Exam 2: Coagulation and Hemostasis

Question 1

What is Primary Hemostasis

Answer 1

immediate vasoconstriction, platelet plug

Question 2

What is Secondary Hemostasis

Answer 2

The coagulation cascade, formation of fibrin clot

Question 3

What are clinical manifestations of bleeding?

Answer 3

Petechiae, purpura, telangiectasia, ecchymosis

Question 4

What is Petechiae?

Answer 4

pinpoint round spots

Question 5

What is Purpura?

Answer 5

purple colored spots of patches

Question 6

What is Telangiectasia?

Answer 6

fiery, stare-shaped mark, widened blood vessels

Question 7

What is Ecchymosis?

Answer 7

bruising

Question 8

What is Hematochezia?

Answer 8

blood passed from rectum

Question 9

What is Melena?

Answer 9

black stools from GI bleeding

Question 10

What is Hematuria?

Answer 10

pinkish or red colored urine from presence of RBC, blood in urine

Question 11

What is Hemoptysis?

Answer 11

coughing up blood from lungs

Question 12

What is Menorrhagia?

Answer 12

abnormally heavy or prolonged bleeding during period

Question 13

What is Epistaxis?

Answer 13

nosebleed

Question 14

What laboratory tests are done to evaluate bleeding?

Answer 14

PT/INR (Extrinsic pathway), aPTT (intrinsic pathway), bleeding time (platelet function)

Question 15

What causes decreased production of Platelet?

Answer 15

chemotherapy/ radiation, cancer of the bone marrow, B12/Folate Deficiency

Question 16

What causes decreased survival of platelets?

Answer 16

ITP, HIT, DIC, Medications (thiazides/ digoxin/ heparin)

Question 17

What causes platelet splenic sequestration (too many blood cells stuck in the spleen?

Answer 17

splenomegaly, hypothermia

Question 18

What causes dilution leading to decreased platelets?

Answer 18

large blood transfusions

Question 19

What is Thrombocytopenia?

Answer 19

Low platelet count, symptoms appear when it falls below 100,000, symptoms: easy bruising, mucosal hemorrhage, petechiae, purpura, “deep” bleeding

Question 20

What is Idiopathic Thrombocytopenic Purpura (ITP)?

Answer 20

abnormal decrease in the number of platelets in the blood, immune system attacking platelets

Question 21

What is Hemophilia A

Answer 21

factor VIII deficiency, coagulation disorder, ability to clot decreases, most common hemophilia

Question 22

What is Hemophilia B

Answer 22

Factor IX deficiency, coagulation disorder, ability to clot decreases, “Christmas disease”

Question 23

What are the clinical manifestations of hemophilia?

Answer 23

spontaneous bleeding, prolonged bleeding after minor procedures, A and B are clinically indistinguishable

Question 24

What is Disseminated Intravascular Coagulation (DIC)

Answer 24

proteins that control clotting become overactive causing small clots to form and block small blood vessels. This then consumes clotting factors and platelets leading to excessive bleeding

Question 25

What is hepatic disease?

Answer 25

Chronic liver disease (liver is the protein factory)

Question 26

What clotting factors are Vitamin K Dependent?

Answer 26

II, VII, IX, X

Question 27

What does Vitamin K Deficiency in Infancy look like?

Answer 27

babies need vitamin K supplements, it is associated with breast feeding, rare in developed world

Question 28

What does acquired Vitamin K deficiency look like?

Answer 28

malnutrition, malabsorption, may be from antibiotic treatment or anticoagulation therapy?

Question 29

What does Heparin do?

Answer 29

anticoagulant, it stimulates the activity of ATIII which inhibits Thrombin

Question 30

What does Coumadin do?

Answer 30

anticoagulant, blocks the production of vitamin K dependent clotting factors

Question 31

Intrinsic pathway in hemostasis

Answer 31

This pathway is the longer pathway of secondary hemostasis. It begins with the activation of Factor XII, which becomes Factor XIIA after exposure to endothelial collagen

Question 32

Extrinsic pathway of hemostasis

Answer 32

The extrinsic pathway is the shorter pathway of secondary hemostasis. Once the damage to the vessel is done, the endothelial cells release tissue factor which goes on to activate factor VII to factor VIIa. Factor VIIa goes on to activate factor X into factor Xa