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09 Hematology > Hemostasis 1 > Flashcards

Hemostasis 1 Flashcards

1
Q

primary vs secondary hemostasis

A

primary: vessel wall and platelet
secondary: plasma proteins

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2
Q

___ is a more stable clot than thrombin

A

fibrin

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3
Q

these will activate thrombin (extrinsic pathway)

A

factor x with factor v –> prothrombin –> thrombin

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4
Q

these will activate thrombin (intrinsic pathway)

A

factor 11 -> factor 9 +8 -> factor 10 + factor 5 -> prothrombin -> thrombin

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5
Q

three major events in secondary hemostasis

A

initiation
amplification
propagation

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6
Q

normal platelet count

A

150,000/uL to 450,00/uL

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7
Q

indications for abnormal or high wbc

A

infection, examine bone marrow for leukemia

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8
Q

low plt, hb and wbc is normal

A

peripheral smear must be done to see if plt are clumped (falsely low plt)

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9
Q

fragmented rbcs in smear

A

microangiopathic hemolytic anemias

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10
Q

normal rbc moprhology in smear

A

drug induced thrombocytopenia
infection induced thrombocytopenia
idiopathic immune thrombocytopenia
congenital thrombocytopenia

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11
Q

causes for thrombocytopenia

A 
decreased production (aplastic anemia, bone marrow infiltration)
increased destruction (immune mediated)
increased sequestration (hypersplenism)
infections
drugs
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12
Q

memorable drugs that can cause thrombocytopenia

A 
acetaminophen
amlodipine
ampicillin
ceftriaxone
cotrimoxazole
heparin
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13
Q

pathophysio of hepatin induced thrombocytopenia

A

antibodies to pf-4 is recognized with heparin -> ig recognize and mark the hep-pf-4 complex -> macrophages in the spleen recognize complexes - platelet removal by splenic macro -> thrombocytopenia + thrombosis

LOW PLATELET + THROMBOSIS

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14
Q

4t score

A

thrombocytopenia
timing of platelet count fall
thrombosis or other sequelae
other causes for thrombocytopenia

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15
Q

4t score interpretation

A

predicts if patient might have heparin-induced thrombocytopenia

<4 = 0.8% risk
4-5 = 11% risk
>5 = 34% risk
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16
Q

management of heparin induced thrombocytopenia

A 
discontinue heparin
alternative anticoagulants (lepirudin, argatroban, fondparinux)
do not give low molecular weight heparins
17
Q

patho in immune thrombocytopenia

A

macrophages destroy antibody coated platelets resulting to thrombocytopenia

18
Q

clinical characteristics of ITP

A

children: acute, remits in 6 mos
adults: chronic and more persistent
- rule out other disorders
- mucocutaneous bleeding (gums, nose, petechiae)

19
Q

indications for treatment of ITP

A

indication: plt <30,000 + bleeding = transfution

20
Q

first line treatment for itp

A

ivig
steroids
anti-rh

21
Q

second line treatment for itp

A

rituximab (anti-cd20 antibody)
tpo receptor agonists (eltrombopag, romiplostim)
splenectomy (last resort)

22
Q

patho in thrombotic thrombocytopenic purpura

A

deficiency of mmp adamts13 or antibodies for adamts13

adamts13 = cleaves vwf to make is usable

non cleaved vwf -> large numbers of platelets attached to vwf –> one big clot -> thrombocytopenia

23
Q

pentad of ttp

A 
hemolytic anemia
thrombocytopenia
renal failure (clots in gloms)
neurologic findings
fever
24
Q

conditions that push a patient to develop ttp

A

hiv, pregnancy, medications, malignancy

25
Q

prognosis of ttp

A

poor if not treated early, 95% mortality

26
Q

treatment for ttp

A

plasmapheresis with plasma exchange

steroids to temporize ttp

27
Q

most common inherited bleeding disorder

A

von willebrand disease

28
Q

patho in von willebrand disease

A

insufficient or dysfunctional vwf

29
Q

presentation of vwf disease

A

mucocutaneous bleeding
post-op bleeding
menorrhagia

childhood: excessive bruising, epistaxis

30
Q

types of vwf disease

A 
type 1 (quantitative): vwf production is low, most common
type 2 (qualitative): vwf is sufficient but abnormal
type 3 (combination): most severe, like hemophilia
31
Q

treatment for vwd

A

desmopressin: release the vwf stored in endothelium
- prone to tachyphylaxis
- hyponatermia

vwf concentrates
imtermediate purity factor 8
anti-fibrinolytic agents (txa)

09 Hematology (9 decks)

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