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Clin Med Lab > Coag review > Flashcards

Coag review Flashcards

1
Q

PTT or aPTT evaluates for which pathway? Used to monitor what therapy

A
  • intrinsic and common pathways
  • used to monitor unfractionated heparin therapy
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2
Q

PT evaluates for which pathway? Used to monitor what therapy

A
  • extrinsic and common
  • used to monitor Warfarin (coumadin) therapy
    • vitamin K dependent clotting factors
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3
Q

which factors are part of the intrinsic pathway

A
  • 8, 9, 11, 12
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4
Q

which factors are part of the extrinsic pathway

A
  • tissue factor
  • VII
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5
Q

what is present in common pathway

A
  • prothrombin (II)
  • Thrombin (IIa)
  • fibrinogen (I)
  • V
  • X
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6
Q

target INR therapy for DVT (prophylaxis)

A

1.8-2.5

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7
Q

target INR therapy for venous thromboembolism and AFIB

A

2-3

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8
Q

target INR therapy for mechanical heart valves

A

2.5-3.5

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9
Q

hemophilia A

A

factor VIII deficiency

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10
Q

how does liver cirrhosis cause thrombocytopenia

A
  • liver cirrhosis -> portal HTN -> splenomegaly -> splenic sequestration -> thrombocytopenia
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11
Q

What is platelet dysfunction and what causes it? Treatment?

A
  • impaired adherence or aggregation of platelets
  • acquired: more common
    • liver disease, von willebrand disease, myeloproliferative disease, drugs
  • treatment:
    • treat underlying cause
    • platelet transfusion
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12
Q

Name conditions that cause increased destruction of platelets

A
  • ITP
  • DIC
  • heparin-induced thrombocytopenia (HIT)
  • thrombotic microangiopathies
    • TTP
    • HUS
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13
Q

what is heparin-induced thrombocytopenia (HIT)

A
  • new onset thrombocytopenia/thrombus while on heparin therapy
  • will occur 5-10 days after putting someone on heparin; patient develops antibodies that bind to platelets
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14
Q

thrombotic thrombocytopenic purpura (TTP) is more common in males or females

A

females

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15
Q

etiology of thrombotic thrombocytopenic purpura (TTP)

A
  • inherited or idiopathic
    • deficiency or antibodies ADAMST-13
  • drugs, pregnancy, HIV infection
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16
Q

explain what happens in thrombotic thrombocytopenic purpura (TTP)

A
  • ADAMTS-13 is responsible for cleaving vWF into a smaller molecule, so without it, platelets aggregate around huge vWF and leads to clots and low platelet levels in blood
  • microthrombi are formed throughout the body
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17
Q

Name the Pentad of symptoms associated with thrombotic thrombocytopenic purpura (TTP)

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • acute kidney injury
  • neurologic defects
  • fever
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18
Q

treatment of thrombotic thrombocytopenic purpura (TTP)

A

plasma exchange

19
Q

hemolytic uremic syndrome typically seen in what patient population

A

children

20
Q

etiology of hemolytic uremic syndrome

A

Ecoli O157:H7

21
Q

name Triad of symptoms seen in hemolytic uremic syndrome

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • acute kidney injury
  • **most cases preceeded by bloody diarrhea
22
Q

treatment of hemolytic uremic syndrome in adults

A

plasma exchange

23
Q

treatment of hemolytic uremic syndrome in children

A
  • IV fluid and electrolyte repletion
  • dialysis if indicated
24
Q

typical of what conditions

  • microangiopathic hemolytic anemia
    • fragmented RBC: schistocytes: helmet cells
A

TTP and HUS

25
Q

clinical findings are associated with this condition

  • increased indirect biliruben
  • decreased serum haptoglobin (binds to iron to preserve it)
  • negative coombs test
  • thrombocytopenia
  • PT and aPTT are normal
  • acute kidney injury
  • microangiopathic hemolytic anemia
A
  • TTP
  • HUS
26
Q

name nutritional causes of impaired production of platelets

A
  • Vitamin B12, folate deficiency
  • alcohol
    • direct toxicity to bone marrow
    • hypersplenism secondary to liver disease
27
Q

List the anticoagulants that are available for use

A
  • IV unfractionated heparin (UFH)
  • LMWH
  • oral warfarin
  • factor Xa inhibitors
  • oral direct thrombin inhibitors
28
Q

Contraindications to anticoagulation

A
  • pregnancy
  • risk of hemorrhage > than the potential clinical benefits of therapy
29
Q

function of warfarin

A
  • inhibits conversion of vitamin K to active form
    • depletion of vit K dependent clotting factors (2, 7, 9, 10)
    • inhibits Protein C and Protein S
  • inhibits propagation - does not remove thrombus
30
Q

indications for use of warfarin

A
  • prophylaxis/treatment
  • VTE
  • AFIB
  • prosthetic heart valve
  • stroke
  • post MI
31
Q

when should warfarin treatment by initiated? Initial dose?

A
  • initiated on day 1 or day 2 of heparin
  • initial dose: < or = 5 mg/day
32
Q

lower initiation doses of warfarin are recommended for

A
  • elderly
  • liver disease
  • malnourished
33
Q

warfarin requires on average how many days before full anticoagulation effect in achieved? peak effect of warfarin occurs when?

A
  • requires 2-3 days before full effect
  • peak effect of drug: after 48 hours
34
Q

Treatment for patients with acute DVT of leg requires warfarin bridge therapy. describe this

A
  • parental therapy (heparin) should overlap with warfarin for a minimum of 5 days AND until the INR is 2.0 or above for at least 24 hours
35
Q

what is a normal INR for a patient who is NOT anticoagulated

A

1.0

36
Q

patients on warfarin should be monitored how often?

A
  • daily and then weekly
  • once stabilized, every 2-4 weeks
37
Q

hemorrhagic risk becomes dominant at an INR greater than

A

4

38
Q

no warfarin efficacy below INR of ? Efficacy diminished when INR is ?

A
  • no efficacy: < 1.5
  • diminished efficacy: < 2.0
39
Q

what common drug can cause decreased warfarin effect

A

oral contraceptive

40
Q

food sources of vit K

A
  • cauliflower
  • green leafy vegetables
    • spinach
41
Q

what is given for supratherapeutic INR (non urgent)

A

vitamin K (oral, SC, or IV)

  • will take 6-24 hours to correct INR
42
Q

what is given for supratherapeutic INR ( urgent)

A
  • 10 mg vitamin K (IV)
  • fresh frozen plasma
  • prothrombin complex concentrate (PCC)
  • recombinant factor VII
43
Q

time to anticoagulation reversal following discontinuation of warfarin

A

5-14 days

44
Q
A

Clin Med Lab (6 decks)

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