Section 8 Flashcards by Kailea Boerste

Reasons to do hemostasis testing

monitor therapy, ID “coag” defects

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manual tilt method

trouble shooting method, not done anymore, hard to tell

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Mechanical
two different types

electromagnetic clot detection:
coductivity between two probes
clot finishes circuit

magnetic
increases viscosity

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Photooptical (turbometric)

measures change in OD of test sample light transmission
light transmitted

cloudy or turbid samples will change result

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nephlemetric

light scatter also immunologic (90-180)

change in light that is scattered

cloudy or turbid will change results

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Chromogenic

color producing substrate PNA (YELLOW)

proteins free pNA, color proportional to protease activity

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Immunologic end point

latex particles w ab

ab-ag complex aggglutinate, absorb more light

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PT Test

Prothrombin Time
Extrinsic path

VIII, X, V, II, I

PPP sodium citrate

neoplastine: heparin inhibitor
phospholipid PF3 substitute
CaCl2 to override sodium citrate

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What can PT not test for

Can not test for TFIII, Ca++, PF3/XIII

used to monitor anticoags

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Ref range for PT

11-13 seconds

pts on oral anticoags will have PT of 20-27 seconds

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INR
international normalized ratio
what does this ratio do?

when on an anticoag….what happens to the magic 4?

protein induced……

“correction” standardizes results between labs

when on an anticoag, magic 4 are not decreased in concentration, they are produced in incomplete forms

Protein induced by VIT K absence PIVKA

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PIVKA extras
refrence … given a …., futher from this number means?

refrence thromboplastin assigned a 1, the further the ISI is from 1 the less sensitive it is to PIVKAS

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Ref range of INR

.9-1.2 ref range

TR: 2-3

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INR calculation

pt PT/normal PT to the power of ISI

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APTT

intrinsic

XII, XI, IX, II, I ,V VIII, PK HMWK, X

2 rgnts:

Activator rgnt - contact activator (XI, XII, PK, HMWK)
PF3 sub

CaCl2

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APTT cannot test?
used to monitor ….what are these values?

cannnot test PF3, Ca++ or XIII

used to monitor effects of heparin (these pts will have 1.5 -2.5x the normal value)

APTT ref range

26-36 seconds

PT normal APTT prolonged

upper part of intrinsic factor problem
XII, XI, IX, HMWK, PK, VIII

PT prolonged APTT norm

VII

extrinsic path

PT prolonged APTT prolonged

common path I, II, V X

TT
thrombin time

tests adequacy of?

reagent?

ref range

tests adequacy of fibrinogen

time required for clot to form is thrombin time

reagent - dilute thrombin

Ref range: 14- 20 sec

50:50 mix
if a test is prolonged, it is due to…..

mix what two things?

a deficiency result
a inhibitor result

if one test is prolonged, it is due to a factor deficiency or inhibitor

mix norm plasma and pt plasma 1:1

Factor deficiency: addition of norm plasma should cause a significant correctioon in prolonged result

Facotr inhibitor: test should remain prolonged

Immunologic fibrinogen
measures?
quantitates….

measures Ag

quantitates total fibrinogen and dysfunctional

Fibrinogen activity
quantitates?

most?

plasma is? for what reason?

plotted on a

quantitates only FUNCTIONAL fibrinogen

most commonly preformed fibrinogen assay

plasma diluted ot 1:10 minimize heparin

std curve

FDPs Fibrinogen degradation products dont differentiate between...will be positive on both

semi quant measure of FDPs will be pos in presence of FDP, Fibringen fibrin ..etc dont differentiate 1 from 2 fibrinolysis, will be positive in both firbinogenolysis/fibrinolysis

D-Dimer only in what is stabllizied assays? seen in cases of? all assays use? common?

only present in 2 fibrinolysis (polymers stabilized by XIII form clot) ELISA/EFA SEEN IN CASES OF THROMBOSIS (DIC/DVT/PE) all assays use monoclonal ab to D-dimer latex aggl common

Interpretation of D-Dimer

particles agglut if D-dumers are present and change OD, flourescne of visible agg on slide Be aware of post zone (too much ag) in assay

Factor Assay using a specific.... if pt is deficient, what do results look like? ref range

using specific factor def plasma (has everything but VIII) re-run APTT If pt is def VIII, APTT will remain prolonged if pt is deficient in some other factor, it will correct Ref range: 60-150%

Anti Xa assay monitors what therapy? 1.)pt pl.... 2.) add increased color means?

to monitor therapy w LMWH, UFH or direct facotr Xa inhibitors 1.)pt plasma w rgnt that has constant Xa amount 2.) add chrom substrate increased color means decreased LMWH,UFH Direct..etc

RT what does the snake venom do? acts like? NOT what can inhibit it? Differentiates? Ref range

snake venm cleaves away fibrinopetpide A TESTS FOR Factor 1 acts like thrombin on fibrinogen NOT inhibited by thrombin inhibitors like heparin/autoab (FDPs can inhibit) Differentiates lack of fibrinogen/inhibitor Ref range: 16-22 sec

TT prolonged, RT normal

thrombin inhibitor like heparin

TT prolonged, RT prolonged

lack of fibrinogen/FDPs

Urea clot lysis/solubility adequacy of what does the test contain? ref range

Adequacy of XIII if clot has been stabilized by XIII, clot will remain If not stabilized it will dissolve PRP, CA++, Glass tube Ref range 60-150%

Euglobulin clot lysis measures make sure pt isnt experiencing dangerous monitor pts on ref range

fibrinolytic capability make sure pt isnt experiencing dangerous degree of fibrinogenolysis monitor activity of pt on tPA, strep/urokinase Euoglobulin fraction, buffer, thrombin/fibrinogen REF RANGE: >1hr (<4hr) increased fibrinolutic activity will make it faster

Clotal

measures coag/fibrinolytic capacity

ACT activated clotting time

whole blood clotting time POCT to monitor high heparin dose during cardiac surgery

RVVT

Direct activator of X mixing venom w ca++ and PPP tests the common path Stypven time 20-30 seconds