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hemostasis Flashcards

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1
Q

what kind of bleeding do you see with primary d/o?

A

immediate small bleeds
its a platelet issue

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2
Q

list the primary hemostasis d/o (3)

A

platelet d/o
von willebrand dz
drug induced platelet dyfx
ITP

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3
Q

which meds can cause drug induced platelet dysfxn?

A

aspirin
NSAIDs
advil

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4
Q

what kind of bleeding do you see with secondary hemostasis d/o?

A

delayed, severe bleeding
platelets there; deficiencies or inhibitors in cascade

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5
Q

list the 4 secondary hemostasis d/o

A

hemophilias
acquired factor inhibitors
liver dz
DIC

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6
Q

what does DIC stand for

A

disseminated intravascular coagulation

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7
Q

what does ITP stand for

A

immune thrombocytopenic purpura

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8
Q

what is ITP?

A

a primary hemostasis d/o when antibodies attack platelets causing thrombocytopenia

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9
Q

what two glycoproteins are being attacked in ITP?

A

GP1B
GPIIB

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10
Q

what is drug induced platelet dysfunction?

A

a primary hemostasis d/o causing platelets to be either less functional or decreased in #

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11
Q

what is von willebrand’s disease

A

a primary hemostasis d/o of abnormal vWF (quantity or quality)
leads to mucocutaneous bleeding depending on type

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12
Q

what is hemophilia A and B?

A

a secondary hemostasis d/o
inherited decrease in factors 8 or 9

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13
Q

what is DIC?

A

a secondary hemostasis d/o
abnormal activation of clotting system in systemic illness; consumptive coagulopathy

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14
Q

labs that can screen for DIC

A

PT, PTT
platelet count
fibrinogen
D-dimers
FDP

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15
Q

expected PT and PTT and platelet count levels in DIC

A

high PT, PTT

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16
Q

expected platelet count and fibrinogen levels in DIC

A

both will be low

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17
Q

will D-dimers and FDP be present with DIC?

A

yes they both will

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18
Q

what are D-dimers and FDP?

A

D-dimers: product of blood clot
FDP: fibrinogen degradation products

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19
Q

5 scenarios to suspect a thrombophilia

A

unprovoked thrombosis at early age
familial tendency
thrombosis at odd site (artery, portal vein)
recurrent thrombosis
arterial vs venous thrombosis

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20
Q

what does Protein C & S depend on?

A

vitamin K
they are also reduced with warfarin

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21
Q

AT-III is lowered by what drug?

A

heparin

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22
Q

_____, _____, and ______ may be reduced w/ acute clotting

A

protein C
free protein S
AT-III

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23
Q

when should you test for hypercoaguable state?

A

before anticoagulants
2-3 wks after stopping anticoagulants

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24
Q

what is prothrombin time (PT/INR)

A

time it takes for factor VII to form complex with tissue factor and form a clot
monitors extrinsic pathway

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25
what test do we use to monitor warfarin therapy?
prothrombin time
26
how does warfarin work in the body?
anticoagulant vitamin K inhibitor to block factor 2,7,9,10
27
what do you give to reverse the effect of warfarin?
vitamin K
28
how do abx affect INR?
they increase it by decreasing the Vit K producing bacteria in the gut
29
what is normal INR goal when starting warfarin?
2-3 if they have artificial valve or if for secondary MI prevention then 2.5-3
30
why do you need to give a bridge when starting warfarin? what do you give as the bridge
pt is HYPERcoagulable for 5 days at start bc of long half life of prothrombin protein C and S are blocked first and they normally do negative feedback give heparin/LMWH bridge
31
what test can see the severity of liver dz?
prothrombin time
32
what test can screen for vitamin K deficiency?
prothrombin time
33
what is INR?
a way of standardizing PT values from diff labs you divide PT by control and raise it to ISI
34
what is normal INR levels
0.9 to 1.2
35
what is normal PT time?
11 to 14 seconds
36
what should you give to a patient with INR > 9 w/o bleeding? how often should you recheck INR?
Vit K 2.5-5mg oral (no backup options) recheck INR q 24hrs
37
when should you NOT give PCC or FFP?
never give it to non-bleeding patients
38
what to do in patient with INR 5-9 without bleeding (2 things)
maybe give 1-2.5mg vit K (don't have to give if no major risk factors) hold 1-2 doses of warfarin recheck INR q 2-3 days
39
what to do in patient w/ INR <5 without bleeding
check INR q 2-3 days hold 1 dose of warfarin
40
what is partial thromboplastin time (aPTT)
measures rate of the contact pathway (intrinsic pathway) adding activator like clay to plasma
41
5 things that can cause elevated PTT
factor deficiency (12,11,10,9,5,2) antiphospholipid antibodies acquired factor inibitors heparin lupus (if its high in unreasonable setting)
42
what lab is used to monitor heparin?
aPTT heparin anti-xa therapeutic (0.3 to 0.8)
43
when are mixing studies done?
to see if they are deficient or if the factors are just being inhibited
44
if you give mixing studies and it corrects, what does this mean?
it means they had a deficiency if it did not correct then it'd mean the factors are being inhibited
45
what is the normal range for aPTT
25-40 seconds
46
how does heparin work? what's the therapeutic range?
activates antithrombin III which inactivates IIA, VIIa-TF, IXa, Xa, XIa therapeutic range is 40-70 secs
47
what is the major risk with heparin therapy?
bleeding- it can be internal if dose is too high
48
how do you reverse heparin? (what do you give?)
protamine sulfate!!!!
49
unfractionated vs LMWH heparin
unfractionated is IV and monitored LMWH is SQ, longer, wt based and no need to monitor
50
what is heparin induced thrombocytopenia (HIT)
low platelet and thrombosis d/t antibodies to heparin/PF4 complex
51
what should you suspect when theres a decrease in platelets by >50% or levels <100k?
HIT
52
what should you do if someone has HIT? (4 things)
stop immediately and permanently check antiPF5 antibody confirm it avoid platelet transfusion
53
2 ways to confirm HIT?
serotonin release assay or P-selectin expression assay (PEA)
54
what should you right after stopping heparin in patient with HIT? why?
a different anticoagulant like argatroban, fondaparinux, bivalirudin bc heparin is still floating around in the body
55
what disorder is HIT similar to? how are they a bit different?
DIC except its more clotting than bleeding and the clots are huge
56
how does tPA work?
breaks down clot by cleaving plasminogen into plasmin and speeding up fibrinolysis
57
name the antiplatelet drug that blocks platelet ACTIVATION
Clopidogrel
58
name the antiplatelet drug that blocks platelet AGGREGATION
Aspirin
59
most common type of von Willebrand dz?
type 1-- low vWF and mild sx
60
what type of von Willebrand dz is a qualitative issue?
type 2
61
what type of von Willebrand dz can resemble hemophilia?
type 3
62
4 initial testings for von Willebrand dz
vWF:Ag--- its low Ristocetin cofactor activity (vWF R:Co)-- for activity measure factor VIII activity vWF multimers
63
what is thrombin time (TT)
measures conversion of fibrinogen to fibrin
64
3 things that elevate TT
hypo or dysfibrinogenemia heparin DIC
65
what is normal fibrinogen range?
175-400
66
2 things that cause decreased & increased Fibrinogen
decreased---DIC, liver dz increased-- inflammatory states, pregnancy
67
when do you do FDP/D-dimer testing?
to screen for clotting including DIC
68
when can you see FDP/D-dimer (6)
DIC malignancy liver dz surgery trauma pregnancy

HEME/ONC (5 decks)

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