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112 Cards in this Set
- Front
- Back
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The best test for platelet function?
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Bleeding time
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Where is FactorVIII is synthesized?
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Endothelium
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What is the most effective way to acutely correct INR?
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FFP
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Antiphospholipid antibody syndrome classically presents with...
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elevated PTT not correctable with FFP (hypercoaguable w/ elevated PTT)
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Who is at greater risk for Wafarin induced skin necrosis? How is it prevented?
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Pts with Protein C deficiency
starting heparin before giving Coumadin |
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what is the intrinsic pathway activated by?
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Exposed collagen, pre-kallikrein, HMW kiniogen, and clotting factor XII
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what is the extrinsic pathway activated by?
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Tissue factor and clotting factor VII
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which clotting factor is the convergence point of both extrinsic and intrinsic pathways?
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Clotting factor X
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which clotting factor has the shortest half-life?
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Clotting factor VII
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which clotting factor is not made in the liver?
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Clotting factor VIII, made in the endothelium
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which clotting factor crosses the placenta?
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Clotting factor VIII (8)
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activity of which clotting factor is lost in stored blood?
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Clotting factors five and eight
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what are the vitamin K dependent factors?
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Clotting factors 2,7,9,10 and proteins C and S
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which clotting factor helps cross-link fibrin?
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Clotting factor XIII (13)
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what does protein C do?
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degrades clotting factor V, 13, and fibrinogen
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where is tissue plasminogen activator made?
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Endothelium
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what is the half-life of red blood cells?
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120 days
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what is the half-life of platelets?
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Seven days
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what is the half-life of PMNs?
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1 to 2 days
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where is prostaglandin made and what does it do?
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From the endothelium, and it decreases platelet aggregation and promotes vasodilation
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where is Thromboxane made and what does it do?
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From platelets, and it promotes platelet aggregation and vasoconstriction
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which blood product has the highest concentration of clotting factor VIII and von Willebrand factor?
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cryoprecipitate
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which blood product has the highest concentration of fibrinogen?
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Cryoprecipitate
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what is the treatment of symptomatic hypo-fibrinogen anemia?
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Cryoprecipitate
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which product stimulates release of clotting factor VIII and von Willebrand factor from the endothelium?
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DDAVP and estrogens
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what is the best test for liver synthetic function?
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PT/INR
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what is the treatment for a first-time DVT? Second time? Third time?
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Coumadin for six months, for one year, and for lifetime, respectively
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what is the most common cause of surgical bleeding?
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Incomplete hemostasis
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what is the most common congenital bleeding disorder?
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Von Willebrand disease
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what does von Willebrand factor do?
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Helps link platelets to collagen (via the platelets GPIb receptor)
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what disease is characterized by platelet GPIb receptor deficiency?
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Bernard-Soulier
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what is the only autosomal dominant bleeding disorder?
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Von Willebrand disease types one and two
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what is the only autosomal dominant hypercoagulable disorder?
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Anti-thrombin III deficiency
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how many types of von Willebrand disease are there?
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three
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what is the specific defect in von Willebrand disease type I and three?
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Type I is characterized by decreased quantities of vWF, whereas type III is characterized by absent vWF
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what is the specific defect in von Willebrand disease type II?
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Type II is characterized by dysfunctional vWF
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DDAVP is not helpful in which type of von Willebrand disease?
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Type II, DDAVP stimulates vWF release from the endothelium, but if the vWF is dysfunctional there is no benefit
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which type of von Willebrand disease is the only autosomal recessive type?
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Type 3
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what is the method of inheritance of hemophilia a and B?
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X linked recessive
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what is deficient in hemophilia A? Hemophilia B?
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Clotting factor VIII in hemophilia a, and clotting factor IX in hemophilia B
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what is the treatment of a hemophiliac joint?
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Ice, range of motion exercises, possibly cryoprecipitate. Do not aspirate
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what receptor do platelets used to bind to each other?
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GPIIb/IIIa, via fibrin
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what disease is characterized by platelet GPIIa/IIIb deficiency?
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Glanzmann's thrombocytopenia
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how does uremia cause platelet disorders?
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Uremia inhibits platelet GPIb and GP IIa/IIIb receptors, as well as von Willebrand factor
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what is the mechanism of action of Plavix (clopidogrel)?
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Platelet ADP receptor antagonist
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what is the pathophysiology of heparin induced thrombocytopenia (HIT)?
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IgG platelet factor 4 antibody
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why is HIT sometimes also referred to as HITT?
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The extra T refers to thrombosis, as H I T can cause platelet aggregation and thrombosis forming white clots
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what is the treatment for HIT?
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stop heparin as well as low molecular weight heparin and anticoagulate with Argatroban or Hirudin
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what is the most common cause of DIC?
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Sepsis
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what is the most common cause of DIC intra-operatively?
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Blood product transfusion
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what is the treatment of DIC?
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Treat the underlying cause
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how does prostate surgery cause abnormal bleeding?
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Prostate or ureteral surgeries cause abnormal bleeding by causing the release of urokinase which activates plasminogen to plasmin
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what drug inhibits plasminogen activation to plasmin?
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Aprotinin
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what drug inhibits plasmin?
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Aminocaproic acid
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what is the best way of predicting a patient's bleeding risk?
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Thorough history and physical
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what is the most common congenital hypercoagulable disorder?
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factor V Leiden
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how does factor V Leiden cause a hypercoagulable state?
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In factor V leiden, there is a genetic mutation whereby clotting factor V becomes resistant to inhibition by protein C
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what is the treatment for hyperhomocysteinemia?
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Folic acid and B12, in order to drive the methionine synthase reaction towards methionine
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how does prothrombin gene defect cause a hypercoagulable state?
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In prothrombin gene defect, a genetic mutation at position 20210A causes an increased amount of thrombin to circulate in the blood, thereby resulting in a thrombophilic state
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what is the method of inheritance of anti-thrombin three deficiency?
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Autosomal dominant
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which type of blood product contains anti-thrombin three?
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FFP
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which antibody is responsible for lupus anticoagulant?
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Antiphospholipid antibody
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is lupus anticoagulant necessarily associated with SLE?
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no, not every patient with lupus anticoagulant has SLE
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what happens to the PTT in lupus anticoagulant?
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Despite causing a thrombogenic state, lupus anticoagulant causes a paradoxical increase in PTT. Elevated PTT not corrected with FFP is indicative of lupus anticoagulant!
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What is the pathophysiologic etiology of venous thrombosis?
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Virchow''s triad: stasis, hypercoagulability, and endothelial injury
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what is the pathophysiologic etiology of arterial thrombosis?
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Endothelial injury
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what is the mechanism of action of warfarin?
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Inhibits the vitamin K dependent carboxylation of glutamic acid residues
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what is the half-life of heparin?
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60 to 90 min.
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what can long-term heparin cause?
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osteoporosis and alopecia
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does heparin cross the placenta?
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No, Coumadin does
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how is heparin reversed?
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Protamine
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what is the most common reaction to protamine?
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Hypotension, occurs in approximately 5% of all patients who received protamine
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what is the mechanism of action of Argatroban?
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reversible direct thrombin inhibitor
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what is the mechanism of action of Hirudin?
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irreversible direct thrombin inhibitor
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what is the mechanism of action of Ancrod?
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Stimulates tissue plasminogen activator tPA release
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what are the three absolute contraindications to thrombolytic use?
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Active internal bleeding, recent CVA less than two months, and intracranial pathology
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what are the only two blood products that don't carry any risk of HIV or hepatitis?
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albumin and serum globulins
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for whom is CMV negative blood reserve for?
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low birth weight infants and transplant patients
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what is the most common bacterial contaminant in blood products?
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E. coli
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what is the most common blood type to be contaminated?
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Platelets
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does stored blood have high or low affinity for 02?
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stored blood is low in 2,3 – DPG and therefore has a high affinity for 02
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what is the cause of acute hemolysis with transfusions?
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antibody mediated
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how does acute hemolysis present clinically?
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Back pain, chills, tachycardia, fever, hemoglobinuria. It can lead to ATN, DIC, and shock.
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What is the treatment for acute hemolysis?
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IV fluids, diuretics, bicarbonate, histamine blockers, and vasopressors if patient is in shock
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what is the cause of delayed hemolysis with transfusions?
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also antibody mediated
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what is the treatment for delayed hemolysis?
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observation if the patient is stable
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what is the most common type of transfusion reaction?
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Febrile non-hemolytic reaction
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what is the cause of febrile non-hemolytic transfusion reaction?
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Recipient antibodies against donor leukocytes
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what is the cause of transfusion related acute lung injury (TRALI)?
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similar to febrile nonhuman lytic transfusion reaction, TRALI is caused by recipient antibodies against donor leukocytes but here, instead of simply getting a febrile reaction clots develop in pulmonary capillaries
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what is the most common cause of anaphylaxis with transfusions?
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Recipient IgG antibodies against donor IgA's, in an IgA deficient recipient
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what is the most common cause of hypocoagulability after massive transfusion?
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Dilutional hypocalcemia (since calcium is required in the clotting cascade)
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what is the most common type of von Willebrand disease?
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Type 1
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what is the best treatment for hemophilia A?
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recombinant factor VIII, DDAVP only works for mild forms
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what is the key dysfunctional element in uremic coagulopathy?treatment?
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down regulation of von Willebrand factor, dialysis is the treatment of choice
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What is the most common source of a PE?
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ilio femoral DVT, left leg
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what is the best treatment for from thrombolytic overdose?
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aminocaproic acid which binds plasminogen and prevents conversion to plasmin and prevents it from degrading fibrin
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what level of fibrinogen is associated with increased risk and severity of bleeding?
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Fibrinogen levels less than 100
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what is low molecular weight heparin (Lovenox) mechanism of action? unfractionated heparin?
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binds AT-III and inhibits factor Xa only, unfractionated heparin binds AT-III and inhibits factors IIa and Xa
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where is prostacyclin synthesized?
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Endothelium
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how does thromboxane calls platelet aggregation?
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By increasing the calcium in platelets which causes exposure of the Gp IIb/IIIa receptor and platelet binding
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what is the treatment of choice for HIT?
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Direct thrombin inhibitors such as argatroban
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what is the most common acquired hypercoagulable disorder?
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smoking
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where is the most common DVT location?
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The calf
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elective surgery recommendations on Plavix? With bare metal stent? With drug eluding stent?semi urgent?
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bare metal stents – Plavix for six weeks before elective surgery, drug eluting stents – Plavix for one year before elective surgery, semi urgent surgery- stop Plavix 5 to 7 days preop bridge with short acting IIa/IIIb inhibitors
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transfusion related acute lung injury is caused by?
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Donor antibodies which bind white blood cells and lodge in the lung
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how can you raise hemoglobin without giving blood? For example Jehovah's Witness before surgery
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Epoetin and iron supplementation should raise hemoglobin 1 to 2 g/dL per week, hematocrit 3 to 5 points per week
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platelet transfusion indications?
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Less than 10,000 – high risk of spontaneous bleeding,
less than 20,000 with infection or bleeding risk, less than 50,000 with active bleeding or preprocedure |
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what is in FFP?
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all coagulation factors including proteins C &S and AT-III
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what is in cryoprecipitate?
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It has the highest levels of factor VIII, von Willebrand factor, and fibrinogen
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what screening is needed in a male or postmenopausal female with iron deficiency anemia?
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screen for colon cancer or another G.I. source
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most common transfusion reactions? Number one and number two?
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Febrile nonhemolytic transfusion reaction ( one in 100), allergic reaction ( one in 150)
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most common cause of death from transfusion reaction?
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Clerical error resulting in ABO incompatibility
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