Coagulation disorders - Tertiary hemostasis

Question 1

Tertiary hemostasis is dissolution of fibrin clot by this

Answer 1

Plasmin

Question 2

These two molecules activate Plasminogen to plasmin

Answer 2

Factor XIIa
tPA (tissue plasminogen activator)

Question 3

What is the function of plasmin?

Answer 3

Cleaves fibrin polymers to monomers

This generates fibrin degradation products and d-dimers

Question 4

When plasmin cleaves fibrin polymers, these products are generated

Answer 4

Fibrin degradation products and d-dimers

Question 5

Presence of this is evidence that cross-linked fibrin polymers were dissolved

Answer 5

D-dimers

Question 6

Heparin acts as a cofactor for this

Answer 6

Antithrombin

Question 7

Proteins C and S bind to endothelial cells via this

Answer 7

Thrombomodulin

Question 8

Endothelium bound plasmin degrades this

Answer 8

fibrin

Question 9

Acquired condition with intravascular activation of coagulation with loss of localization due to various causes

Answer 9

Disseminated intravascular coagulation (DIC)

Question 10

The main issue with Disseminated intravascular coagulation (DIC) is uncontrolled formation of this molecule

Answer 10

thrombin

Question 11

What is the usual cause of uncontrolled thrombin formation in Disseminated intravascular coagulation (DIC)?

Answer 11

Factor VII released/formed in circulation

Question 12

Cytokine activation of monocytes results in the release of this, which activates Factor VII

Answer 12

Tissue Factor

Question 13

These cells release Tissue Factor when activated by cytokines

Answer 13

Monocytes

Question 14

Consumption coagulopathy occurs in this condition
Caused by uncontrolled activation of thrombin by widespread Factor VII activation

Answer 14

Disseminated intravascular coagulation (DIC)

Question 15

In this condition, microthrombi are formed throughout circulation until clotting factors are consumed
Then bleeding may start

Answer 15

Disseminated intravascular coagulation (DIC)

Question 16

What is the result of PT and PTT testing in Disseminated intravascular coagulation (DIC)?

Answer 16

High PT (more than PTT)

Question 17

Does Disseminated intravascular coagulation (DIC) cause low or high platelets?

Answer 17

Low

Question 18

Does Disseminated intravascular coagulation (DIC) cause low or high fibrinogen?

Answer 18

Low

Question 19

This test is elevated in disorders with dissolution of cross-linked clot
Causes: DIC, MI, pneumonia, sepsis, etc

Answer 19

D-dimer

Question 20

What is the treatment for Disseminated intravascular coagulation (DIC)?

Answer 20

Treat underlying disease

Question 21

These are two related disorders which are both caused by excessive platelet activation resulting in microthrombi and intravascular hemolysis

Answer 21

TTP and HUS

Question 22

A child who had an O157:H7 infection, now with bloody diarrhea, likely has this condition

Answer 22

Hemolytic uremic syndrome (HUS)

Question 23

What is the typical patient with Hemolytic uremic syndrome (HUS)?

Answer 23

Child
Usually with preceding O157:H7 infection

Question 24

How does Hemolytic uremic syndrome (HUS) begin?

Answer 24

Begins with endothelial injury usually secondary to Enterohemorrhagic E. coli (EHEC) O157:H7 and shiga-like toxin

Question 25

In Hemolytic uremic syndrome (HUS), Shiga toxin binds to this molecule

Answer 25

endothelial glycolipid 3b exposes collagen and ultra large vWF multimers induces platelet activation/aggregation

Question 26

This condition produces intravascular hemolysis with schistocytes, thrombocytopenia, renal failure, and fever

Answer 26

Hemolytic uremic syndrome (HUS)

Question 27

Does Hemolytic uremic syndrome (HUS) produce CNS signs/symptoms?

Answer 27

No

Question 28

Does Hemolytic uremic syndrome (HUS) produce low or high platelets?

Answer 28

Low

Question 29

This is microangiopathic hemolytic anemia due to ADAMTS13 deficiency/inhibition

Answer 29

Thrombotic thrombocytopenic purpura (TTP)

Question 30

Thrombotic thrombocytopenic purpura (TTP) is due to a deficiency/inhibition of this

Answer 30

ADAMTS13

Question 31

In Thrombotic thrombocytopenic purpura (TTP), deficiency/inhibition ADAMTS13 results in failure to do this

Answer 31

Cleave vWF multimers

Question 32

Thrombotic thrombocytopenic purpura (TTP) occurs especially in this population

Answer 32

African women

Question 33

Is Thrombotic thrombocytopenic purpura (TTP) typically fatal?

Answer 33

90% fatal without treatment 25% with treatment

Question 34

This condition produces intravascular hemolysis with schistocytes, thrombocytopenia, fever, renal failure, and neurologic symptoms

Answer 34

Thrombotic thrombocytopenic purpura (TTP)

Question 35

Does Thrombotic thrombocytopenic purpura (TTP) produce CNS symptoms?

Answer 35

Yes Headache, confusion, stroke, seizure, coma

Question 36

What causes RBC fragmentation and platelet consumption in TTP and HUS?

Answer 36

Injured/narrowed vessels (thrombi form in microcirculation throughout body)

Question 37

Thrombotic microangiopathy produces this type of anemia

Answer 37

Normochromic normocytic

Question 38

Hepatocytes produce all clotting factors except these

Answer 38

Factor VIII vWF

Question 39

This is the earliest coagulation test to prolong

Answer 39

PT

Question 40

This clotting factor has the shortest half life

Answer 40

Factor VII

Question 41

In liver disease, bleeding is usually due to this

Answer 41

Varices (not due to coagulopathy)

Question 42

Are D-dimers elevated in DIC or liver failure?

Answer 42

Both

Question 43

Is PT/PTT elevated in DIC or liver failure?

Answer 43

Both

Question 44

Are platelets decreased in DIC or liver failure?

Answer 44

Both

Question 45

Low Factor V and low Factor VIII occur in this condition

Answer 45

DIC

Question 46

Low Factor V with high factor VIII occurs in this condition

Answer 46

Cirrhosis

Question 47

Does this describe arterial or venous thrombosis: Tend to arise from hypercoagulable states (clotting cascade)

Answer 47

Venous

Question 48

Does this describe arterial or venous thrombosis: Most common presentation is DVT and PE

Answer 48

Venous

Question 49

Does this describe arterial or venous thrombosis: Tend to arise with vascular damage and platelet/coag activation

Answer 49

Arterial

Question 50

Does this describe arterial or venous thrombosis: May present with AMI, ischemic bowel, CVA

Answer 50

Arterial

Question 51

Does this describe arterial or venous thrombosis: Risk factors include age and male sex, obesity, immobilization, surgery, pregnancy, malignancy

Answer 51

Venous

Question 52

Does this describe arterial or venous thrombosis: HTN, hyperlipidemia, smoking, SLE and RA

Answer 52

Arterial

Question 53

Arterial thrombosis occurs in these two instances

Answer 53

Antiphospholipid syndrome Endothelial damage (atherosclerosis, aneurysm)