14

NO, it will just be destroyed even more. Correct underlying problem or steroids

Question 15

Which meds can cause thrombocytopenia?

Answer 15

AZT, benzene, chloramphenicol, vinblastine

Question 16

What is heparin induced thrombocytopenia?

Answer 16

IgG attacks heparin after it forms a complex with Platelet Factor 4, usually occurs 3-10 days after initiating heparin therapy (HIT 2)

Question 17

What is the difference between HIT 1 and HIT 2?

Answer 17

HIT 1 occurs due to PLT clumping within 48 hours (spleen removing PLTs); HIT 2 occurs 3-10 days after and involves IgG.

Question 18

What is responsible for the “lucid” interval in epidural hematoma?

Answer 18

vasoconstriction

Question 19

What are the 3 steps of Platelet plug?

Answer 19

1.platelet adhesion to injured vessel
2.platelet degranulation
3.platelet aggregation

Question 20

What starts the platelet adhesion process?

Answer 20

endothelial injury exposes sub endothelial collagen, vWF binds to collagen, PLTs bind to vWF

Question 21

What do platelets give off in degranulation?

Answer 21

Thromboxane A2, ADP and Ca

Question 22

What does ADP do?

Answer 22

exposes GpIIb/IIIa so it can bind fibrinogen and provides energy for clumping process

Question 23

What starts the platelet adhesion process?

Answer 23

endothelial injury exposes sub endothelial collagen, vWF binds to collagen, PLTs bind to vWF via GpIb

Question 24

What is Bernard-Soullier syndrome?

Answer 24

defective GpIb (platelets don’t aggregate, prolonged bleeding)

Question 25

What is Glanzmann thrombasthenia?

Answer 25

defective GpIIb/IIIa; platelets don't aggregate, prolonged bleeding)

Question 26

What does Prostaglandin I-1 do?

Answer 26

inhibits platelet aggregation; vasodilation

Question 27

What does Prostaglandin E2 do?

Answer 27

vasodilation; decreases gastric secretion; increases gastric mucous secretion

Question 28

What does prostaglandin F2a do?

Answer 28

bronchoconstriction, vasoconstriction, uterus contraction

Question 29

What does TXA2 do?

Answer 29

platelet aggregation (aspirin irreversible inhibitor)

Question 30

Which test is used to detect vWF or Bernard-Soullier?

Answer 30

ristocetin (add ristocetin to blood, no clumping)

Question 31

What can you use to stop moderate bleeding in vWF, Bernard-Soullier, Glanzmann?

Answer 31

cryoprecipitate

Question 32

What do you use for severe bleeding?

Answer 32

fresh frozen plasma (FFP)

Question 33

Name a few ADP receptor blockers:

Answer 33

Clopidogrel, Ticagrelor, prasugrel

Question 34

When are aspirin and clopidogrel used together?

Answer 34

In cardiac stenting; aspirin and clopidogrel for first 30 days; after that just aspirin

Question 35

What do you use cilostazol for?

Answer 35

TTP first 2 weeks (inhibits TXA2 while increasing prostaglandin)

Question 36

Name a GpIIb/IIIa inhibitor

Answer 36

abciximab

Question 37

What is an irreversible TXA2 inhibitor?

Answer 37

aspirin

Question 38

compartment syndrome 5 P's

Answer 38

1.Pain out of proportion 2.Pallor 3.Paresthesia 4.Poikilothermia 5.Paralysis

Question 39

What is Hemophilia A?

Answer 39

deficiency of Factor VIII

Question 40

What lab is high in Hemophilia A?

Answer 40

PTT

Question 41

What is Hemophilia B?

Answer 41

deficiency of Factor IX

Question 42

What lab is high in Hemo B?

Answer 42

PTT

Question 43

What do you do for mild bleeding of Hemophilia A?

Answer 43

DDAVP

Question 44

What do you do for severe bleeding in Hemophilia A?

Answer 44

administer Factor VIII

Question 45

What do you do for all bleeding Hemophilia B?

Answer 45

FFP

Question 46

To stop passive hemorrhage (massive):

Answer 46

tranexamic acid activated factor VII activated prothrombin concentrate activated fibrinogen complex concentrate

Question 47

Direct thrombin inhibitors

Answer 47

argatroban, dabigatran

Question 48

factor X inhibitors

Answer 48

rivaroxaban, apixaban

Question 49

In which autoimmune disease is vWF blocked and intrinsic pathway stimulated (easy to clot)?

Answer 49

SLE, anticardiolipin

Question 50

What is reflex sympathetic dysfunction from carpal tunnel syndrome?

Answer 50

severe autonomic discharge due to pain caused by NE (Tx: NE blocker phentolamine)

Question 51

What is the earliest sign of Factor XIII defeciency?

Answer 51

recurrent umbilical stump bleeding

Question 52

Skin necrosis upon administering warfarin

Answer 52

stop warfarin and give direct Factor X inhibitor

Question 53

Why is there a two day bridge between heparin and warfarin?

Answer 53

because factor VII has a half-life of 2 days, hep blocks next thrombolytic after prot. C and antithrombin III

Question 54

What should INR be for warfarin?

Answer 54

2-3 unless for metallic heart valves 2.5-3.5