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Hematology MLT Unit 5 > Introduction to Thrombosis and Anticoagulation Therapy > Flashcards

Introduction to Thrombosis and Anticoagulation Therapy Flashcards

(53 cards)

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1
Q

What is Thrombophilia?

A
  • Environmnetal, inherited, and acquired conditions that alter coagulation.
  • Predispose a person to thrombosis
  • Hypercoagulability is synonymous w/ thrombophilia
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2
Q

What are the 2 types of thrombsis and what does each consist of?

A
  1. Arterial Thrombi - composed of PLTS, RBCs and WBCs
  2. Venous Thrombi - composed of fibrin and RBCs
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3
Q

What are the risk factors for inherited thrombosis? (8)

A
  • PAPPAHEF
    • Protein C deficiency
    • Antithrombin deficiency
    • Protien S deficieny
    • Prothrombin G20210A
    • APCR
    • Hyperhomocysteinemia
    • Elevated Factor VIII
    • Factor XII deficiency
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4
Q

What are the risk factors for aquired thrombosis? (8)

A
  • Cancer
  • Surgery
  • Immobility
  • Nephrotic syndrome
  • DIC
  • Pregnancy
  • Antiphospholipid antiodies
  • Drugs (oral contractceptives)
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5
Q

What is the main component of arterial thrombosis?

A

PLT abnormalities

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6
Q

A decrease in what can result in arterial and venous thrombosis?

A

Decrease in fibrinolysis

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7
Q

What is antithrombotic factor deficiency?

A

Inhibitors that interfere with clotting factors

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8
Q

Antithrombin neutralises what factors?

What enhances it’s activity?

A
  • IIa, IXa, Xa, XIa, XIIa (1972a)
  • Heparin
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9
Q

This protien in Vitamin K dependent, circulates as zymogen (inactivated protein) and is activated into a serine protease to inhibit clotting factors?

A

Protein C

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10
Q

This is a cofactor for protein C and is needed to activate protein C. It is also vitamin K dependent.

A

Protein S

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11
Q

Antithrombin Deficiency

What is the genetic inheritence?

What are the 2 types?

What thrombosis is it associated with?

A
  • Auto. Dom. found in 1 in 600 people
  1. Type 1: quantitatve
  2. Type II: qualitative
  • Venous thrombosis
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12
Q

Protein C Deficiency

Genetics

What type is more common?

What form has 160 mutations?

What is it associated?

A
  • Auto. Dom
  • Type I: quantitative
  • Type II: qualitative
  • Venous thromboembolism
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13
Q

Protein S Deficiency

What are it’s 2 circulating form?

A
  • Free (40%)
  • Bound to C4b-binding protein (60%)
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14
Q

Protein S Deficiency

In Type I how is protein S affected?

A

Free protein S and protein S activity are reduced to about 50% of normal value.

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15
Q

Protein S Deficiency

  • What are the 2 subtypes of Type II: qualitative disorder
A
  • Type IIa - reduced free protein S, normal total protein
  • Type IIb - both free and total protein S levels are normal.
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16
Q

Protein S Deficiency

What thrombosis is this associated with?

A

Venous thrombosis (25% arterial)

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17
Q

What is the most comon inherited cause of thrombosis?

A

Activated Protein C Resistance (Factor V Leiden)

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18
Q

ACPR (Activated Protein C Resistance) is found in what percentage of patients with recurrent thrombosis.

A

20 - 60%

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19
Q

What complications are assciated with factor V Leiden deficiency? (2)

A
  • Venous thromboembolism
  • Miscarriage
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20
Q

92% of APCR is an inherited mutation of what?

A

Factor V (Arg506GIn) (Factor V Leiden)

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21
Q

What is the second most prevalent form of hypercoagulability?

Genetics?

What increases the risk of venous thrombombolism?

A
  • Prothombin Mutation
  • G20210A
    • single point mutation
    • Auto dominant
  • Plama prothombin level >115 IU/dL
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22
Q

Hyperhomocysteinemia

  • Genetics?
  • What is homocystein?
Study These Flashcards
A
  • Inherited or aquired
  • it’s an amino acid formed from coversion of methionine to cystein.
23
Q

What is Lupus Anticogulant/Antiphospholipid Syndrome?

  • What proteins are antibodies produced against (2)?
  • What age does it occur?
Study These Flashcards
A

Antibodies to proteins associated with phospholipids

  • ß2-glycoprotein I
  • Apolipoprotein
  • 35 - 45
24
Q

What is Heparin Induced Thrombocytopenia (HIT)?

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A
  • Immune mediated complication associated with Heparin therapy
  • Antibodies produced against heparin PLT factor IV complex causing PLT activation.
25
How soon after therapy does Heparin Induced Thrombocytopenia (HIT) occur?
5 - 14 days after
26
Heparin Induced Thrombocytopenia (HIT) may cause (5)?
* Life-threatening thrombosis * thrombocytopenia * venous thrombosis more likely than arterial * Skin leisions * Heparin
27
Heparin Induced Thrombocytopenia (HIT) Clinical Diagnosis. What is seen in peripheral smear? What develops and leads to thrombocytopenia?
* MHA Schistocytes * Ab PF4 develops which coats PLTs then sequestered in spleen leading to thrombocytopenia.
28
What are the most common acquired thrombotic disorders?
* Lupus Anticoagulant/Antiphospholipid Syndrome (LAAS) * Heparin Induced Thrombocytopenia (HIT)
29
Coagulation samples are drawn in?
Blue top 3.2% Sodium Citrate
30
What coagulation specimens will need to be drawn differently?
Samples w/ Hct \>60%
31
What are the three types of anticoagulant drugs for treatment of thrombotic discorders? What do they do and what do they treat?
* **Antiplatelet Drugs** * Inhibit PLT activation and aggregation * Most effective in arterial disease * **Anticoagulant drugs** * Inhibit thrombin and fibrin * treat venous thrombosis * **Thrombolytic Drugs** * break down fibrin clot
32
Antiplatelet Drugs: Aspirin What does Apsirin do? and What does this prevent?
* Irreversible inbitor of cyclo-oygenase enzyme (COX) * Inbits formation of Thromboxane A2 (TXA2) (plt activating substance released by PLTs)
33
* Dipyridimole * Thienopyridines * Ticlopidine * Clopidogrel The above are all what?
Antiplatelet Drugs
34
What is Heparin? What does it bind to and inactivate?
* Short-term anticoagulant, naturally occuring highly sulphated glycosaminoglycan * binds to AT and complex and inactivates thrombin and factor Xa. intravenous/ subcutaneous administration
35
Low Molecular Weight Heparin Works on which on which factor?
factor X
36
What drug is an anticoagulant used as a long term therapy? What factors does it inhibit? What is its derivative?
* Coumadin * II, VII, IX, X (1972) * Warfarin
37
tPA, urokinase and streptokinase are what type of drug?
Thrombolytic drugs
38
What test monitors Coumadin (warfarin) therapy?
PT/INR test
39
What is the therapeutic range for INR? What range of INR is at high risk of bleeding? What is needed for prosthetic heart valves to prevent myocardial infarction?
* 2.0 - 3.0 foe venous thromboembolism treatment. * \>3.0 * higher dose of warfarin 2.5 - 3.5 range
40
What test monotors heparin therapy?
APTT
41
What must be done before herpain therapy is started?
Baseline APTT and PLT count
42
How often should APTT be repeated during therapy?
every 4 - 6 hours tp adjust dosage to therapeutic levels, 1.5 - 2.5 the mean lab reference range.
43
What is evidences of heparin induced thrombocytopenia (HIT)?
40% reduction in PLT count from baseline
44
What is the test for Activated Protein C resistance (Factor V leiden)? What is it based on? How is the test performed?
* two part aPTT test * based on inhibition of factor Va by APC causing a prolonged aPTT * Test performed on plasma w/ or w/o APC (results expressed as ratio * patient aPTT+APV/patient aPTT-APC
45
What is the normal ratio for the aPTT test for APCR (factor V Leiden)?
2.0 or greater less than 2.0 is diagnostic
46
What test is used to confirm Factor V Leiden?
DNA Testing
47
What are the 3 assays for testing HIT?
* Herparin induced PLT aggregation * Herparin-induced PLT ATP release by lumiaggregometry * C-serotonin release assy (C-SRA) by ELISA
48
Lupus Anticoagulant/ Antiphospholipid Assays What the 3 assays? What is the mixing study procedures?
* aPTT * Kaolin clotting time * Dilute Russel Viper Venom (DRVVT) * Px plasma mixed with normal plasma (aPTT) and test is repeated. * LA present mixing study not correct to normal * LA confirmed by adding excess PLTs
49
What are the 2 coagulation methodologies?
* Mechanical * Photo-optical
50
What is the principle of mechanical methodology based on?
Impedence principle * no fibrin = no flow of curren * fibrin present = current flows through detection circuit and de-energizes relay
51
What is the principle of photo-optical methodology based on?
detects change in absorbance when a clot forms enables for large volume with high accuracy
52
What are the automated and semi automated coagulation tests?
* Semi-automated * Firometer (electromechanical) * Automated * MLA Coagulation analyzer (photo-optical) * Hemachron Jr. (photo-optical)
53
How are PT results reported? Normal reference range? Critical value
* in Seconds * 11.0 - 13.0 seconds * \>50.0 seconds

Hematology MLT Unit 5 (5 decks)

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