Hemostasis And Thrombosis

Question 1

Primary Hemostasis

Answer 1

Platelets Plug Formation

Question 2

Secondary Hemostasis

Answer 2

Fibrin Clot formation

Question 3

Primary Hemostasis membrane receptor

Answer 3

Glycoproteins Ib

Question 4

Primary Hemostasis adhesive protein

Answer 4

VWf

Question 5

Primary Hemostasis appropriate surface

Answer 5

Subendothelial matrix

Question 6

Platelets activation secretion

Answer 6

Alpha granules and dense bodies

Question 7

Platelets activation of GP _____receptor

Answer 7

IIb/IIIa

Question 8

Platelet activation _____ reorganization and ______ change

Answer 8

Phospholipid

Shape change

Question 9

Platelet shape change important, why?

Answer 9

From rounded discs to flat plates increases surface area

Question 10

Formation of fibrin clot with crosslinking of ________

Answer 10

Fibrin monomers by factor XIIIa

Question 11

Regulation of Primary Hemostasis (platelets )

Answer 11

NO
PGI2
ADPase

Question 12

Regulation of Secondary Hemostasis (Coag Pathway)

Answer 12

Serine protease (antithrombin)
Protein C pathway
Fibrinolytic system

Question 13

Fibrinolytic systems

Answer 13

Removes excess clot

Question 14

Protein c pathway controls

Answer 14

Va and Viiia

Question 15

Serpins

Answer 15

Anti thrombin-serine protease inhibitors

Question 16

Activated protein C plus _____ serve to inactive factors _____ and _____

Answer 16

Protein

Va
VIIIa

Question 17

Protein C or S deficiencies result in

Answer 17

Hypercoagulable states

Question 18

Plans in

Answer 18

Removes excess fibrin clot

Question 19

Screening test of Hemostasis

Answer 19

Prothrombin Time
Internal normalized ratio
Partial thromboplastin time
Platelet count
Bleeding time

Question 20

Prothrombin Time

Answer 20

Screens for activity of Proteins in the extrinsic pathway

Phospholipid and tissue factor are added to plasama with Ca

Question 21

Extrinsic pathway proteins

Answer 21

Factors V VII II X and fibrinogen

Question 22

Partial Thromboplastin Time

Answer 22

Screams for activity within the intrinsic pathway

Negatively charged activator of factor XII to serum together with Ca

Clot formation after 28-35 seconds

Question 23

PTT is used to monitor

Answer 23

Heparin

Question 24

INR is used to monitor

Answer 24

Warfarin

Question 25

Clinical manifestation of primary Hemostasis disorders

Answer 25

Muccocutaenous bleeding Petechial Excessive bleeding with trauma

Question 26

Lab findings of primary Hemostasis disorders

Answer 26

Prolonged BT/PFA-100 | Thrombocytopenia

Question 27

Clinical manifestations of secondary Hemostasis disorders

Answer 27

Soft tissue bleeding | Excessive bleeding with trauma

Question 28

Lab findings of secondary Hemostasis disorders

Answer 28

Prolonged PT and PTT | Prolonged TT

Question 29

Clinical manifestation of regulatory disorders associated with bleeding

Answer 29

Soft tissue bleeding | Excessive bleeding with trauma

Question 30

Lab manifestations of regulatory disorders of Hemostasis

Answer 30

Normal PT and PTT Normal Bleeding Normal platelet count

Question 31

Congenital Bleeding disorders (3)

Answer 31

Von Willebrand Disease Favor VIII deficiency Factor IX deficiency

Question 32

Von Willebrand Disease

Answer 32

AD Mucocutaenous bleeding is the dominant clinical manifestation

Question 33

Classification of vWD

Answer 33

Type 1: quantitative partial Type 2: Qualitative Type Quantitive total

Question 34

Clinical manifestations of vWD

Answer 34

``` Epistaxis Ecchymoses Mucosal bleeding Bleeding with trauma or surgery Symptoms often improve post adolescence ```

Question 35

Treatment of vWD

Answer 35

``` Desmopressin Antifibrinolytic agents Factor VIII concentrates Cryoprecipitate Recombinant factor VIII ```

Question 36

Hemophilia A

Answer 36

X linked recessive disorder | Deficiency of factory VIII

Question 37

Hemophilia lab features all normal except

Answer 37

Factor VIII decreased PTT prolonged

Question 38

Hemophilia A Classification

Answer 38

Severe <1% viii Moderate Mild>5% VIII

Question 39

Hemophilia B

Answer 39

Sex linked Recessive Factor IX deficiency

Question 40

Hemophilia A: Therapy

Answer 40

Factor VIII concentrates Recombinant Factor Inhibitors of fibrinolysis

Question 41

Hemophilia B: therapy

Answer 41

Factor IX concentrates Recombinant Factor IX Inhibitors of fibrinolysis

Question 42

Mechanisms of thrombocytopenia

Answer 42

Decreased platelet production Increased destruction Sequestration Congenital versus acquired

Question 43

Acute Childhood ITP

Answer 43

``` Viral prod Rome common Sudden onset Sever thrombocytopenia Spontaneous remission M:F 1:1 ```

Question 44

Chronic adult ITP

Answer 44

``` No antecedent infection Gradual onset Moderate thrombocytopenia Infrequent spontaneous remission More common in females ```

Question 45

ITP autoantibodies direct at

Answer 45

Platelet membrane antigens Increased IgG bound to the platelet surface promotes increased sequestration/destruction by the reticuloendothelial system

Question 46

ITP clinical features

Answer 46

Petechial hemorrhages Gingival bleeding Ecchymoses Bleeding with trauma or surgery

Question 47

ITP bone marrow and blood findings

Answer 47

Megakaryocytes normal to increased No microangipathic changes on blood smear review

Question 48

ITP therapy

Answer 48

Corticosteroids Intravenous immunoglobulin Immunosuppressive Splenectomy

Question 49

TTP Thrombocytopenic Purpura

Answer 49

Acute disorders characterized by intravascular platetl activation with formation of platelet rich microthrombi throughout the circulation

Question 50

TTP due to

Answer 50

deficiency of ADAMTS 13 a metalloporetinase that normally degrades very high molecular weight Can be inherited or acquired

Question 51

Disseminated Intravascular coagulation DIC

Answer 51

Unregulated widespread intravascular activation of the Hemostatic system

Question 52

DIC clinical setting

Answer 52

Infection Tissue injury Obstetrical complications Certain malingancies

Question 53

DIC clinical manifestation

Answer 53

``` Bleeding from multiple sites Thromboembolic problems Hypotension and shock Respiratory dysfunction Hepatic dysfunction Real dysfunction CNS dysfunction ```

Question 54

DIC therapy

Answer 54

Remove/Re the initiating stimulus Supportive therapy with transfusion of blood products FFP- Coagulation and regulatory proteins Cryoprecipatesis- Fibrinogen VIII vWF Platelets- Platelets