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71 Cards in this Set
- Front
- Back
Coagulation |
Process that leads to fibrin formation |
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Hemostasis |
Coagulation that occurs in a physiological setting and results in sealing a break in the vasculature |
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Thrombosis |
Coagulation that occurs jna pathological setting that leads to localized intravascular clotting and potential occlusion of a vessel |
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Thrombosis |
Increase Pro Coagulation |
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Bleeding |
Increase Anti Coagulation |
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Primary Hemostasis |
Involves action of blood vessels and platelets |
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Primary Hemostasis |
Usually occurs within 3-5 minutes |
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Primary Hemostasis |
End product: formation of platelet plug that provides surface phospholipods for coagulation |
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Primary Hemostasis |
Important events are platet adhesion, activation, secretion, aggregation |
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Secondary Hemostasis |
Involves interaction of coagulation factors |
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Secondary Hemostasis |
End product: stable fibrin clot |
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Secondary Hemostasis |
Usually occurs within 10-30 minutes |
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Factor XIII |
longest half-life |
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Factor VII |
Shortest half-life |
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Factor XII, XI, IX, VIII |
Intrinsic pathway |
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Factor III, VII |
Extrinsic pathway |
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Factors X, V, I, II |
Common pathway |
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Tissue Factor Pathway Inhibitor |
Primary inhibitor of blood coagulation |
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Tissue Factor Pathway Inhibitor |
If excess, may result to severe bleeding |
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Tissue Factor Pathway Inhibitor |
Targets Factor VII and Xa |
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Antithrombin III |
Non-Vitamin K dependent protease inhibitor |
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Antithrombin III |
Major inhibitor of Thrombin/Factor IIa |
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Antithrombin III |
Also inhibits Factors IXa, Xa, XIa, XIIa, Kallikrein and Plasmin |
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Protein S and Protein C |
Degrades Factor Va & VIIIa |
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Fibrinolysis |
Digestion of fibrin clot, keeps vascular system free of deposited fibrin |
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Fibrinolysis |
Occurs when plasminogen is converted to plasmin |
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Plasminogen activators |
Urokinase-like PA Tissue-like PA Streptokinase Urokinase |
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Dysfunctional hemostasis |
Easy bruising with induration |
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Dysfunctional hemostasis |
Frequent/prolonged nosebleeds |
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Dysfunctional hemostasis |
Heavy menstrual period |
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Dysfunctional hemostasis |
Prolonged bleeding after surgery |
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Dysfunctional hemostasis |
Prolonged/mucosal bledding after dental work |
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Primary Hemostasis |
Immediate, superficial, mucosal |
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Primary Hemostasis |
Petechiae, ecchymoses, more common in females |
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Primary Hemostasis |
Immediate, local measures effective |
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Secondary Hemostasis |
Delayed, deep joints |
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Secondary Hemostasis |
Ecchymoses, hematoma, hemarthroses, only in males |
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Secondary Hemostasis |
Requires sustained systemic therapy |
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Vascular Bleeding Disorders |
Characterized by easy bruising and spontaneous bleeding from small vessels |
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Vascular Bleeding Disorders |
With underlying abnormality in either vessel, bleeding - purpura, standard screening tests are normal |
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Thrombocytopenia |
Decreased platelet production, increased destruction, platelet sequestration by spleen, and dilution of platelet count |
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Thombocytosis |
Mucosal bleeding, petechiae, persistent bleeding from skin |
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Immune Thrombocutopenic Purpura |
Decreased platelet count, normal PBS, Proliferation of megakaryocytes in BM biopsy |
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Oral Corticosteroids |
First line of treatment for ITP |
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Splenectomy |
Indicated for patients < 60 years old |
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IV-Ig; Anti-RhD |
For immediate surgical intervention |
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Plasma pheresis |
Removes antibodues to lower antibodies in circulation |
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Immune Thrombocytopenic Purpura |
Production of autoantibodies to Glycoprotein IIb/IIIa |
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Thrombotic Thrombocytopenic Purpura |
Clinical syndrome wih high mortality that is by formation of microthrombi in microvasculature |
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Thombotic Thombocytopenic Purpura |
Pentad of severe thrombocytopenia, microangiopathic hemolytic anemia, fever, confusion, renal disease |
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Thombotic Thombocytopenic Purpura |
Hematologic emrgency more common in females |
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Thombotic Thombocytopenic Purpura |
Deficiency of metalloprotease ADAMTS13 that cleaves vWF |
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Thombotic Thombocytopenic Purpura |
Decreased platelet count, presence of schistocytes/helmet cells and reticulocytosis in PBS, (-) Coomb's test, inc. LDH, B1, dec. Haptoglobin |
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Therapeutic plasma exchange |
Standard of treatment for TTP |
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Hemolytic Uremic Syndrome |
Common in children at 6 mos.-4 years of age |
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Hemolytic Uremic Syndrome |
More pronounced acute renal failure, microangiopathic hemolytoc anemia, thrombocytopenia |
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Hemolytic Uremic Syndrome |
Associated with enterohemorrhagic diarrhea and E. coli O157:H7 |
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Supportive; Dialysis |
Treatment for HUS |
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Hemophilia |
X-linked recessive hemorrhagic disease due to mutation in thw F8 gene or F9 |
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Hemophilia A |
Most common hereditary clotting factor deficiency |
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Hemophilia |
Prolonged APTT with males clinically affected |
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Hemophilia A |
Profuse post-circumcision hemorrhage, joint and soft tissue bleeds and excessive bruising |
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Hemophilia A |
Recurrent painful hemathroses and muscle hematomas, entrapment neuropathy or necrosis |
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Hemophilia A |
Spontaneous hematuria and GI hemorrhage |
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Hemophilia A |
Prolonged aPTT, Factor VIII clotting assay, normal platelet count and function and PT |
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FVIII Replacement Therapy |
Treatment for Hemophilia |
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Disseminated Intravascular Coagulopathy |
Widespread intravascular firbrin formation |
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Disseminated Intravascular Coagulopathy |
Main clinical presentation: Bleeding |
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Acute DIC |
Sudden exposure of blood coagulants |
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Chronic DIC |
Reflects compensated state |
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Disseminated Intravascular Coagulopathy |
Decreased platelet count, red cell fragmentation syndrome on PBS, decreased fibrogen, prolonged PT, APTT, Thombin time, high levels of D-dimer |