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34 Cards in this Set

  • Front
  • Back
most common antigen to cause immune thrombocytopenic purpura
GpIIb/IIIa receptor
virchow's triad
1. stasis
2. endothelial injury
3. hypercoagulable state
activated protein C acts on which clotting factors?
factor VIIIa
factor Va
antithrombin acts on which clotting factors?
thrombin (IIa)
factor Xa
how does heparin induced thrombocytopenia occur
HIT type 2
heparin binds platelet factor 4 (PL4) and renders it immunogenic. antibodies form against PL4 and bind platelets. white, platelet rich clot forms (thrombosis), and thrombocytopenia occurs.
tissue factor pathway inhibitor acts on which clotting factors?
thromboplastin - VIIa complex
what is neonatal purpura fulminans?
newborns presenting with purpura all over their body because they have a deficiency of protein C and protein S
what is warfarin skin necrosis?
out of the vitamin K dependent serine proteases(II, VII, IX, X, protein C, protein S), protein C has the shortest half life. This means that its levels drop first, resulting in intial HYPERcoagulability with initiation of warfarin treatment. thrombi form in the skin, and warfarin skin necrosis occurs
what are the vitamin K dependent serine proteases in the clotting cascade?
II, VII, IX, and X.

protein C and protein S
try to name 9 very common acquired risk factors for thrombosis
1. Pregnancy (esp. postpartum)
2. Immobilization
3. Obesity
4. Advanced age
5. Estrogen use
6. Trauma
7. Postoperative state
8. Malignancy
9. Heparin-induced thrombocytopenia
how does factor V leiden cause a hypercoagulable state?
it is APC resistant.
most common inherited coagulation risk factor
factor V leiden
factor five - 5%
(U.S. caucasians)
second most common inherited coagulation risk factor
prothrombin 20210
factor two - 2%
(U.S. caucasians)
who has the worst thrombophilia:
1. factor V leiden heterozygote
2. antithrombin deficiency
3. factor V leiden homozygote
1. factor V leiden homozygote. 18x
2. antithrombin deficiency 10-20x
3. factor V leiden 3x
what is the worst inherited coagulation risk factor that is compatible with life?

at age 60, what is these people's risk of developing thrombi?
antithrombin deficiency
60% at age 60. this shows that
how are people tested for factor V leiden?
APC susceptibility test.

perform a clotting assay with and without APC added.
APC should increase time to clot. If it doesn't increase time to clot as much as it should, then then they have APC resistance.

If the patient has a positive test for APC resistance, they then have a genetic test (PCR) to prove that they have factgor V Leiden.

This is important to know zygosity (3x vs 18x...)
how are people tested for prothrombin 20210?
genetic test (PCR)

there is no screening test available
in what parts of the world are prothrombin 20210 and factor V leiden prominent?
prothrombin 20210 - france, spain, portugal

factor V leiden - scandinavia
what problems do patients with too much factor VIII have?
why can't you test people for factor VIII excess in the hospital?
it's an acute phase protein and will be physiologically elevated with stress
what are several causes of acquired protein C or protein S deficiency?
-warfarin treatment
-vitamin K deficiency
-liver disease
-trauma (consumption)
-surgery (consumption)
-DIC (consumption)
-lupus anticoagulant

S only
what is lupus anticoagulant's effect in vitro and in vivo?
lupus anticoagulant is an IgG autoantibody!
in vitro - binds phospholipids so increases PT and PTT

in vivo - binds to endothelium and causes coagulation
name a few things that can cause an acquired antithrombin deficiency
1. estrogen?
2. pregnancy?
3. DIC
4. liver dysfunction
5. recent surgery
6. recent thrombosis
7. heparin
8. proteinuria
what are two things that can cause antiphospholipid syndrome?
1. anticardiolpin antibody
2. lupus anticoagulant
if you suspect lupus anticoagulant, what tests can you order?
1. no correction by mixing study.
2. clotting time improves upon addition of more phospholipid
if you suspect anticardiolipin antibodies, what can you do?
ELISA test
do antiphospholipid syndromes cause venous or arterial thrombosis?
they cause both
patient has had 3 consecutive abortions before 10th week of gestation and thromboses. what is likely problem?
antiphospholipid syndrome
how is hyperhomocysteinemia treated?
vitamin B12

these increase the number of methyl groups going to regenerate methionine from hcy
what are 2 things that can cause both arterial and venous thromboses?
1. antiphospholipid syndromes
2. hyperhomcysteiemia
what are some things that can cause hyperhomocysteinemia?
1. stress (acute phase protein)
2. B12, folate, B6 deficiency
3. renal failure
4. hypothyroidism
5. methotrexate, phenytoin, theophylline
6. malignancy

no idea why
what drug interferes with lupus anticoagulant tests?
what drug decreases protein c and protein S?
what drug interferes with antithrombin functional tests?