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33 Cards in this Set

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  • Back
Pathway associated with tissue injury and release of thromboplastin
Extrinsic
Pathway associated with vascular injury and release of collagen
Intrinsic
Plt's are activated by ___
Exposure to collagen secondary to bv injury
How long does vascular spasm tend to be maintained
20-30 minutes until Plt's can respond
Which system is fast
-Exstrinsic or intrinsic
Extrinsic
Most powerful enzyme in clotting cascade
Trombin which converts fibrinogen to firbin
Essential component of clot
Fibrin
Enzyme required to breakdown clot
Plasminogen which converts to plasmin that is then able to dissolve fibrin clot (which will then produce FDP's/FSP's
increased consumption of Plt's
-ITP, TTP, DIC
TTP and DIC
More rapid destruction of Plt's
-ITP, TTP, DIC
ITP via antibodies
Dx in which Plt membrane is coated with autoantibody (IgG) and sensitized Plt are destroyed by RES in spleen/liver.
ITP
Main clinical feature of ITP
Bleeding (may be gradual or abrupt)
Initial therpay for ITP
Steroids/prednisone
Block binding receptors of macrophages
Usually enough to induce remission (some still ahve long term probs)
Prednisone works short term for ITP pt but is not controlling long term.
What next?
Spleenectomy possibly.
ITP pt at high risk for bleeding may require what tx
IVIG
Plt transfusion not used prohylactically but may be indic in acute bleed
When would plasmapharesis be indic in ITP pt
Refractory to all interventions
-Prednisone
-Spleenectomy
-IVIG
Plt's b/c snesitized and clump in blood producing occlusions
TTP
Caused by defieciency of von Willebrand cleaving protease
TTP
How is thrombocytopenia induced in ITP
RES/macrophages secondary to immune mediation
How is thrombocytopenia induced in TTP
Increased consumption of Plt's
lab finding that is hallmark of TTP
Shistocytes
Why is simple plasma transfucion potentially adequate in TTP
Based on knowledge that pt's are deficient of von Willebrand protease
TOC in acutely ill TTP pt
Plasmapharesis ASAP
Prednisone (prevents further damage to endothelium)
Why is a Plt transfusion C/I in TTP
It's a Dx of thrombosis thus Plt's will only exacerbate the problem
Dx of bleeding
-ITP or TTP
ITP
Dx of thrombosis
-ITP or TTP
TTP
Plasmapharesis (but not Plt transfusion) indic in
Acute TTP pt
FFP may be inidic otherwise
ITP=postentially Plt transfusion in life thrreatening bleed along with IVIG
Why is PTT time longer the PT
It measure the intrinsic pathway which is slower in clot formation
Lab test that measures local fibrinolysis
D-Dimer
Normal lab value or FDP
<10
Procoagulants
Thromboplastin/Prothrombin/Thrombin
Fibrinogen/Fibrin
Anticoagulants
Plasminogen/Plasmin
Describe two (2) common complications associated with plasmapheresis.
Hypotension
Citrate tox