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64 Cards in this Set
- Front
- Back
What are promoters of the coagulation cascade?
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Tissue factor (extrinsic)
Intrinsic pathway Fibrinogen, Factor XIII,Fibrinolysis |
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Which clotting factor is unique to PT?
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Factor VII
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What factors are unique to PTT?
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In the context of bleeding:
XI IX VIII Other: XII |
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What factors are in the overlap between PT and PTT?
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Thrombin
X V |
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What are the inhibitors of tissue factor?
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Tissue factor inhibitor
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What are the inhibitors for the intrinsic pathway?
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Protein S
Protein C |
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What is the activity of Protein S, C?
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Cleaving factor V, VIII
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What is antithrombin?
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Degrades thrombin
Degrades X |
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What is the activator of antithrombin?
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Endogenous Hepaprans
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What are endogenous heparans? What do they activate?
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Proteins that inhibit clotting
Antithrombin |
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What are the two forms of protein S? How do they work? What implications does this have
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Bound: bound to C4b
Free: able to complex with C In serious infections, C4b BP is upregulated. As a result, you get less activation of the protein C/S, which leads to less degradation of V and VIII. As a result, people with infections are prone to clot. |
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What happens when fibrinogen is cleaved?
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1. Loses solubility
2. Monomers come together 3. Formation of large thrombin complex |
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What is the activity of factor 13?
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Cross linking of thrombin chains
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What is the site of TPA release?
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Endothelium around the site of damage
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What is the activation of TPA?
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Activates tissue plasminogen, which cleaves the fibrin
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Where is tissue plasminogen released?
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From the liver
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What are causes of increased PT and aPTT?
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Medical conditions:
-Anticoagulation -DIC -Vitamin K deficiency -Liver disease -Massive tranfusion Dysfibrinogenemias Acquired inhibitors to factors V, II, and X |
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What processes are dysregulated in DIC?
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Thrombin acting: procoagulation
Plasmin acting: fibrinolysis |
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What is the presentation of someone with DIC?
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Accute hemorrhagic disorder
Indolent, subacute thrombotic disorder (presenting with bleeding) |
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What are serious consequences of DIC?
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-Multiorgan failure due to multiple ischemic events
-Thrombocytopenia` |
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What are causes of acute DIC?
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INFECTION
Obstetric Malignancy Trauma Other |
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What are some infectious causes of DIC?
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Gram negative sepsis
Viremia Parasites |
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What are some obstetric causes of DIC?
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Abruption (placenta separates from endometrial wall)
Amniotic fluid embolism (fluid gets into body) Eclampsia (HTN in pregnancy) |
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What are some malignant causes of DIC?
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Acute promyeocytic leukemia
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What are some traumatic causes of DIC?
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Crush injury
Freshwater drowning Heat stroke Snakebites |
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What are some other causes of DIC?
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Homozygous protein C and S deficiency
Severe liver disease HIT (heparin induced thrombocytopenia) |
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What are some broad causes of subacute DIC?
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Malignancy
Obstetric Vascular |
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What are some malignant causes of subacute DIC?
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Mucinous adenocarcinoma/Trousseau syndrome
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What are some obstetric causes of subacute DIC?
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Retained dead fetus
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What are some vascular causes of subacute DIC?
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Hemangioendothelioma
Venous thromboembolic disease Chronic renal failure |
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How do you go about diagnosing DIC?
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Screening:
aPTT: prolonged PT: prolonged Fibrinogen: decreased Platelet count: decreased Confirmatory: D-dimer: elevated Fibrin degradation products: elevated |
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What is your "cash money" test for DIC?
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D-dimer
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What conditions should you order up a D-dimer for?
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DIC
DVT PE (high NPV, low PPV) |
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What's the treatment for DIC?
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Get the underlying condition!!!
Replace different components Heparin |
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What's the therapy for APML? How does this work?
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All trans retinoic acid
It induces the cells to differentiate to a further stage, causing them to not cause DIC |
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IN what DIC scenarios should you use heparin?
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Acute cyanosis
Digital ischemia Purpura fulminans Retained dead fetus Migratory thrombophlebitis |
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What does a smear of microangiopathic hemolytic anemia look like?
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Shistocytes (RBC fragmentations)
Small RBCs (microcytes) NO PLATELETS! |
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What type of hemolysis happens in the microangiopathic hemolytic anemias?
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Intravascular hemolysis
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Where are the red cells disposed of in the microangiopathic hemolytic anemias?
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The spleen/reticuloendothelial system
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What are some potential causes of microangiopathic hemolytic anemias?
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DIC
Thrombotic thrombocytopenic purpura Hemolytic uremic syndrome Malignant hypertension Aortic stenosis HELLP syndrome Heparin-induced thrombocytopenia Severe glomerulonephritis |
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What are the classic symptoms of thrombotic thrombocytopenic purpura?
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Microangiopathic hemolytic anemia
Thrombocytopenia Renal involvement Neurologic signs Fever |
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What is the cause of thrombotic thrombocytopenic purpura?
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Acquired autoantibodies that inhibit ADAMTS13
You can get giant vWF complexes |
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What is the function of ADAMTS13?
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Metalloprotease that cleaves vWF
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What is the name for congenital thrombotic thrombocytopenic purpura?
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Upshaw-Schulman syndrome
DEFICIENCY of ADAMTS13 |
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What's the treatment for thrombotic thrombocytopenic purpura?
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Plasma exchange
Immunosuppression |
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What are the findings in DIC vs. TTP?
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|
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What are the procoagulents that have a vitamin K tacked on?
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II
VII IX X |
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What are the anticoagulents that have a vitamin K tacked on?
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Protein C/S
|
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What reaction is assisted by vitamin K?
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Gamma carboxylation: glutamic acid-->gamma carboxyglutamidc acid
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What enzymes regenerate vitamin K?
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Quinone reductase
Epoxide reductase |
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What enzyme is the target of warfarin?
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Epoxide reductase
|
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What are some causes of vitamin K resorption deficiency?
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Nutritional deplertion
Antibiotic Warfarin |
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What labs are off if there is liver disease?
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Factor VIII elevated
Factor V decreased Late in the game, fibrinogen falls |
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What parts of the coagulation cascade are synthesized by the lungs?
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Factor VIII
vWF |
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How do you differentiate between liver disease and vitamin K deficiency?
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Factor V
IN liver disease, it, along with the other clotting factors from the liver are low IN K deficiency, levels of V stay high, as it's not dependent on vitamin K |
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What is the definition of a massive transfusion?
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Adults: 4 units RBC in < 4 hrs, ongoing uncontrolled bleeding
Child: 1/2 blood volume in <4 hours and ongoing, uncontrolled bleeding |
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What are the complications secondary to a massive transfusion?
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Coagulopathy:
-Drops in levels of clotting factors -Citrate binds calcium-->lack of clotting |
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What are some of the super rare acquired coagulation protein defects?
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Dysfibrinogenemia
Inhibitors to X, V, II and fibrinogen Hypergammaglobulinemia Systemic amyloidosis Heparinoids Factitious |
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What are some causes of hypergammaglobulinemia?
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Multiple myeloma (IgG)
Waldenstrom macroglobulinemia (IgM) |
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What are the findings in systemic amyloidosis related to clotting?
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Decreased factor X/IX
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What are heparinoids?
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Heparin-like anticoagulents produced in patients with an underlying malignancy
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What acquired disorder is associated with ONLY a prolonged aPTT?
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Inhibitors to factor VIII
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What are the symptoms of someone having inhibitors to factor VIII?
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Prolonged aPTT, normal PT
Skin ecchymoses, tissue hematomas |
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What's the treatment for having inhibitors to factor VIII?
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IMmunosuppression
Treat the bleeding |