Lec 3 And 4- Exam 1 Heme

Front 1

Secoundary hemostasis goal

Back 1

to reinsforce platlet plug with fibrin formation

Front 2

Secoundary hemostasis is actiavated by

Back 2

contact factors in endothelium, and platelets porlogated activity.

Front 3

When is secoundary hemostasis activated

Back 3

when the inury is severe enough beyond capcity of platlets and vessels.

Front 4

Secoundary hemostasis invole intraction of

Back 4

several coagulation factors.

Front 5

Charectorestics of coagulation factors in secounday hemostasis.

Back 5

they are protein in plasma ,most of them are serine proteases. They circulate in inactive form

Front 6

How do coagulation proteins circulate in plasma

Back 6

inactive form.

Front 7

Untilate goal of secoundary hemostasis

Back 7

generate thrombin.

Front 8

List all the coagulation factors

Back 8

Fibrinogen, Prothrombin, tissue thromboplastin, calcium, Factor 5, factor 7, factor 8, factor 9, factor 10, factor 11, factor 12, factor13, HK ( high molecular weight kininogen) , Pre-kallekrein. There are no factor 6.

Front 9

two subsystem in secoundaty hemostasis

Back 9

intrensic and extrensic.

Front 10

both intrensic and extrensic feed into

Back 10

common pathway and activate factor X.

Front 11

Factors in intresnic pathway in order

Back 11

XII, XI, IX, , VIII, X, V, II

Front 12

Factors in extresnic pathway IN order

Back 12

VII, X, V, II, I

Front 13

factors aPTT measures

Back 13

Insrensic pathway factors such as , VIII, XII,XI, X, V, II, I

Front 14

FACTORS PT measures

Back 14

extrensic pathway such as VII, X, V, II, I

Front 15

Extresnsic system activate substances in where

Back 15

outside of vessels such as tissue thromboplastin.

Front 16

Compare the time needed I, intresnsic and extrensci pathway

Back 16

extrinsic Ard 12 secounds, while intrensic is <30 sec.

Front 17

Postive feedback of thrombin

Back 17

by having an amplifing effects on VIII and V, also activated factor XIII ro stabilize clot, and activate fibrinolysis system

Front 18

we can measure extrensic system by

Back 18

PT - prothrombin time test

Front 19

Compare the amount of thrombin prodiced by intresnsic and extrensci pathway

Back 19

extensic pathway produce onlt a small amount of thrombin, while intrensic pathway generates large amount of thrombin.

Front 20

Intresnsic pathway is nameed because of

Back 20

activating substances are inside the vessels such as collagen, PF3 etc.

Front 21

Intresic pathway enhanced by

Back 21

contact groups such as HK, PK, Factors XII, and XI …….. HK - high molecular weight kinase, PK - prekallikrein.

Front 22

Intresic pathway factor IX is activated by

Back 22

contact groups such as HK, PK, Factors XII, and XI …….. HK - high molecular weight kinase, PK - prekallikrein.

Front 23

Intresic pathway factors monitered by

Back 23

aPTT - acivated partial thromboplastin test.

Front 24

Common pathway begins with factor and their untimate goal

Back 24

factor X to produce thrombin.

Front 25

Activated susbstance in common pathway

Back 25

Xa, Ca, V, and II.

Front 26

Mechanisam of common pathway

Back 26

activated substanced such as Xa, Ca, V, and II. Convert prothrombin to thrombin. Thrombin converts fibrinogen to fibrin.

Front 27

process of firbin formation

Back 27

fisrt form monomer, then polymer with initial weak hydrogen bonds. With an unstable clot that can dislodge and blead again.

Front 28

process of factor XIII

Back 28

it replaced h bodes with S-S covalent bonds to have a stronger clot.

Front 29

Factor X activation requres the activation of complex in intrensic

Back 29

VIIIa, Ixa, PL ( PF3) and Calcium

Front 30

Factor X activation requres the activation of complex in extrensic

Back 30

VIIa, TF3 and and Ca.

Front 31

Factor II ( prothrombin) activation requres the action of complexe

Back 31

factors Xa, Va, ca, and PL.

Front 32

Thrombin purpose on fibrin

Back 32

Iia, its is the only substance that requre to convert fibrinogen to fibrin.

Front 33

Thrombin enhances

Back 33

factor V and VIII

Front 34

Factor V and VIII charectorenstics

Back 34

they are labile factors that are short lived in stored plasma, they are referred to as cofactors they are target of protein C as a coagulation inhiitors.

Front 35

Cofactors in coagulation cascade

Back 35

factor V and VIII

Front 36

Coagulation inhibitors in cascade that target protein C

Back 36

factor V and VIII

Front 37

Factor II, VII, IX, and X charectorestics

Back 37

they are vitamin K dependednt, they are preduced in liver, and all depleted by oral coagulation thereapy.

Front 38

Factors that are vit K dep

Back 38

Factor II, VII, IX, and X

Front 39

foactors that can depleted by oral anticoagulant therapy

Back 39

Factor II, VII, IX, and X

Front 40

factors in contact group

Back 40

factor XI, XII , fletcher ,and fitzgerals.

Front 41

how factor XI, XII , fletcher ,and fitzgerals. Initiates internsic pathway

Back 41

when contact with PF3 and collagen.

Front 42

Charectorestics of factor XI, XII , fletcher ,and fitzgerals.

Back 42

they are presnt in plasma and in serum. They are not consumed by clotting.

Front 43

Prothromin proteins and their charectorestics

Back 43

Factor II, VII, IX, and X. they are also known as vit K dep factors. Only factor II is consumed by cloting.

Front 44

Facrots that not consumed by clotting in prothrmbin proteins

Back 44

factor VII, IX, and X.

Front 45

Factors in fibrinogen group

Back 45

I,V,VIII, and XIII

Front 46

Charectorestic of fibrinogen group

Back 46

I,V,VIII, and XIII - they are consumed by clotting and not found in serum .all are high molecular weight proteins, all acted upon thrombin.

Front 47

Factors in fibrinogen group that not present in stored plasma

Back 47

factor V and VIII

Front 48

Factors that you can always found in serum and total plasma

Back 48

factor XI, XII , fletcher

Front 49

Factors thaat not found in serum

Back 49

fibrinogen group, they are I, V, VIII, XIII

Front 50

Factors thaat not found in stored plasma

Back 50

in fibrinogen group, they are , V, VIII,

Front 51

Screening procedures to evaluate secoundary hemostasis

Back 51

PT, aPTT, Thrombin time, and fibrinogen.

Front 52

defects in secoundary hemostasis

Back 52

factor deficienced and factor inhibitors.

Front 53

Coagulation procedure specimen collecting tube requirements

Back 53

sodium citrate with 3.2%. NOT EDTA or heprarin. 9 parts of blood to 1 part anticoagulant. Use plastic tube and plastic pipettes.

Front 54

reason why hemolysed blood not acceptable in coagulation lab

Back 54

erythrocetin in rbcs has thromboplastic effect.( clotting effect)

Front 55

Coagulation procedure specimen hematocrit requirements

Back 55

abnormal hemotacrit can affect ratio of blood to coagulation that should be 1:9, so wee need to abject >55 high , and low hematocrit.

Front 56

what happed of ut hematocrit id >55 for coagulation procedure

Back 56

false poasitive result. Incres in coagulation.

Front 57

type of specimen need for coagulation studies

Back 57

use PPP - platlet poor plasma

Front 58

type of specimen need for platlet studies

Back 58

use PRP- platlet rich plasma.

Front 59

Storage protocoles for specimen to evalulate secoundary hemostasis

Back 59

up to 4 hours at 18-24 ( room temp, then freeze )

Front 60

Specimen collection protocoles

Back 60

clean, not traumatic. Wuth butterfly needle - discard first tube, IV- collect from other arm, indwelling catheter - avoid heparin condamination. Aviod carry over from ther anticoagulants so second speciment collected.

Front 61

purpose of prothrombine time measurment

Back 61

to detect factor deficencies or inhibitors within the system, detect vitamin K dependents, mnitor walfarin therapy = coumadin.

Front 62

monitor walfarin theropy by

Back 62

prothrombin time.

Front 63

Detect vitamin therapy by

Back 63

prothrombin time.

Front 64

procedure fot prothrombin time test

Back 64

thromboplastin reagent + PPP, record the time to clot.

Front 65

ref range for prothrombin time test

Back 65

10 - 13 sec

Front 66

purpose of aPTT test

Back 66

to screen factors such as XII, XI, VIII, X, V, II, and I to monitor unfractionated heparin.

Front 67

Procedure for aPTT test

Back 67

Activator reagent mixed with PPP and add CaCl2 to initiate clotting process. Time is recorded for clot to form.

Front 68

If PT is normal and aPTT is abnormal, posible facor difficensies are

Back 68

factor, XI, XII, and VIII deficent

Front 69

If PT is adnormal and aPTT is normal, posible facor difficensies are

Back 69

Facter 7 deficent

Front 70

If PT is abnormal and aPTT is abnormal, posible facor deficency are

Back 70

common pathway deficent such as facotr X, V, II, and I

Front 71

Procedure fot mixing study to evaluate prolonged PT or aPTT

Back 71

mixed patient plasma with normal pooled plasma

Front 72

Mixed study to evalate prolonged PT, corrected the PT time suggests?

Back 72

Factor in the pool was missing and you corrected it.

Front 73

Mixed study to evalate prolonged PT, did nor corrected the PT time suggests?

Back 73

there is an inhibitory problem.

Front 74

Mixed study to evalate prolonged aPTT and normal PT, and corrected the aPTT time suggests?

Back 74

Dificency on X!, XII, and VIII.

Front 75

causes of false increase in PT and aPTT tests

Back 75

Citrate concentration, clot in tube, hepatin condamination, IV fluid dialution optimal interferance in plasma. Citrate concentration is affected when blood to citrate ration Is not 9:1, HCT>55, when tube is underfull/ Short draw. Clot in the tube may consume the factors .

Front 76

a underfilled citrate tube cause aptt and PT result?

Back 76

to be fals'y elivated. More citrate in the tube.

Front 77

Clot in the tube for PT and aPTT test

Back 77

cause facter consumption lead to falsly increase the result time,

Front 78

a abnormal secoundary hemostasis screening test, first condier

Back 78

FALSE increase in time

Front 79

a abnormal secoundary hemostasis screening test, cosider after ruling our false increase

Back 79

second determine that the abnormality if persist that not just a fluke by reanalyzing the abnormal test. Third, is further evaluation warranted clinically that will it lead to a change in patient care.

Front 80

When is conformotory testes are done on abnormal aPTT or PT

Back 80

after rulling out false increase .

Front 81

Principle on thrombin time test

Back 81

to detect problems of fibrinogen or to see of there is any inhibitors in last step in coagulation cascade. Problems with fibrinogens such as Hypofibrinogenemia, dysfibrinogenemia. Inhibitors such as anticoagulation drugs - heparin, argatroban, and Hirudin.

Front 82

Reagent for TT- thrombin time

Back 82

diluted thrombin.

Front 83

Procedure for Thrombin time

Back 83

regent is diluted thrombin. Warm the reagent, and add patients PPP and report the time to clot.

Front 84

Referance rrange for Thrombin time

Back 84

10 - 16 secs

Front 85

Refarence range for aPTT

Back 85

21 - 35. secs

Front 86

Problems with fibrinogens that can detect with TT- thrombin time

Back 86

Hypofibrinogenemia, dysfibrinogenemia

Front 87

Problems with inhibitors that can detect with TT- thrombin time

Back 87

Inhibitors such as anticoagulation drugs - heparin, argatroban, and Hirudin.

Front 88

referance methord for measuring fibrinogen levels

Back 88

ref methord is Clauss Assay that is a modified thrombin time test.

Front 89

Principle of Clauss Assay

Back 89

it is a ref methord that is a modified thrombin time test to measure fibrinogen.

Front 90

Procudure for Clauss assay

Back 90

same as thrombin time exept, you dilute 1:10 with referance plasma / calibrator, controls and patients plasma. Report is results as mg/L of fibriogen. Instead of seconds.

Front 91

How to report result in clauss assay

Back 91

in mg/dL of fibrinogen

Front 92

referance range for Clauss assay

Back 92

200 - 400 mg/dL of fibrinogen.

Front 93

Reagents in fibrinogen assay

Back 93

Fibrinogen calibrator, thrombin, and buffer such as phosphate,

Front 94

Prepare standard curve in fibrinogen assay

Back 94

by plotting time on Y and concentration on X in a log paper.

Front 95

Fibrinogen assay procedure

Back 95

dilute controls and patent plasma to 1:10 , 200ul of specimen warmed to 37 temp, add 100ul of thrombin, and compare time using standard curve to determine concentration of fibrinogen.

Front 96

Conditions with decreased level of fibrinogen

Back 96

DIC, primary fibrinolysis, secoundary fibrinolysis, liver disease, Dysfibrinogenemia, heriditary afibrinogenemia.

Front 97

Conitions with increased level of fibrinogen

Back 97

pregnancy, infimatory disorders, and oral contraceptive.

Front 98

when PT is used to monorot therapeutic monitoring

Back 98

coumadin therapt monitor, when patient has thromboses and are on coumadin therapy.

Front 99

INR - international normalized ratio principle

Back 99

to monitor PT that can be more constant between labs.

Front 100

INR formula

Back 100

(Patienr PT on scounds / Mean PT of lab ref in sec) ^ ISI

Front 101

ISI

Back 101

international standart Index that avialable from manufacture of thromboplastim to calulate ISI.

Front 102

Innovin principle

Back 102

it is a prothrombin time reagent that currently in use to moneture INR that between 2 and 3. ISI is colse to 1, and very constant from lot to lot.

Front 103

when aPTT is used to monorot therapeutic monitoring

Back 103

when unfractionated heprin is used.