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IMS- Strand 4 > The Coagulation Panel > Flashcards

The Coagulation Panel Flashcards

(43 cards)

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1
Q

What is Haemostasis?

A

Process to fix a break in blood vessel wall

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2
Q

How are coagulation factors involved in secondary haemostasis measured?

A
  • Blood contained in citrate tube
  • Spin blood, set off the coagulation cascade
  • Visually look for a clot
  • Automated system detects light penetration (as fibrinogen becomes fibrin and strands start to crosslink the mixture gets cloudy and machine detects this)
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3
Q

What is PT?

A

Prothrombin time measured in seconds

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4
Q

What is APTT?

A

activated partial thromboplastin time measured in seconds

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5
Q

What is Fibrinogen?

A

beware derived versus measured, measured in g/L

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6
Q

What is INR?

A

Internationally standardised ratio based on the PT, technically only valid for warfarin

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7
Q

What are results affected by?

A

sampling issues and other interferences in the test tube

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8
Q

What are DOACs?

A

Direct- acting oral anticoagulants
Rivaroxaban/ apixaban

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9
Q

Where does DOAC act?

A

Factor X (prevents from activating)
IIa

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10
Q

What DOACs affect factor X?

A

apixaban
rivaroxaban

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11
Q

What DOACs act on IIa?

A

dabigatran

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12
Q

What is the benefit of DOACs?

A
  • Don’t need routine monitoring of levels
  • Standard dose
  • Act on factor X prevents it from becoming activated
  • Means no prothrombin to thrombin which means no fibrinogen= prevents a clot
  • Act on fac 2 directly
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13
Q

How DOACs affect coag panel tests?

A

Variable non- linear impact of PT & APTT

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14
Q

What clinical scenarios are DOACs used?

A

Blood clots

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15
Q

What does Warfarin inhibit?

A

Inhibits activity of vitamin K
Vitamin K dependent clotting factors= inhibited

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16
Q

What vitamin K dependent clotting factors are there?

A

IX, VII, X, II= inhibited

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17
Q

How does Warfarin affect the coag panel?

A
  • Warfarin affects both PT & APTT
  • INR is standardised way of reporting PT
  • Use INR to adjust warfarin dosing
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18
Q

What is PT sensitive to?

Study These Flashcards
A
  • PT is particularly sensitive to the clotting factors affected by warfarin so can be used to accurately monitor the degree of warfarin- induced anticoagulation
19
Q

What clinical scenarios is warfarin used for?

20
Q

What are Heparins?

Study These Flashcards
A
  • Naturally occurring sulphated glycosaminoglycans isolated from animal tissue, most commonly porcine intestine
21
Q

What do heparins do?

Study These Flashcards
A
  • Indirectly inhibit blood coagulation, by potentiating the anticoagulant effect of antithrombin x2000
  • Accelerates the inactivation of thrombin (IIa) & factor Xa
22
Q

What is the unfractionated heparin?

Study These Flashcards
A
  • Can bind to both antithrombin (AT) & thrombin (IIa)
  • Given intravenously
  • Requires a loading dose before continuous infusion
  • Requires careful monitoring
23
Q

What is low molecular weight heparin?

Study These Flashcards
A
  • Smaller molecular size
  • Binds antithrombin and potentiates its inhibitory effect on Xa
  • Cannot bind thrombin (IIa)
  • Subcut injection
  • More predictable pharmacokinetics
  • Weight dependent dosing
24
Q

How does Heparin affect coag panel tests?

Study These Flashcards
A
  • UFH affects APTT
  • Adjust dosing using APTT ratio
  • LMWH also affects APTT but less sensitively, depends on chain length of the LMWH, longer chain= more APTT prolongation
25
What is an example of a Thrombolytic?
tPA
26
What are the uses of thrombolytics?
Thrombolysis= "clot buster" medicine Systemic versus catheter- directed thrombolysis
27
What clinical cases are Thrombolytics used for?
- Massive PE with haemodynamic instability - Acute ischaemic stroke - Blocked CVC line - Acute limb ischaemia
28
Do antiplatelets affect coag panel tests?
NO
29
What are the uses of antiplatelets?
- Primary prevention- high cardiovascular risk score - Secondary prevention- after MI, stroke, PCI/ stenting, PVD, arterial thrombosis - No effect on clotting cascade - Involved in primary haemostasis - stop platelets being so sticky
30
What is Haemophilia A?
- X- linked - Recessive - Mainly affects males - Problem with factor 8 (severe end= no factor 8)
31
What is Haemophilia B?
- Affects gene which makes factor 9 - Recessive - X linked - Rarer
32
What are the symptoms of Haemophilia?
Both can cause huge pregnancy complications, huge risk of bleeding Haemorrhages, excessive brusing
33
What is the treatment for Haemophilia?
Preventative drugs which stop bleeding
34
What does Von willebrand's disease affect?
- Important in primary and secondary haemostasis
35
How does vwb affect primary haemostasis?
Binds platelets Binds exposed endothelium Forms adhesive bridge between vascular endothelium & platelets Forms platelet plug
36
How does VWD affect secondary haemostasis?
As it is a carrier for FVIII in the blood (otherwise FVIII would be rapidly degraded in the circulation)
37
What different types of vWB disease are there?
Quantitive (low levels) Qualitative (abnormal function)
38
What can happen to APTT in VWB?
APTT can be prolonged in some forms of more severe VWB due to the resulting low FVIII levels
39
What are symptoms of VWD?
Spectrum of severity Often mucosal bleeding
40
What is DIC?
Disseminated intravascular coagulopathy
41
What happens in DIC?
-Dysregulation of normal process of haemostasis -Balance of clotting versus bleeding (fibrinolytic) tendency - Generation and deposition of fibrin
42
What are the 2 stages of DIC?
Overactive clotting followed by bleeding - Initially prothrombotic, as things continue the clotting factors & platelets get used up leading to bleeding symptoms
43
How do you treat DIC?
Identify underlying cause: - Severe sepsis - Malignancies - Obstetric complications - Trauma - Severe burns - Liver failure - Pancreatitis - CAPS - heat stroke/ hyperthermia Blood product support as required

IMS- Strand 4 (4 decks)

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