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Coagulation > Coagulation Testing > Flashcards

Coagulation Testing Flashcards

1
Q

Clotting End Point

A

Photo-optical
Electromechanical
Chromogenic
Immunologic

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2
Q

Photo-optical

A

Most Common
Measure change in optical density

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3
Q

Electromechanical

A

Clot completes the circuit
Clot impedes movement of steel ball

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4
Q

Chromogenic

A

Use of synthetic substrate
- Mimics natural counterpart
- Subtrate is linked to color indicator
- P-nitroanilide (yellow color)

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5
Q

Immunologic

A

Detection/measurement by antigen-antibody
- Electrophoresis
- Latex agglutination
- RID
- EIA

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6
Q

Prothrombin Time (PT)

A

Function of Extrinsic & Common Pathway
Factors: 7, 10, 5, 2, 1

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7
Q

PT Normal Time

A

12-15 seconds

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8
Q

PT Clinical Correlation

A

Prolonged
- Liver disease
- Vitamin K deficiency
- Factor deficiency of 1, 2, 5, 7, or 10
- Anticoagulatns
- DIC (Disseminated Intravascular Coagulation)

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9
Q

Activated Partial Thromboplastin Time (APTT)

A

Tests function of Intrinsic and Common Pathways
Factors: 12, 11, 9, 8, 10, 5, 2, 1

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10
Q

APTT Reagent

A

Phospholipid (PF3)
Contact activator (Silica, ellagic acid, kaolin)
CaCl2

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11
Q

APTT Normal Time

A

25-35 seconds

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12
Q

APTT Clinical Correlation

A

Prolonged
- Liver disease
- DIC
- Factor deficiencies: 12, 11, 9, 10, 5, 2, 1
- Anticoagulants

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13
Q

Thrombin Time (TT)

A

Thrombin added to plasma
Testing Factor 2

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14
Q

TT Normal Time

A

15-19 seconds

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15
Q

TT Clinical Correlation

A

Prolonged
- Hypofibrinogenemia
- Dysfibrinogenemia
- DIC
- Liver diease
- Increased FSP
- Heparin

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16
Q

Fibrinogen Assay

A

Determines amount of Factor 1 (fibrinogen)

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17
Q

Fibrinogen Assay Testing

A

Plasma diluted 1:10 with veronal buffer
Thrombin reagent added

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18
Q

Fibrinogen Normal Amount

A

200-400 mg/dl

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19
Q

Fibrinogen Clinical Correlation

A

Decreased amounts in:
- Liver disease
- DIC
- Fibrinogen deficiencies

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20
Q

FSP/D-Dimer Testing

A

Determines amount of FSP or D-Dimers present
Latex agglutination testing
- Visible agglutination above normal range

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21
Q

FSP (Fibrin Split Products) Normal Range

A

0-0.5 ug/mL or <400 ng/L

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22
Q

FSP Increased fibrinolysis Condition

A

DIC
Primary fibrinolysis
Pulmonary embolism

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23
Q

FSP Decreased or Incomplete Condition

A

Liver Disease

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24
Q

False Increase to Clotting Times

A

Hematocrit >55%

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25
Q

Unreliable Clot Times

A

Hematocrit <25%

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26
Q

Specimen Anticoagulant

A

Sodium Citrate
1:9 of citrate:blood
Chelates Calcium

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27
Q

Adjustment for Hematocrit Calculation

A

(0.5 x (100-patient hct))/60

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28
Q

Testing Correction with Normal Plasma

A

Mix equal volumes of Pooled Normal Plasma (NP) to patient plasma
Correction: within 2 sec PT within 5 sec APTT

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29
Q

Correction with NP

A

Consistent with Factor deficiencies

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30
Q

No/Partial Correction with NP

A

Consistent with presence of circulating anticoagulants
- Heparin, Coumadin, FSPs, Lupus Inhibitor, Factor Inhibitors

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31
Q

Testing Correction with Saline

A

Mix with equal volumes of Normal Saline and Patient Plasma
Correction: within 2 sec of PT or within 5 sec of APTT

32
Q

Full/Partial Correction with Saline

A

Consistent with presence of circulating inhibitors

33
Q

No Correction with Saline

A

Consistent with Factor deficiencies

34
Q

Correction with NP, No with Saline

A

PT prolong, APTT normal
- Possible Factor 7
PT normal, APTT prolong
- Possible deficiency of PK, HMWK, 12, 11, 9, 8
PT prolong, APTT prolong
- Deficiencies of any factor(s)

35
Q

Pre Kallekrein Screening

A

Repeat APTT with increased incubation time
- Allows for more contact activation
- If correction is seen, evidence of deficiency

36
Q

Pre Kallekrein Followup Test

A

PK Assay

37
Q

Factor VIII:c Inhibitor

A

Most Common specific inhibitor

38
Q

Reasons for 8:c Inhibitor

A

Hemophiliacs
Drugs
Post partum women
Autoimmune disease
Lymphoproliferative disease
Unknown

39
Q

Clinical Signs of 8:c Inhibitor

A

No response to therapy
Severe bleeding
Hemarthrosis (bleeding into joints)

40
Q

Laboratory Signs of 8:c Inhibitor

A

Increased APTT, normal PT
Correction with NP at 0 hrs
No correction with NP at 2 hrs
* TIME AND TEMPERATURE DEPENDENT *

41
Q

Bethesda Titer

A

Determine the strength of Factor 8:c inhibitor

42
Q

Bethesda Test

A

Equal volumes patient plasma and NP
Incubate for 2 hrs at 37 C
Factor assay test to determine amount of residual 8:c

43
Q

Other Specific inhibitors

A

Possible with any inherited factor deficiency
Caused by exposure to factor through treatment
Not time or temperature dependent

44
Q

Heparin

A

Acts as co-factor with Antithrombin
Makes Antithrombin 280x more effective
Most common cause of prolonged APTT in hospitalized patients
Monitored by Heparin assay, Xa assay, or APTT

45
Q

Heparin Laboratory Signs

A

Prolonged APTT, PT, TT
No Correction with NP
Correction/partial with Saline

46
Q

Heparin Correction Testing

A

Protamine sulfate
Reptilase Time

47
Q

Low Molecular Weight Heparin

A

Inactivates platelet bond with Xa and resists PF4 inhibition
No interference with platelets or endothelial cells
Less antigenic
Laboratory monitoring not required

48
Q

Coumadin (Coumarin or Warfarin)

A

Vitamin K antagonist
Common cause of prolonged PT
Monitored with PT and INR

49
Q

Coumadin Laboratory Signs

A

Prolonged PT, APTT
Correction with NP
No Correction with saline

50
Q

Fibrin Split Products (FSP)

A

Acts by complexing with fibrin monomers and preventing polymerization

51
Q

FSP Laboratory Signs

A

Prolonged PT, APTT, TT
No correction with NP
Correction/Partial with saline

52
Q

Lupus Inhibitor (Anticoagulant)

A

Second most common cause of prolonged APTT
Antibody (IgM, IgG) directed against phospholipid
Inhibits reagent in APTT testing

53
Q

Lupus Inhibitor Causes

A

SLE
Drugs
Infections
Lymphoproliferative Disease
Unknown

54
Q

Lupus Inhibitor Clinical Signs

A

No Bleeding problems
Thrombosis
Possible increased platelet aggregation

55
Q

Lupus Inhibitor Laboratory Signs

A

Prolonged APTT
No correction with NP
Correction/Partial with Saline
Correction with platelet Neutralization procedure

56
Q

Tissue Thromboplastin Inhibition Test (TTIT)

A

Used for Lupus Anticoagulant (LA)
PT with dilute thromboplastin (contains phospholipids)
- LA will cause greater prolongation of PT
Results are compared with normal control

57
Q

TTIT Calculation

A

Dilute PT/Orig PT
Ratio >1:3 is consistent with LA

58
Q

Dilute Russell Viper Venom Time (RVVT)

A

Used in LA testing
Dilute RVV + phospholipid + CaCl2 + patient plasma
RVV directly activates X
if dRVV is higher than normal control = evidence of LA

59
Q

Test Results Consistent with Heparin

A

FSP - normal
TT - corrected with protamine sulfate
PNP - NA

60
Q

Immunological Assays

A

Laurel Rocket
PIVKA (Prothrombin Induced VItamin K Antagonist)

61
Q

Laurel Rocket Assay

A

Antibody to factor in agar
Serial dilutions of NP, Control plasma, and patient are electrophoresed
Antigen/Antibody complex precipitate and are stained

62
Q

Factors Tested Using Laurel Rocket

A

VWF:Ag
VIII Ag
IX Ag

63
Q

PIVKA

A

Antibody to factor 2 in agar
Patient plasma is adsorbed with barium carbonate to remove carboxylated factor 2
Adsorbed sample is electrophoresed

64
Q

Reptilase Time (RT)

A

Snake venom - Bothrox atrox
Clots fibrinogen in different way than thrombin

65
Q

Increased RT Associated with

A

FSPs
Dysfibrinogenemia
Hypofibrinogenemia

66
Q

RT Removes Interference

A

Heparin

67
Q

Factor Assays

A

Reagents for PT or APTT
Factor deficient plasma - contains 100% factor of all factors except for specific one
Pooled Normal Plasma

68
Q

Factor XIII (13) Assay

A

Not tested by PT or APTT
5M Urea or Clot Solubility Test

69
Q

5M Urea or Cold Solubility Test

A

Patient Plasma + CaCl2 = clot
Add 5M urea
Observe clot for lysis
Clot lysis within 24 hrs indicates <5% XIII activity or inhibitor

70
Q

Factor Antigenic Testing

A

Determines AMOUNT of protein present, not activity

71
Q

Stypven Time (ST)

A

Also called Russell Viper Venom Time (RVVT)
Snake venom - Viper russellii
Activates coagulation pathway at X, bypassing 7

72
Q

ST Interpretation

A

Prolonged PT and normal ST = 7 deficiency
Prolonged PT and ST = common pathway deficiency

73
Q

Activated Clotting Time (ACT)

A

Screening test for coagulation system
Whole blood clotting time (performed at bedside)

74
Q

ACT Testing

A

Venous sample
Tube contains silaceous earth

75
Q

Normal Clot time with ACT

A

80-125 seconds

76
Q

VIII: VWF:Rco

A

Determines activity of the VWF portion of factor 8 molecule
Serial dilutions of normal plasma, control, and patient
Dilution + ristocetin + reagent platelets
Observe for platelet aggregation

Coagulation (6 decks)

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