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Advanced Haematology > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What are the 3 component of the haemostatic system that help prevent blood loss?

A

Blood vessels, platelets, Plasma Proteins :blood clotting

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2
Q

What is considered Primary haemostasis?

A

Blood vessels & Platelets

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3
Q

What is considered Secondary haemostasis?

A

Platelets & Plasma Proteins

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4
Q

What does haemostasis mean?

A

the process to prevent and stop bleeding

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5
Q

What are the 3 functions of platelets?

A

Adhesion (reversible), Aggregation (irreversible), Secretion (irreversible)

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6
Q

Which factor is activated by both intrinsic and extrinsic pathways?

A

X marks the spot

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7
Q

Which factor acts as a co-factor with FX?

A

Factor V (V fits into X)

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8
Q

Which factors are in the common pathway?

A

FII and FI

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9
Q

Which factor(s) are in the extrinsic pathway?

A

FVII

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10
Q

Which factor(s) are in the intrinsic pathway?

A

FXII, XI, IX, VIII (TENET)

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11
Q

Which factor crosslinks fibrin?

A

FXIII

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12
Q

Intrinsic pathway is measured by what test

A

APTT

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13
Q

Extrinsic pathways is measured by what test

A

PT

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14
Q

What does APTT and PT stand for?

A

APTT - Activated partial thromboplastin time.

PT - Prothrombin Time

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15
Q

It is called an intrinsic pathway because …

A

FXII is found IN blood

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16
Q

It is called an extrinsic pathway because……

A

Tissue factor is not found in blood

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17
Q

What is normally contained in a clot-base pro-coagulant screen? (5)

A

PT, APTT, thrombin clotting time (TCT), Fibrinogen Assay (FIB), platelet count

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18
Q

Which test monitors for warfarin and which one for heparin?

A

Warfarin - PT

Heparin - APTT

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19
Q

The PT test is most sensitive to levels of what factor?

A

FVII

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20
Q

What is International Normalised Ratio (INR)?

A

a calculation based on results of a PT. Used to monitor warfarin.

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21
Q

In the APTT test a Reagent contains ________ that

activates Factor _______ which then Initiates an _______ cascade

A

phospholipid, FXII, intrinsic

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22
Q

A PT test consists of what 3 things?

A

PPP + PT reagent + Ca++

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23
Q

Which factor gets activated in a PT test?

A

FVII

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24
Q

An APTT test is prolonged with <30% normal activity of what 3 factors?

A
  • FVIII
  • FIX
  • FXI
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25
Q

In a TCT test Bovine thrombin reagent cleaves

________ to form ______ polymer

A

fibrinogen, fibrin

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26
Q

A prolonged TCT test occurs in the presence of what 3 things?

A
  • Low fibrinogen
  • Heparin
  • FDPs
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27
Q

What are the 3 principal regulators of the coagulation regulatory system?

A

i. Tissue factor pathway inhibitor (TFPI)
ii. Protein C pathway
iii. Antithrombin (AT)

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28
Q

TFPI only functional if which factor is activated

A

X

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29
Q

Protein C pathway is _____ dependent anticoagulant proenzyme

A

vitamin K

30
Q

What activates protein C?

A

thrombomodulin

31
Q

APC acts as an anticoagulant by proteolytically inactivating which factors?

A

FVa & FVIIIa

32
Q

APC acts as an anticoagulant and is enhanced by

A

Protein S

33
Q

Protein S is a glycoprotein dependent on which vitamin?

A

Vit K

34
Q

Protein C pathway is a natural __________

A

Anticoagulant

35
Q

Which protein deficiencies result in risk of recurrent DVT and risk of pulm embolism

A

Protein C & S

36
Q

AT is a serine protease inhibitor (serpin)

→binds an neutralises all serine proteases except ________

A

FVIIa

37
Q

Heparin cofactor II → serpin that inactivates ________primarily

A

thrombin

38
Q

AT & Heparin cofactor II both require ______ for effective anticoag activity In vivo heparin from EC

A

heparin

39
Q

Therapeutic heparin: ↑ ability of AT to neutralise serine proteases by _______ fold

A

1000

40
Q

What are the 6 different ways to classify bleeding symptoms?

A

Localised (single site) vs Generalised (multiple sites)
Mucocutaneous (systemic) vs Anatomic (soft tissue)
Acquired vs Congenital

41
Q

List examples of mucocutaneous (systemic) bleeding.

A 
Thrombocytopaenia
Qualitative platelet disorder
Von Willebrand disease
Vascular disorder
Eg: purpura, petechiae, eccymoses
42
Q

List examples of Anatomic (soft tissue) bleeding

A

Excessive bleeding after : minor trauma, dental extraction, surgery, bleeding into muscles, joints etc.

43
Q

Draw the trauma triad of death.

A

slide 24 week 5
What are the key elements of the “triad of death” in acute
coagulopathy of trauma?

44
Q

Liver disease predominantly affects which dependent factors

A

Vit K dependent factors

45
Q

What are the vitamin K dependent coag factors? and what are the anticoag factors?

A

II, VII, IX, X (TV stations)

C,S,Z

46
Q

List some situations where Vit K deficiency may be seen.

A

Fad diets
Biliary duct obstruction
Newborn (minimal vit K in milk)

47
Q

Which anti coagulant is a vit k antagonist?

A

warfarin, ratsack

48
Q

Which test would you use to monitor warfarin?

A

PT

49
Q

What are 3 things you could use to reverse warfarin therapy if needed?

A

Vitamin K
Fresh frozen plasma
Prothombinex

50
Q

List 3 congenital coagulopathies

A

Von Wilebrand Disease
Haemophilia A
Haemophilia B

51
Q

Von willebrand Disease is a carrier molecule for which factor?

A

FVIII

52
Q

What is the name of the VWF cleaving protease?

A

ADAMTS-13

53
Q

When the endothelium is damaged what does the produced VWF bind to?

A

collegen

54
Q

What is the most common mucocutaneous bleeding disorder

A

Von Willebrand Disease

55
Q

Besides FBC

PT & PTT what other tests would be conducted for VW Disease? (besides specialised tests)

A

PTT mixing tests

Fibrinogen or Thrombin Time (TT)

56
Q

What are 4 specialised tests for Von Willebrand Disease

A 
Quantitative 
Immunoassay (Ag –Ab based)
VWF:RCo ristocetin cofactor activity
Ability to bind to platelets - functional
Also called Ristocetin Cofactor Assay
FVIII activity assay
VWF multimer analysis
Gel electropheresi
57
Q

Is Haemophilia a X-linked or Y-linked recessive pattern?

A

X-linked - females are normally just carriers

58
Q

Haemophilia A is a deficiency in which factor?

A

FVIII

59
Q

FVIII deficiency slows the production of __________ which leads to __________

A

thrombin, haemorrhage

60
Q

Is Haemophilia usually a quantitative or qualitative disorder?

A

quantitative but can sometimes be qualitative

61
Q

The severity of haemophilia A correlates with level of what activity

A

F VIII activity

62
Q

List the lab findings for Haemophilia A:

FBC, APTT, FVIII & IX, PT, vWF

A 
FBC - Normal
APTT - prolonged
FIII & IX - low or absent
PT- Normal
vWF - Normal
63
Q

How do we treat Haemophilia A

A

Clotting factor therapy

64
Q

What is the most common acquired form of haemophilia? (acq. coagulopathy 2nd to disease)

A

Autoantibodies to FVIII

65
Q

What test can you do to differentiate inhibitor from deficiency?

A

Mixing studies

66
Q

In mixing studies if you combine patient plasma+normal plasma and it corrects the prolonged APTT what does that mean?

A

There was a FVIII deficiency

67
Q

In mixing studies if you combine patient plasma+normal plasma and the APTT remains prolonged what does that mean?

A

Inhibitor (e.g. autoAb)

68
Q

Haemophilia B is a deficiency in which Factor?

A

FIX deficiency

69
Q

How do you test single factor assays?

A

Use the plasma deficient in specific factors and combine with the patients. If it is still prolonged then that is the deficient factor, If it is corrected it is not the factor.

70
Q

What specimen do we use for coagulation assays?

A

3.2% sodium citrate

71
Q

Do you centrifuge for PPP or PRP?

A

PPP - used in factor assays

72
Q

List 4 steps usually visible on a platelet aggregometry trace.

A
  1. Baseline
  2. Agonist added
  3. Primary wave of aggregation
  4. Secondary wave of aggreation

Advanced Haematology (13 decks)

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