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Flashcards in Thrombotic Disorders (complete) Deck (21):
1

What are the components of Virchow's triad?

1) Venous stasis
2) Altered vessels
3) Altered coagulability

2

How does venous stasis contribute to thrombosis?

- Viscosity is higher
- Tendency for clotting to take place is higher
- aka decreased blood flow

3

How does altered vessels contribute to thrombosis?

- Includes inflammation damage, mechanical injury, hypoxia
- Any of these can cause/create a clot

4

How does altered coagulability contribute to thrombosis?

- Can be genetic causes or acquired disorders
- alterations in nature of the blood itself

5

What are 3 major clinical symptoms that occur when a pt suffers from an acute iliofemoral thrombosis of the leg?

Aka: Phlegmasia cerulean dolens (extremely swollen, blue, painful leg)

1) Pain
2) Pitting edema
3) Warm, dusky, reddish-blue discoloration of the skin

6

Describe pain in acute iliofemoral thrombosis of the leg. What is the pathophysiological reason?

Pain is pain

- Due to complete obstruction of venous outflow from extremity

7

Describe pitting edema in acute iliofemoral thrombosis of the leg. What is the pathophysiological reason?

Pitting = when you press on it, it doesn't immediately restore itself to normal

- Due to complete obstruction of venous outflow from extremity
- Fluid can't be resorbed back into the circulation

8

Describe the warm, dusky, reddish-blue discoloration of the skin in acute iliofemoral thrombosis of the leg. What is the pathophysiological reason?

Can be subtle --- requires good light, must ask pt to stand for a few minutes to appreciate this

- Caused by enhanced superficial venous blood flow
- Due to complete obstruction of venous outflow from extremity

9

What is the cause and mechanism of a thrombus occurring in the arterial circulation?

Cause: high shear stress

10

What are the instigating factors and composition of the clot in arterial thrombosis?

Contributors:
- HTN, turbulent blood flow, atherosclerosis
- Abnormal vessels (e.g. cell injury, aneurysm)

Composition:
Aggregated platelets, small amounts of fibrin/RBCs (white thrombi)

11

What is the cause and mechanism of a thrombus occurring in the deep vein of the leg?

Cause: low shear stress, sedentariness

12

What are the instigating factors and composition of the clot in the deep vein of the leg?

Contributors:
- Stasis, right-side heart failure, OCs, trauma, increased age, malignancy (there's a lot, go look at notes)

Composition:
- Lots of fibrin and RBCs (red thrombi)

13

What are three clinical clues that suggest an inherited hypercoagulable disorder?

1) First thrombosis <50yo
2) Family history
3) Recurrent episodes of thrombosis
4) Thrombosis at unusual sites
5) Neonatal thrombosis
6) Thrombosis w/o apparent antecedent thrombogenic event

14

Briefly describe at the molecular level the pathophysiologic reason that patients with deficiencies of antithrombin is likely to have thrombosis. What tests are used to diagnose this?

- Antithrombin 3 regulates coagulation => inactivates thrombin and 10a, 9a, 11a, 12a
- AD mutation

Acquired w/ this:
- DIC
- Liver disease
- Tx w/ heparin

Tests:
- Antithrombin assay

15

Briefly describe at the molecular level the pathophysiologic reason that patients with deficiencies of protein C is likely to have thrombosis. What tests are used to diagnose this?

- A Vit-K dependent plasma protein
- when activated (APC) => inactivates 5a and 8a
- AD mutation

Tests:
- Protein C activity

16

Briefly describe at the molecular level the pathophysiologic reason that patients with deficiencies of protein S is likely to have thrombosis. What tests are used to diagnose this?

- A Vit-K dependent plasma protein
- Facilitates anticoagulant activity of APC
- AD mutation

Tests:
- Ag assays

17

Briefly describe at the molecular level the pathophysiologic reason that patients with factor V Leiden is likely to have thrombosis. What tests are used to diagnose this?

- B/c of AD mutation of factor 5 => partial resistance to protein C mechanism
- 5(leiden) inactivated 10x slowed than normal 5

Tests:
- Genetic tests (Factor 5 gene, PT 20210)
- Measure Factor 5

18

Briefly describe at the molecular level the pathophysiologic reason that patients with the prothrombin gene mutation is likely to have thrombosis. What tests are used to diagnose this?

Genetic polymorphism causes increased amount of prothrombin (Factor 2)

- Mild hypercoag state
- associated w/ VENOUS thrombosis
- Most people w/ this mutation DO NOT clot

19

What are three acquired disorders that are associated with recurrent venous or arterial thromboembolism?

1) Antiphospholipid AB syndrome
2) Myeloproliferative disorders
3) Malignancy

20

Describe the clinical features and criteria for diagnosis of antiphospholipid antibody syndrome.

- Thrombotic or obstetric complications caused by Abs
- Venous AND arterial thrombosis
- Any vascular bed, any age, both male and female
- Related to drug exposure, infections, acute illness

In vitro prolonged PTT

Thrombocytopenia, hemolytic anemia, livedo reticularis

21

What is the key factor in determining how long someone should be anticoagulated for a venous thrombosis? Describe it.

Is it:

- Transient
- Low/high risk
- Something more long term (cancer)
- More than one event