Unit 3 Coagulation

Question 1

Factors that require vitamin K:

Answer 1

Vitamin K activates clotting and fibrinolysis factors
factor II
factor VII
factor IX
factor X 
protein C 
protein S

Question 2

PT/INR

Answer 2

-measures extrinsic pathway

Question 3

aPTT

Answer 3

• take out tissue factor
• just have phospholipid
• measures intrinsic pathway

Question 4

Hemophilia A

Answer 4

• deficiency in factor 8
• inc aPTT
• muscle bleeding, bruising

Question 5

Hemophilia B

Answer 5

• deficiency in factor 9
• inc. aPTT
• muscle bleeding, bruising

Question 6

Factor 5 Leiden

Answer 6

• mutation in factor 5 that inhibits it from getting inactivated by protein C
• inc. clotting

Question 7

Von Willebrand Disease

Answer 7

-most common bleeding disorder
-VW factor stored in weibel pilate bodies
-treated with desmopressin (DDAVP) before procedures (only works type 1)
-Type 1- low amounts
-Type 2- nonfunctional
Type 3- not present at all

Question 8

Bernard-Soulier

Answer 8

-deficiency of GP1B

Question 9

Immune Thrombocytopenic Purpura (ITP)

Answer 9

• antibodies attack platelets
• acute and chronic
• tx: steroids, IVIG (overwhelms immune system), rituximab (lowers B cells), splenectomy

Question 10

Bleeding Time Test

Answer 10

-does not diagnose factor deficiencies

Question 11

Primary Hemostasis

Answer 11

• platelet plug formation
• measure with bleeding time or PFA100
• defects lead to mucocutaneous bleeding

Question 12

prothrombin G20210A

Answer 12

x

Question 13

Plasmin

Answer 13

The key enzyme responsible for clot digestion (fibrinolysis).
-plasminogen is incorporated into clots and is activated by tPA and uPA, and it becomes plasmin

Question 14

D-Dimer Test

Answer 14

x

Question 15

Glycoprotein 2b3a

Answer 15

x

Question 16

Heparin

Answer 16

• cofactor for antithrombin which greatly increases its ability to inactivate thrombin
• works in intrinsic pathway
• effects are immediate
• safe in pregnancy
• protamine reverses unfractionated heparin
• unfractionated heparin inactivates thormbin and factor 10 (IV)
• low molecular weight heparin also possible- inactivates factor 10 (injection)
• can be reversed with protamine sulfate (opposite charge of heparin) (hep is -)
• heparin induced thrombcytopenia- antibodies attack platelet factor 4-heparin complexes- tx in future with argatroban or leparudin

Question 17

Warfarin

Answer 17

• works on extrinsic pathway
• takes a while for effects to begin (4 or 5 days)
• teratodenic- do not use in pregnant people
• oral

Question 18

Desmopressin

Answer 18

• DDAVP
• stimulates VWF
• temporarily stop sx of VW disease

Question 19

Argatroban

Answer 19

-drug that would be given if heparin is not working

Question 20

mucocutaneous bleeding

Answer 20

-associated with platelets, VWF, and adherance

Question 21

Idiopathic Thrombocytopenic Purpura

Answer 21

-antibody mediated destruction of platelets

Question 22

TTP

Answer 22

ADAM

Question 23

lupus anticoagulant

Answer 23

• antibodies mess up aPTT making it appear long
• pt is actually at risk for clots
• do mixing tests to confirm

Question 24

citrate in blood tests

Answer 24

• chelates calcium

- add calcium when ready to run test

Question 25

intrinsic tenase complex

Answer 25

- factors 8, 9, 10 | - activates factor 10

Question 26

extrinsic tenase complex

Answer 26

- TF and factor 7 | - activates factor 10

Question 27

prothrombinase

Answer 27

-factor 5, factor 10, prothrombin (factor 2)

Question 28

factor 13

Answer 28

- covalently binds fibrins together in clot | - measuring of D-dimer is measurement of two fibrins between crosslink

Question 29

central enzyme in blood coagulation

Answer 29

-thrombin

Question 30

protein C

Answer 30

- protein S is cofactor - activated by thrombin thrombomodulin to APC - secondarily activated by vitamin K

Question 31

tissue factor pathway inhibitor

Answer 31

- binds to 10a and then can bind to factor 7 and TF | - inhibits extrinsic pathway

Question 32

plasminogen activation inhibitor 1 (PAI-1),

Answer 32

- inhibits fibrinolysis | - inhibits plasminogen activation by inibiting tPA and uPA

Question 33

alpha2-antiplasmin

Answer 33

- inhibits fibrinolysis | - inhibits plasmin directly

Question 34

thrombin-activatable fibrinolysis inhibitor (TAFI)

Answer 34

-activated by thrombo-thrombomodulin (which also activates protein C

Question 35

endothelial lining prevention of clots

Answer 35

- makes heparin - expressed thrombomodulin - makes tPA and uPA - vasodilates

Question 36

secondary hemostasis

Answer 36

-coagulation cascade arm of hemostasis

Question 37

3 Functions of Platelets

Answer 37

- adhere to endothelium and release granules - aggregate and form plug - provide phospholipid surface to support coag cascade

Question 38

lupus anticoagulant

Answer 38

- have high aPTT but pt presents with clot - antiphospholipid antibody - causes clotting - associated with lupus - inc. risk of arterial and venous clotting

Question 39

thrombin time (TT) test

Answer 39

- add thrombin to plasma | - if inc. it indicates problem with fibrinogen

Question 40

DIC

Answer 40

-associated with ebola and APML

Question 41

Mixing Studies

Answer 41

- mix pt plasma and normal plasma | - determines inhibitor vs. deficiency in clotting factors

Question 42

Test for Hypercoagulability

Answer 42

-factor assay

Question 43

Tissue Plasminogen Activator

Answer 43

- activates plasminogen to plasmin - fibrinolytic agent - use only in emergencies - give at high dose compared to amount in body

Question 44

Fibrinolytic Drugs

Answer 44

- break down fibrin - break clots that are already there - tissue plasminogen activator

Question 45

Anti Platelet Drugs

Answer 45

- aspirin- prevents formation of thromboxane - prevent clots from forming - GP2B3A inhibitors - ADP receptor blockers (plavix) - works in arterial clots best