Coags

Question 1

intrisnic pathway

Answer 1

XII, XI, IX, VIII

Question 2

extrisnic pathway

Answer 2

III and VII

Question 3

Common pathway (where they converge)

Answer 3

X, V, prothrombin (II), fibrinogen (I)

Question 4

measures extrinsic and common pathways

Answer 4

prothrombin time (PT): factor I, II, V, VII, X

Question 5

normal prothrombin time (PT)

Answer 5

11-13.5s

Question 6

Critical PT time

Answer 6

> 20 seconds

Question 7

prolonged PT can suggest

Answer 7

deficiencies in extrinsic pathway factors (VII) or presence of inhibitors (warfarin, liver disease)

Question 8

What can cause a factor deficiency?

Answer 8

hepatocellular disease, obstructive biliary disease, oral anticoagulant, hereditary factor deficiency
or
alcohol, diet high in fat or leafy vegetables, allopurinol, ASA, barbiturates, beta lactam antibiotics, glucagon, heparin, massive blood transfusion, DIC

Question 9

PT may be elevated or may be 1.5x normal in

Answer 9

fully anticoagulated patient

Question 10

What can cause a shortened PT

Answer 10

PT = Vit-K dependent factors, anabolic steroids, Vit K, digitalis, benadryl, OCPs

Question 11

aPTT normal range

Answer 11

25-35s

Question 12

activated partial thromboplastin time measures

Answer 12

intrinsic and common pathways

Question 13

critical aPTT value is

Answer 13

> 70 seconds

Question 14

aPTT is used to monitor

Answer 14

heparin therapy

Question 15

a in aPTT stands for

Answer 15

activator

Question 16

prolonged aPTT can stand for

Answer 16

intrinsic pathway issues (hemophilia, factor deficiencies) or presence of inhibitors (heparin, lupus anticoagulant)

Question 17

decreased aPTT could be

Answer 17

early stages of DIC, extensive cancer

Question 18

What can interfere with aPTT?

Answer 18

antihistamines, ascorbic acid, heparin, salicylates

Question 19

standard method of expressing PT to monitor warfarin therapy

Answer 19

INR

Question 20

normal INR

Answer 20

.8-1.2

Question 21

Critical INR

Answer 21

> 5

Question 22

high INR =

Answer 22

risk for bleeding

Question 23

measures the conversion of fibrinogen to fibrin

Answer 23

thrombin time

Question 24

abnormalities in TT could be from

Answer 24

fibrinogen deficiency or presence of inhibitors (anticoagulants)

Question 25

Normal activated clotting time

Answer 25

70-120s on anticoagulant = 150-699s

Question 26

When do you need ACT?

Answer 26

measure anticoagulant effect of heparin or other thrombin inhibitors - cardiac angioplasty - hemodialysis - cardiopulmonary bypass surgery

Question 27

ACT measures

Answer 27

time it takes for whole blood to clot after addition of particulate activators

Question 28

What can monitor the response of unfractionated heparin therapy and determine amount of protamine sulfate needed to reverse heparin effectS?

Answer 28

ACT

Question 29

What can interfere with ACT?

Answer 29

- hypothermia, hemodilution, platelet # and function, pharmacokinetics of heparin increased = heparin, clotting factor deficiencies, cirrhosis, coumadin, lupus inhibitors decreased = thormbosis

Question 30

ACT is more useful than

Answer 30

aPTT when high doses are used (during cardiopulm bypass surgery)

Question 31

ACT is ___ expensive

Answer 31

less, be done more easily

Question 32

normal D dimer

Answer 32

<.4

Question 33

D-dimer indications

Answer 33

intravascular clotting

Question 34

what assesses both thrombin and plasmin activity

Answer 34

d-dimer: degrades product of fibrin as plasmin acts on clot

Question 35

What interferes with a D-dimer?

Answer 35

decreased in lipemic patients, increased if rheumatoid factor (RF) is >50, normal <20

Question 36

What can increase a d-dimer

Answer 36

-DIC -primary fibrinolysis -DVT -PE -arterial thromboembolism -sickle cell anemia w or w/o crisis -malignancy, pregnancy, surgery

Question 37

monitoring warfarin

Answer 37

PT/INR

Question 38

monitoring heparin

Answer 38

aPTT