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85 Cards in this Set
- Front
- Back
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what are the two natural inhibitors of coagulation?
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antithrombin, protein C
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mode of action for antithrombin:
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works against thrombin, part of the common pathway, so it will interfere withe factors 7, 11, 10, and 9, but it mostly targets thrombin
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what is the specific function of protein c?
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inactivates factor 5 and 8
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the PTT measures which pathway?
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intrinsic
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which test monitors heparin?
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PTT
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what is the mode of action of heparin
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to increase the activity of antithrombin
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which factors are vitamin k dependent
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2, 7, 9 and 10
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what is the mode of action of coumadin
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inhibits vitamin k dependent factors
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what is the mode of action of heparin
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increases the activity of antithrombin
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what is the panic value for INR, via PT?
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40 seconds
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what is the panic value for ptt?
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greater or equal to 140
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what do we use to inactivate heparin?
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protamine sulfate
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what is the alternative to unfractionated heparin?
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low molecular weight heparin
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what is the mode of action of low molecular weight heparin?
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it inactivates factor 10
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can you use the ptt to measure for low molecular weight heparin?
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no
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whatt assay do we use to measure for low molecular weightt heparin?
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anti factor 10a assay
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is plasminogen active and circulating in your blood?
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it is circulating but it is nott active
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how is plasminogen activatted?
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tissue plasminogen activator is released from the vessel wall
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when plasmin breaks down a clot you get
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d dimers and fdps
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activation of whatt factor causes covalent linking between d dimers?
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factor 13
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bleeding time measures _____ and reflects _____
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measures platelet function and reflects platelet count
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asprin will ____ the bleeding time
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prolong
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what is the gold standard for platelet function
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the aggretory study
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the aggretory study looks at the ____ of fibrinogen
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concentrattion
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what is the normal concentrattion for fibrinogen in healthy person?
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200-400 mg/dL
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thrombin time measures the function of ____ and reflects ______
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thrombin time measures thte function of fibrinogen and reflects the concentration
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what is the normal thrombin time?
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15-20 seconds
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the d dimer test is a
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latex agglutination test, with latex particles coated in d-dimers, the patients d-dimers agglutinate with the latex ones
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for the fdp test, what color tube is neccessary?
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a special blue top tube, not the sodium citrate. the special tutbe contains thrombin and soybean extract. once tthis is spun down, thte liquid portion is the serum
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thrombin time measures the function of ____ and reflects ______
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thrombin time measures thte function of fibrinogen and reflects the concentration
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what is the main principle of thrombin titme?you are skipping all factors and going straitt to tthe botttom of the cascde
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you are skipping all factors and going straitt to tthe botttom of the cascde
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what is the normal thrombin time?
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15-20 seconds
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the d dimer test is a
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latex agglutination test, with latex particles coated in d-dimers, the patients d-dimers agglutinate with the latex ones
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for the fdp test, what color tube is neccessary?
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a special blue top tube, not the sodium citrate. the special tutbe contains thrombin and soybean extract. once tthis is spun down, thte liquid portion is the serum
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in the navy tube, for tthe fdp test do we want the blood to have clotted?
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yes
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what is the purpose of soybean extract in the navy top?
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to prevent the clot from being broken down
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a decrease in platlett countts/thrombocyttes, best defined when someone has a platelet count below 50k/mm^3thr
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thrombocytopenia
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what could cause thrombocytopenia?
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bone marrow probleems where tthe megakaryocytes are nott developing properly, or distribution problems where more thrombocytets are in the spleen than norm, or a transfusion which could cause a dilution, or thte plateletts are being desttroyed
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what does ITP stand for?
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immune thrombocytopenic purpura
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and what does TTP stand for?
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thrombotic thrombocytopenic purpura
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what is the cause of ITP?
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itt is idiopathic i.e. unknown
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What is the problem with ITP?
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for some reason these individuals are destroying their own platelets, they are creating autoantibodies against their own platelets. The important thing to note is that it is the spleen that sees this these coated platelets and then kills them
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what is ITO
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autoantibodies against the platelets, and the spleen doesn't like it
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what is the acute form of ITP and what is the chronic ?
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sudden and short onset is the acute, and the chronic is slower and usually lasts awhile
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if a physician ordered a pt, ptt, and a platelet count on a patient with ITP what would be the result?
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the platelet count would be decreased but the PT and PTT would be normal
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what is a emergency treatment for ITP?
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splenectomy
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whatt is TTP?
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thrombotic tthrombocytopenic purpura are caused by damaged endothelial cells. the vwf released from the endothelial cells complex with the factor eight coagulant, deposition of platelet thrombi tot capillaries caused by endothelial cell injury resultts in the purpura
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which part of factor 8 is associated with hemophila?
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part c
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in thtrombocytopenia whatt is the platelet count?
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decreased
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what are the pt, PTT, and platelet counts for someone with TTP
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the PT and PTT should be normal, so should the platelet count, but bleeding time will be prolonged
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mode of action of anti-thrombin
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inhibits thrombin and certain factors
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convers plasminogen into plasmin
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tissue factor
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mode of action of unfractionated-heparin
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increases the activity of anti-thrombin
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what tests monitors heparin therapy?
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the PTT
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the prothrombin titme measures the ____ which includes factors
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extrinsic pathway by measuring factors 1,2, 5, 7, 10
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prothrombin is which factor?
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2
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factor ___ cleaves prothrombin, factor 2, into factor 2a also known as _____
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factor 10 activates factor 2, prothrombin, which is converted intto 2a which is thrombin
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the partial thtromboplastin titme is a performance indicator of the ____ pathway
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intrinsic
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would you have a prolonged partial thtromboplastin time when on coumadin?
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yes because coumadin inhibitst the vitamin k dependent factors
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what is TTP?
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the release of von willebrands from tthe endothtelial walls causing thrombi
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where is vWF stored?
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endotelial cells and alpha granules in platelets
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what is the function of factor 8, and the attached vWF
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it mediattes platelet adhesion to collagen. vWF functions as a bridge bettween the collagen and the platelet
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whatt breaks vwf into smaller monomers?
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ADAMTS13
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what would result from a deficiency in ADAMTS13?
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nothing would break down the vwf and they will have a huge amount of bridging between the collagen and platelets
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what are the two diseases we discussed on problems with platelet membranes
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glanzmann's thrombasthenia, andd bernad-soulier
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what test is used to dx glanzmnn's thrombasthenia?
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we use flow cytometry because platelett aggregattion and platelett counts would be normal
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what is glanzmann's thrombasthenia and how would it react in a platelet aggregation study with ristocetin?
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itt is a receptor problem, of note is 2b3a. with ristocetin it would be normal
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what are the symptoms of someone with glanzmann's thrombasthenia?
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they will have a mucous type bleeding, from gums, or thte gi tract
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what is bernard-soulier and what would be the resultt of a platelet aggregation study using ristocetin?
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it is a receptor problem of thte platelet, of note is receptor 1b9. twith ristocetin the results would be abnormal
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what is the normal reference range for fibrinogen?
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200-400mg/dL
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whatt is afibrinogenemia?
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it is a factor problem resulting in a low fibrinogen concentration, PT and PTT would botth also be abnormal
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whatt is the normal reference range for thtrombin time?
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15-20 seconds
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thrombin ttime measures
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the time itt takes to go from fibrinogen to fibrin
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what is dysfibrinogenemia?
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it is a functional problem with fibrinogen
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whatt is DIC?
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over clotting and over fibrinolysing
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what is the primary symptom of someone with DIC?
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they are oozing out of seemingly random sites
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whatt tests do you use to see if there is a problem with fibrinolysis?
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d-dimers and fibrin splits
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what are the treatments for DIC?
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cryoprecipitate and/or plasma transfusion
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what is primary fibrinolysis
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there is no over clotting, but over lysing hence the name
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what tests do you run for primary fibrinolysis?
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fdps or d-dimers
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what is severe hemophilia
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a factor 8 molecule tthat is not working at all(0-2%). these people will bleed everywhere from anything
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moderate hemophili is?
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bleeding from trivial injuries, with factor 8 being 2-5% active
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mild hemophilia
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is a factor 8 issue where the person won't stop bleeding from traumatic injuries, factor 8 is 5-25% active
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what is hemophilia b?
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a factor 9 deficience (christtmas factor ddeficiency) so itt is also called christmas disease
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what is the screening test for factor 5 leiden
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you run an apc which has 2 testts tubes, one with extra APC so it has hopefully if normal a 2x as long clotting time
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