hypercoaguable states

Question 1

what is virchows triad ?

Answer 1

endothelial damage
stasis of blood
hypercoaguable state

Question 2

what are the common hypercoaguable states ?

Answer 2

post op
malignancy
OCP
pregnancy
elevated homocysteine levels
nephrotic syndrome ( loss of antithrombin 3)
smoking

Question 3

what are the causes of high homocysteine levels in the plasma ?

Answer 3

folate/B12/B6 deficiency

Question 4

what can lower the levels of homocysteine ?

Answer 4

folate

Question 5

what is the pathology associated with factor V leiden mutation ?

Answer 5

abnormal factor 5 , that cannot be cleaved by protein C

Question 6

what is the mutation in factor 5 leiden mutation ?

Answer 6

exchange from guanine to adenine
activated protein C resistance

Question 7

what is the prothrombin gene mutation ?

Answer 7

associated with 20210 gene mutation , resulting in an increase in prothrombin and hence the hypercoag state

Question 8

what are the causes of acquired deficiencies of antithrombin 3 mutation ?

Answer 8

1- impaired production of antithrombin 3 by the liver
2- protein losses such as with nephrotic 3- syndrome \consumption as with DIC

Question 9

what is the classic presentation of antithrombin 3 defeciency ?

Answer 9

heparin resistance , where there is an escalation of the dose with no change in PTT

Question 10

what is the MOA in protein C defeciency and what is the clinical association ?

Answer 10

there is an inability to normally inactivate 5a and 8a
clinically associated with warfarin skin necrosis. ( thrombosis of the skin tissue)

Question 11

what is the cause of the antiphopholipid syndrome ?

Answer 11

antiphospholipid antibodies are made

Question 12

what are the clinical consequences associated with antiphospholipid antibodies ?

Answer 12

1- an increased risk of venous and arterial thrombosis - causing recurrent fetal loss and DVT
2- increased PTT
3- false positive syphillus test

Question 13

what are the three antibodies tested for in APS ?

Answer 13

1- anti cardiolipin - false positive syphillus
2- lupus anticoagulant
3- anti B2 glycoprotein

Question 14

what test can be used to detect the ab in APS ?

Answer 14

ELISA assay
for lupus anticoagulant it is detected indirectly through the coagulation assay through PTT and mixing study

Question 15

what are the criteria required for a diagnosis of APS ?

Answer 15

2 lab criteria which are positive for more than 12 weeks apart
clinical criteria : evidence of thromboembolism or history of recurrent pregnancy loss

Question 16

what is the hypercoaguable workup ?

Answer 16

antithrombin level
protein C and S
factor 5 leiden gene mutation
prothrombin gene mutation
APS antibodies
cancer screening