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24 Cards in this Set

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What is DIC?
It is a disease of small thromboses everywhere in the body that does not cause a symptom per se, but because of the consumption of normal clotting components, a deficiency develops and the patient starts bleeding from various sites.
What symptom in the hands would make you think DIC?
Dark fingernails.
What two things could make DIC worse?
DIC is worsened by acidosis and massive transfusion (when the patient requires the approximate same volume of blood his/her blood in blood transfusions in a 24 hour period).
What is the main cause of DIC?
A. Some of the most common causes of DIC are related to the release of tissue factor or tissue factor-like substance (i.e., thromboplastic substances) in circulation.
What does tissue factor bind to?
Factor VIIa
What type of leukemia causes DIC?
APL
What does the initiation phase consist of?
Tissue Factor combining with Factor VII leading to the activation of Factor X.
What does the propagation phase consist of?
Factors VIII and IX activating Factor X to help activate thrombin to form a clot and to activate Protein C.
How does gram (-) bacteria cause DIC?
LPS causes increased expression of Tissue Factor on the surface of the cells via TNF and IL-1 along with decreased expression of Thrombomodulin.
When do you confirm DIC from laboratory tests?
1. High D-Dimers
2. Low Platelet count
3. Fragmented RBC (schistocytes)
4. Decreased Fibrinogen
5. Prolonged PT and PTT
6. Decreased levels of antithrombin, protein C, and protein S
Does fibrinogen have to be decreased to diagnose DIC?
No
What is a D-Dimer? What creates it?
1. Small part of a clot that is cleaved off curing clotting. Elevated D-Dimers mean elevated clotting.

2. Plasmin
What others things does plasmin do?
1. Makes D-Dimers
2. Cleaves Factors V, VII, IX, and high molecular weight kininogen
3. Activates platelets
What D-Dimer level is indicative of DIC?
D-dimer level is much increased, >10,000ng/ml (normal range: 110-240ng/ml).
In a DIC patient, what is their level of RDW like?
It is elevated
Prothrombin test mimics what? What is the reactant in the tube?
The initiation phase of clotting. Basically adding Tissue Factor to see how long it takes to start clotting?

Sodium Citrate
PT is really testing for activity in what factors?
It is testing to see how factor VII is activating II, V, X, XI.
PT is reliant on what factor the most?
Factor VII
PTT measures what phase? What factors are not involved in this?
Propagation (Intrinsic) phase

Factors VII
What factor is involved with hemophilia A?
Factor VIII
What factor is involved with hemophilia B?
Factor IX
What factor is involved with hemophilia C?
Factor XI
Protein C and S are both dependent on what Vitamin?
K
Anithrombin inactivates what factors?
Antithrombin inactivates factors XIIa, XIa, Xa, IXa, IIa.