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Coagulation > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

What are the 3 different types of bleeding

A

local or general
mucocutaneous or anatomic
acquired or congenital

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2
Q

Define localized vs generalized bleeding

A

local-bleeding from a single location
general-bleeding from multiple sites

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3
Q

Define mucocutaneous vs anatomic bleeding

A

muco-skin or body orifices
ana-bleeding in soft tissue, muscle, joint, deep tissue

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4
Q

What is hematemesis

A

blood in vomit

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5
Q

Define acquired vs Congenital

A

acquired-physical trauma induced, not p 2
congenital-acquired at birth

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6
Q

What are the 3 most most common congenital deficiencies in order

A

VWD
Factor VIII hemophilia A
Factor IX hemophilia B

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7
Q

What does systemic shock lead to

A

reduction of ADAMTS13

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8
Q

What is the massive transfusion component ratio

A

6:6:1
6 RBC
6 plasma
1 platelet

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9
Q

What is the first coag facor to decrease activity in liver disease

A

factor VII

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10
Q

What factor is the best early marker of liver disease
What lab test

A

prolonged PT- factor VII issue

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11
Q

What factors can be used to differentiate liver disease from vitamin K deficiency

A

factor V and VII- if decreased means liver disease
if the only VII, means vitamin K

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12
Q

When is there a change in fibrinogen

A

increases in early or mild liver disase

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13
Q

What factors are unaffected or elevated in liver disease

A

VWF, F VIII, XIII

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14
Q

How is renal disease related to bleeding deficiencies

A

fibrinogen is deposited into renal microvasculature, if the kidney fails there is reduced glomerular function

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15
Q

What coag factors are lower in newborns

A

II, VII, IX, X proteins C, S, Z

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16
Q

How does a vitamin K deficiency or coumadin treatment lead to bleeding

A

coumadin disrupts enzymes involved in vitamin K coag factors
vitamin K needed for vitamin K dependent factors to create a clot

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17
Q

How do PIVKA factors affect coagulation factors

A

they inactivate factors II, VII, IX and X and proteins C, S, Z

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18
Q

What lab tests indicate a vitamin K deficiency

A

prolonged PT
prolonged PTT

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19
Q

What is a common diagnostic of acquired hemophilia

A

the presence of autoanti fator VIII

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20
Q

What testing is done to find hemophilia

A

PT, TT, PTT
in mixing studies- the presence of inhibitor

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21
Q

What is the most prevalent congenital mucocutaneous bleeding disorder

A

VWD

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22
Q

What are the 2 types of VwD

A

type 1 quantitative
type 2 qualitative

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23
Q

What causes impaired primary hemostasis

A

decreased plt adhesion to vessel walls

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24
Q

What is the function of VWF

A

mediates plt adhesion to subendothelial collagen in areas of high flow rate and shear force

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25
Explain the process started by VWF
VWF binds to exposed collagen plts adhere to GPIb IX/V site to the VWF carpet plts activated and express GPIIb/ IIIa allows plt aggregation
26
severe quantitative VWF deficiency leads to ___ factor deficiency
VIII
27
Which VWD is most common
Type 1 quantitative
28
How to ristocetin affect VWF
infolds it and reduces neg charges,
29
Define hemophilia
congenital single factor deficiency marked by anatomic soft tissue bleeding
30
What gender does hemophilia mostly occur in
Males
31
What factor causes hemophilia A
factor VIII deficiency
32
How does factor VIII affect the coagulation pathway
slows the pathway i its production of thrombin
33
What chromosome carries the gene of hemophilia A
X chromosome Males affect all daughters and all sons are carriers
34
What are the clinical manifestations of hemophilia A
muscle and joint hemorrhages, hematomas, wound oozing and bleeding into CNS
35
PT, FBG, and TT normal prolonged PTT
Hemophilia A
36
What other name does hemophilia B have
christmas disease Factor IX deficiency
37
What causes hemophilia B
deficiency of factor IX, vitamin K factor dependent.
38
How does hemophilia B cause bleeding, what type of bleeding
soft tissue anatomic bleeding, reduces thrombin production
39
PT, TT, FBG normal PTT prolonged Factor IX assay
hemophilia B
40
What other name does hemophilia C have
rosenthal syndrome factor XI deficiency
41
PT normal PTT prolonged
hemophilia C
42
What populations are more prone to hemophilia C
Ashkenazi Jews
43
How is hemophilia A hemophilia B hemophilia C treated
A: B: purified factor IX concentrates C: plasma infusions
44
How is hemophilia A hemophilia B hemophilia C treated
A: raise factor VIII B: purified factor IX concentrates C: plasma infusions
45
What does the Russel viper venom time test do
activates coag mechanism at factor X level can find factor VII deficiency
46
What test is done to find factor XIII deficiencies
screening assay, suspended in 5 molar urea solution
47
Define thrombosis
inappropriate formation of a platelet or fibrin clot
48
What are the 2 main consequences of thrombotic obstructions
ischemia- loss of bleed necrosis
49
Define thrombophilia
hypercoagulability, predisposition to thrombosis
50
Define emboli
fragments of thrombi that move through circulation and get lodged onto veins
51
What is the most frequent cause of MIs and strokes
arterial thrombosis
52
2 main examples of venous thrombosis
Pulmonary embolisms and deep vein thrombosis
53
2 main examples of arterial thrombosis
Myocardial infarction stroke
54
What is the most common inherited thrombosis risk factor
factor V Leiden gene mutation
55
What is the second most common inherited thrombosis risk factor
prothrombin G2021A gene mutation
56
What is APC resistance
a risk factor: factor V leiden mutation causes factor V to become resistant to APC
57
What is prothrombin G20210A
a mutation in prothrombin where prothrombin activity becomes elevated
58
What are antiphospholipid antibodies
APLAs immunoglobulins that bind protein phospholipid complexes they increase the risk of thrombosis non specific inhibitor
59
What are the 3 main types of APLAs in order of importance
lupus anticoagulants LACs anticardiolipin abs anti beta GPI abs
60
What are the signs of APLAs
recurrent fetal loss thrombocytopenia unexplained thrombosis
61
What are mixing studies for
to differentiate an LAC from a factor deficiency
62
PTT -> TT ->repeated then PTT is long, if PTT remains uncorrected LAC factor deficiency factor inhibitor
LAC
63
PTT long, TT normal, PTT mix is corrected
next PTT corrects-factor deficiency next PTT doesn't correct-factor inhibitor or LAC
64
What are the 2 most common tests required for an LAC profile
DRVVT- factor X Silica PTT-factor XII
65
What result from DRVVT indicates the presence of an LAC
if shortened >1.2 LAC present <1.2 must do silica based low phospholipid
66
Describe APC resistance and why it is important
APC has Arg that resists APC hydrolysis resistant factor Va remains active and causes clot formation presence of APC is 3X more thrombosis risk
67
What is the FVL assay
Factor V Leiden mutation assay to confirm APC resistance
68
How does G20210A affect hemostasis
elevates plasma prothrombin levels, gene mutation
69
How does Antithrombin affect hemostasis
SERPIN neutralizes thrombin slows down clot formation
70
How does PC or PS affect hemostasis
causes recurrent venous thrombosis
71
increased lipoprotein A mean ___ thrombosis
increased
72
How does CRP help predict thrombosis
if high, increased risk of MI or stroke
73
How does fibrinogen affect the changes of thrombosis
if high, increased thrombotic risk
74
Increased homocysteine levels ___ risk of thrombosis
increase
75
What are the cardinal symptoms of DVT
edema, erythema, pain, sensation of heat
76
distended neck veins, tachycardia, shortness of breath
DVT
77
What tests can predict risk of DVT
D-dimer- if normal rules it out if high- rules it in
78
What is DIC
disseminated intravascular coagulation bleeding and clotting at the same time
79
What occurs to lab tests in DIC plt count coag factors PT/PTT/TT FSP D-dimer
plt count- decreased coag factors- decreased PT/PTT/TT- prolonged FSP-increased D-dimer-increased
80
What cells are in smears in pts with DIC
schistocytes
81
What is HIT
Heparin induced thrombocytopenia immune response to UFH and LMWHabs against platelet factor 4
82
How does HIT affect hemostasis
reduces plt count,
83
Venous or arterial thrombosis lipoprotein a CRP homocysteine high fibrinogen high VIII DVT PE
DVT PE venous everything else arterial

Coagulation (7 decks)

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