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28 Cards in this Set

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Bleeding Time
Only to screen for platelet disorders or vWD
Affected by platelet count & function
PFA-100
platelet disorder screening
meaures the time acquired for anticoagulated blood to occlude a standard aperture
Affected by platelet count & function
Platelet aggregometry
>60% platelet aggregation in response to platelet agonists: ADP, Collagen, Epi, ristocetin, arachodonic acid
Platelet aggregrometry - biphasic curve
low dose ADP & epi from primary & secondary wave (degranulation)
platelet aggregometry - monophasic curve
high dose ADP, collagen & ristocetin
platelet aggregometry - abnormal - medication
Aspirin - decreased aggregation with arachidonate
platelet aggregometry - poor response to all agents except ristocetin
Glanzsmann's thromboasthenia
platelet aggregometry - poor response only to ristocetin
Bernard Soulier (anemia, lg plts, tcp) & vWD
platelet aggregometry - absent secondary phase (epi & ADP)
storage pool deficiency & ASA
platelet aggregometry - poor response to epi
myeloproliferative disorders
Clot retraction test
Normal produce clot retraction within four hours
Glanzmann's thromboasthenia - diminished clot retraction
Platelet antigens detected by flow
GPIIb/IIIa - glanzmann's
CD62-alpha granule when present
CD63
Fibrinogen when bound to GPIIb/IIIa
ACT
point of care testing
heparin >400s
whole blood - affected by plts, hematocrit
Can use anti-Xa if need to
elevated PTT
Intrinsic pathway (F12, F11, F9, F8) or common pathway (FV, FX, F2, F1) or inhibitor
prolongation of both PT & PTT
common pathway (FX, FV, F2 or F1) Or an inhibitor
Shortened PTT - by what factor
elevated F8
PTT monitors what drugs
heparin, hirudin, argatroban
Heparin resistance
acute phase response (inc F8 & binding of heparin) or antithrombin deficiency.
Mixing study - adding aged plasma
Aged plasma lacks F2, F5, F8, F`13
Mixing study - adsorbed plasma
Adsorbed plasma lacks-F2,F7,F9,F10
(vit k dependent)
Mixing study - serum
Serum lack fibrinogen, F2,FV,F8,F13
PF4
platelet factor 4 can artificially shorten PTT
Activated Protein C Resistance
Factor V Leiden mutation - point mutation glutamine for arginine at cleavage sites = FV resistant to protein C
Anticardiolipin Antibody (ACA)
IgG, IgA, IgM
have either ACA (Elisa) or LAC
80% antiphospholipid syndrome have ACA
ACA testing w/Beta2 glycoprotein I manner - antibodies to cardiolipin bound to Beta2 glycoprotein i
Syphilis, Q fever, HIV - false positive ACa (IgM)
ACA false positive RPR
Clot stability test (urea solubility test)
F13 generates covalent bonds
5M urea - pts w/ 1-2% F13 activity clot stable for 24 hrs - detects homozygotes
Fibrinogen is qualitatively & quantitatively normal
D-dimer
fibrin degredation product
formed only by plasmin degredation of fibrin
fibrin formed then degraded
DIC, thrombosis, bleeding, cirrhosis, mucin secreting adenocarcinomas
What does D-Dimer tell us
normal = excludes ongoing in vivo thrombus (DVT, PE)
Low probablity
D-Dimer Assays
Latex agglutination, serial dilutions (semiquantitative)
ELISA - quantitative