TESTS FOR SECONDARY HEMOSTASIS

Question 1

APTT = “partial” because the reagent consist only the

Answer 1

Phospholipid portion of the tissue thromboplastin

Question 2

APTT = “activated” because there are

Answer 2

Negatively charged activators added

Question 3

APTT Reference range

Answer 3

35 to 45 secs

Question 4

Uses of APTT

Answer 4

To monitor Unfractionated heparin therapy
To detect coagulation factor deficient in the COMMON and INTRINCSIC pathways

Question 5

PT reference range

Answer 5

10-13 seconds

Question 6

PT uses

Answer 6

Monitor warfarin therapy
Detects deficiencies in COMMON and EXTRINSIC PATHWAYS

Question 7

Standardized way of reporting PT

Answer 7

INTERNATIONAL NORMALIZED RATION (INR)

Question 8

A mathematical calculation that corrects for the variability in PT results caused by variable sensitives of the thromboplastin agents used by labs

Answer 8

INR

Question 9

To be computed only for samples from patients who have achieved a stable anticoagulant response with COUMADIN

Answer 9

INR

Question 10

A target INR range of ___ to ___ is recommended for most indications

Answer 10

2,0 to 3.0

Question 11

Introduced to minimize the differences in PT results due to different reagent instrument combination

Answer 11

INR

Question 12

INR FORMULA

Answer 12

(Ptx PT / Mean Normal PT ) ^ISI - International sensitivity index

Question 13

ISI stands for

Answer 13

International sensitivity index

Question 14

ISI of more sensitive thromboplastin

Answer 14

<1.0

Question 15

ISI of less sensitive reagents

Answer 15

> 1.0

Question 16

The more sensitive the thromboplastin reagent, the ____

Answer 16

Longer the result PT

Question 17

The less sensitive the reagent, the ____

Answer 17

The short the resulting pt

Question 18

Therapeutic anticoagulants

Answer 18

Coumarin drugs
Unfractionated heparin

Question 19

Vitamin K antagonist ; Oral anticoagulants

Answer 19

Coumarin drug

Question 20

WARF stands for

Answer 20

Wisconsin
Alumni
Research
Foundation

Question 21

Warfarin is an example of what drug

Answer 21

Coumarin

Question 22

Most commonly used ; interferes with the normal synthesis of factors II, VII, IX, X as well as Protein C and S

Answer 22

WARFARIN

Question 23

Brand name of coumarin drugs

Answer 23

Coumadin

Question 24

For reversal of Coumadin overdose, these may be given

Answer 24

Vitamin K (oral or intravenous)
Fresh frozen plasma (FFP)
Prothrombin complex concentrate
Recombinant activated factor VII (rVIIa)

Question 25

Used routinely in cardiac surgery ; therapy requires monitoring with PTT or activated clotting time (ACT) ; administered INTRAVENOUSLY

Answer 25

Unfractionated heparin

Question 26

Used for neutralizing UFH ; extracted from SALMON SPERM

Answer 26

Protamine sulfate

Question 27

Specifically used at the high UFH dosages

Answer 27

Activated coagulation time (ACT)

Question 28

Produced by the controlled fragmentation of heparin

Answer 28

Low molecular weight fragmentation

Question 29

Reacts with regulatory protein antithrombin III to inhibit activated factor X but not thrombin

Answer 29

Low molecular weight heparin

Question 30

The following are advantages of using LMWH : Lowered incidence of heparin induced thrombocytopenia compared with unfractionated heparin Lowered incidence of hemorrhage and osteoporosis True or false

Answer 30

True

Question 31

The following are disadvantages of using LMWH : Increased cost compared with traditional heparin More complicated monitoring of LMWH than traditional heparin true of false

Answer 31

True

Question 32

Examples of mechanical/electromechanical coagulation instrument

Answer 32

BBL fibrometer Diagnostica Stago analyzers

Question 33

Uses electromechanical clot detection system that measures a change in conductivity between two metal electrodes in plasma

Answer 33

BBL fibrometer

Question 34

May be used to identify specific factor deficiency by mixing correction reagents with patients plasma and then performing the PT and or APTT ; May also be used to detect lupus anticoagulant and specific factor inhibitors

Answer 34

Substitution test

Question 35

Fresh plasma - normal plasma contains

Answer 35

All coagulation factors

Question 36

Aged plasma contains all coag factors except

Answer 36

5 and 8

Question 37

Contains all coagulation factors except factors

Answer 37

1, 2, 5, 8, 13

Question 38

Adsorbed plasma contains all except factors

Answer 38

2, 7, 9, 10

Question 39

Used to detect deficiencies in fibrinogen, prothrombin, and factors V and X

Answer 39

Stypeven time (Russel’s Viper Venom Time)

Question 40

Stypven time differs from the PT in that deficiencies in factor ___ are not detected

Answer 40

VII

Question 41

Stypven time uses the coagulant properties of Russel’s viper venom obtained form the snake

Answer 41

Vipera russeli

Question 42

Russels viper venom is capable of bypassing the action of factor ____ and directly activating factor __ to ___

Answer 42

VII ; X ; Xa

Question 43

May help differentiating factor VII and X deficiencies

Answer 43

Stypven time

Question 44

Normal value for Stypven time

Answer 44

20-25 seconds

Question 45

Used to detect lupus anticoagulants ; normal value is ____

Answer 45

Dilute Russel’s viper venom time ; 30-35 secs

Question 46

This test is prolonged when the fibrinogen level is low, when fibrinogen function is impaired, and in the presence of HEPARIN, fibrin(ogen) degradation products and streptokinase

Answer 46

Thrombin time

Question 47

A sensitive test in detecting heparin inhibition ; normal value ____

Answer 47

Thrombin time ; 15 - 18 secs

Question 48

An enzyme found in the venom of Bothrops atrax snake and is capable of converting fibrinogen to fibrin ; UNAFFECTED by heparin ; Normal value ____

Answer 48

Reptilase time ; 10 -15 secs

Question 49

Prolonged thrombin time

Answer 49

Hypofibrinogenemia Immunologic antithrombin Heparin therapy

Question 50

Reptilase time prolonged

Answer 50

Hypofibrinogenemia

Question 51

Normal Reptilase time

Answer 51

Immunologic antithrombin Heparin therapy

Question 52

Clothing time slide or drop method normal value

Answer 52

2 to 4 mins

Question 53

Normal PT, APTT, TT, PLT CT

Answer 53

Factor XIII deficiency

Question 54

Prolonged APTT, the rest is normal

Answer 54

Von willebrand’s disease

Question 55

Prolonged PT and APTT

Answer 55

Vitamin K deficiency

Question 56

Prolonged PT, APTT, TT, Low PLT COUNT

Answer 56

Disseminated intravascular coagulation

Question 57

Weakens platelet function, platelet aggregation, interaction of vWF with platelets ; increases bleeding time

Answer 57

Penicillin G (carbencillin and ticarcillin)

Question 58

Increases plasma levels of VIII:C by releasing endogenous protein from body storage sites ; can shorten the APTT

Answer 58

DDAVP (1-deaminase—B-D-arginine vasopressin)

Question 59

Can produce thrombocytopeni ; increases bleeding time

Answer 59

Isoniazid

Question 60

Prolongs bleeding time by inhibiting Thromboxane A2 synthesis in the platelets

Answer 60

Aspirin product

Question 61

Stimulates the production of a lupus anticoagulant ; prolongs the APTT

Answer 61

PHENOTHIAZINES

Question 62

Weakens platelt function but enhances the effect of warfarin ; may prolong the bleeding time

Answer 62

Phenylbutazone

Question 63

Improves the effect of warfarin in patient on both drugs ; can prolong the PT

Answer 63

METRONIDAZOLE

Question 64

Stimulates formation of inhibitors to factor V ; can prolong the PT and possibly the APTT

Answer 64

STREPTOMYCIN