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Hematology - Absite
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- 1What are the 3 initial responses to vascular injury?vascular vasoconstriction
platelet adhesion
thrombin generation - 2Intrinsic Pathwaycontact activation pathway
most often initiated when factor XII (Hageman factor)
Activates VIII, IX, XI - 3Extrinsic Pathwaytissue factor pathway
quicker responding and more direct
releases Factor III + Ca
Factor VII is activated - 4Common PathwayIntrinsic and Extrinsic converge with
Factor X.
Fibrin is produced to seal off the vessel - 5Prothrombin ComplexX, V, Ca, Platelet factor 3, prothrombin
forms platelets
catalyzes formation of thrombin - 6What does fibrin do?links platelets together(binds GpIIb/IIIa molecules) to form platelet plug
hemostasis - 7What does Factor XIII do?helps cross-link fibrin
- 8Effects of ThrombinFibrinogen --> Fibrin + split products
Activates factors V and VIII
Activates platelets - 9Effects of Antithrombin IIIBinds and inhibits Thrombin
Inhibits factors IX, X & XI - 10Effects of Heparin on Antithrombin IIIheparin activated antithrombin III up to 1000x normal activity
- 11Protein CVitamin K dependent
degrades factors V and VIII
degrades fibrinogen - 12Protein Svitamin K dependent
protein C co-factor - 13Molecules associated with fibrinolysistissue plasminogen activator
plasmin
alpha-2 antiplasmin - 14Tissue Plasminogen Activatorreleased from endothelium and converts plasminogen to plasmin
- 15Plasmindegrades factors V and VIII, fibrinogen and fibrin. Lose Platelet Plug
- 16Alpha-2 AntiplasminNatural Inhibitor of Plasmin
released from endothelium - 17Factor with the shortest half-lifeFactor VII
- 18What factors are lost in stored blood but not FFP?Factor V and VIII
- 19Which factor is not synthesized in the liver? Where is it synthesized?Factor VIII, it is synthesized in the endothelium along with vWF
- 20Which Factors are Vitamin K dependent?II, VII, IX, and X; protein C and S
- 21How long does it take for Vitamin K in IV form take to have an effect?12 hours
- 22What is Factor II?Prothrombin
- 23Normal half-life of RBC120days
- 24Normal half-life of platelets7 days
- 25Normal Half-life of PMNs1-2days
- 26Prostacyclin - where is it from? - what effects does it have?from endothelium
decreases platelet aggregation
promotes vasodilation
antagonistic to TXA2
increases cAMP in platelets - 27Thromboxane (TXA2) - where is it from? - what are its effects?from platelets
increases platelet aggregation
promotes vasoconstriction
triggers Ca release from platelets
Exposes GpIIb/IIIa-R - 28GpIIb/IIIa receptorwhen activated, causes platelet-to-platelet binding
- 29GpIb ReceptorWhen activated, platelet-to-collagen binding
- 30Cryoprecipitate - what does it contain? - What diseases is it commonly used for?contains the highest concentration of vWF-VIII and high levels of fibrinogen; used in vWD and Hemophilia A
- 31FFPFresh Frozen Plasma
high levels of all coagulation factors
protein C+S, AT-III - 32DDAVP and conjugated estrogens release which factors?causes release of Factor VIII and vWF from endothelium
- 33What does prothrombin time (PT) measure?Factors II, V, VII, and X
Fibrinogen
best for liver synthetic function - 34What does partial thromboplastin time measure? What range do we want?I, II, V, VIII, IX, X, XI and XII
(not factors VII or XIII)
Range: 60-90sec - 35Activated Clotting Time we want for routine A/C vs for cardiopulmonary bypassroutine ACT: 150-200sec
Cardiopulm Bypass ACT: >480sec - 36relative contraindication to performing surgical procedures (INR)>1.5
- 37Relative contraindication for placing a central line, percut. needle biopsies, and eye surgeryINR >1.3
- 38MCC of surgical bleedingincomplete hemostasis
- 39MC congenital bleeding disordervon Willebrand's Disease
- 40MC symptom associated with vWDepistaxis
- 41Which type(s) of vWD are autosomal dominant?Type I and II
- 42Which type(s) of vWD are autosomal recessive?Type III
- 43Effects of vWFlinks GpIb receptor on platelets to collagen
- 44Effects of vWD on PT and PTTPT normal
PTT normal or abn - 45Effects of vWD on bleeding timeLong bleeding time
Ristocetin Test - 46MC type of vWDType I, mild symptoms
- 47Which type of vWD is most severe?Type III
- 48What is Type I vWD? and it's treatmentreduced quantity of vWF
Tx: recombinant VIII:vWF, DDAVP, cryoprecipitate
mostly DDAVP - 49What is Type II vWD? what is its treatment?defect in vWF molecule, vWF doesn't work well
Tx: recombinant VIII:vWF, cryoprecipitate and DDAVP - 50what is Type III vWD? Treatment?complete vWF deficiency
Tx: Recombinant VIII:vWF, cryoprecipitate
NOT: DDAVP - 51What is Hemophilia A? MC symptom?VIII deficiency
Sex-linked recessive
MC symptom: hemarthrosis - 52PT and PTT in Hemophilia APT: normal
PTT: prolonged, follow this 8hrs after surgery - 53What to do for Hemophiliac joint bleedingice, keep joint mobile, factor VIII concentrate or cryoprecipitate
- 54Treatment for Hemophiliac epistaxis, ICH, or hematuriarecombinant factor IX or FFP
- 55Hemophilia B and treatmentIX Deficiency, Christmas Dx
sex-linked recessive
Tx: recombinant factor IX or FFP - 56PT and PTT in Hemophilia BPT: normal
PTT: prolonged - 57Factor VII deficiency PT & PTT, and treatmentPT: prolonged
PTT: normal
bleeding tendency
Tx: recombinant factor VII or FFP - 58Symptoms associated with Platelet Disordersbruising, epistaxis, petechiae, purpura
- 59What can cause acquired thrombocytopeniaH2 blockers
Heparin - 60What is Glanzmann's Thrombocytopenia? Its treatmentGpIIb/IIIa-R deficiency on plts
platelets can't bind together
Tx: platelets - 61Bernard Soulier and its treatmentGpIb-R Deficiency on platelets
cannot bind to collagen
Tx: platelets - 62Uremia and its effect on platelets TreatmentBUN >60-80
inhibits plt fxn, mainly but inhibiting release of vWF
Tx: HD, for acute reversal use DDVAPm cryoprecipitate for moderate to severe bleeding - 63Antibody associated with HIT syndromeanti-heparin antibodies or IgG heparin-PF4 antibody
- 64Difference between HIT and HITTHIT: heparin induce thrombocytopenia
HITT: thrombosis - 65Clinical Signs of HITPlatelets <100 or drop in platelets >50% admission levels
or thrombosis while on heparin - 66Type a clot that is formed associated with HIT syndromewhite clot
- 67Diagnostic Testing for HIT syndromeELISA for heparin Abs
Serotonin Release Assay - 68Treatment of HIT syndromestop heparin
start agatroban (direct thrombin inhibitor)
avoid giving plts - 69What is DIC? What is increased and decreased on bloodwork?Disseminated Intravascular Coagulation
decreased plts, fibrinogen
high D-Dimer fibrin split prod
Prolonged PT and PTT - 70Treatment for DICtreat the underlying cause
- 71When do you stop aspirin before surgery?7days before surgery
- 72MoA and Effects of aspirininhibits cyclooxygenase in plts and decreases TXA2
Causes prolonged bleeding time - 73When to Stop Clopidogrel (Plavix) before surgery7 days prior to surgery
- 74MoA of clopidogrelADP receptor antagonist
- 75How to treat someone for bleeding while on Clopidogrel/PlavixPlatelets
- 76What to do for a patient with coronary stent and need to stop Plavix for elective surgery?bridge with Integrilin (eptifibatide)
GpIIb/IIIa inhibitor - 77Treatment for bleeding in a patient on CoumadinVit K and FFP
- 78When to stop Coumadin prior to surgery7days prior
- 79Platelet levels prior to surgery and after surgeryprior >50,000
after >20,000 - 80Effects of prostate surgery on coagulationIt can release urokinase, activate plasminogen and cause thrombolysis
- 81Best way to predict bleeding riskH&P
- 82MC congenital hypercoagulability disorderFactor Leiden V Mutation
- 83Effects of Factor Leiden V mutationcauses venous thromboses
resistance to activated protein C
defect on Factor V - 84Tx for Factor Leiden V mutationheparin, warfarin
- 85Effects of hyperhomocysteinemia and treatment for ithypercoagulability
Tx: folic acid and B12 - 86Prothrombin gene defect G20210Agene mutation in which a guanine (G) is changed to a adenine (A) at position 20210
in prothrombin gene
causes DVT and PE - 87Treatment of G20210AHeparin, Warfarin
- 88Treatment of Protein C or S deficiencyHeparin, Warfarin
- 89Polycythemia VeraBM overproduction
can get thrombosis - 90What platelet and Hct levels are expected in patients with Polycythemia Vera prior to surgery?Hct <48
Platelets <400 - 91Treatments for Polycythemia VeraPhlebotomy
ASA
Hydroxyurea - 92Symptoms with Anti-phospholipid antibody syndromethromboses and loss of pregnancy
- 93Antibodies associated with anti-phospholipid antibody syndromecardiolipin (mitochrondria)
lupus anticoagulant (cell membrane) - 94Diagnostic Tests for Anti-phospholipid Ab Syndrome (not antibodies)prolonged PTT, not corrected with FFP
(+) Russell viper venom time
false positive RPR - 95Treatment for anti-phospholipid antibody syndromeheparin, warfarin
- 96MC factor for acquired hypercoagulabilityTOBACCO
- 97Name 10 Causes of Acquired Hypercoaguable statesTobacco, Malignancy, Inflammatory States, IBD, Infections, OCP, Pregnancy, RA,
Post-op patients, myeloproliferative disorders - 98Warfarin-induced skin necrosiswhen someone is on Coumadin without being heparinized first, d/t short t1/2 of proteins C&S.
Esp. in protein C deficiency patients - 99Tx of Warfarin-induced skin necrosisheparin, otherwise best to just prevent with heparin before starting
- 100Virchow's Triadelements for venous thromboses
stasis, endothelial injury, hypercoagulability - 101Key element in the development of arterial thrombosisEndothelial injury
- 102Indications for IVC filter placementcontraindications for A/C
PE while on A/C
free-floating IVC, ilio-femoral or deep femoral DVT
recent pulmonary embolectomy - 103How to treat someone for DVT post-op 1st time? 2nd time? 3rd time?1st: Warfarin x 6mon
2nd: warfarin x 1 year
3rd/significant PE: warfarin lifetime - 104MC origin for PEilio-femoral region
- 105Aminocaproic Acid (amicar) MoAinhibits fibrinolysis by inhibiting plasmin
- 106When to use Aminocaproic AcidDIC, persistent bleeding following cardiopulmonary bypass,
thrombolytic overdoses - 107MoA of Warfarinprevents vitamin-K dependent decarboxylation of glutamic residues on vitamin K dependent factors
- 108List 3 direct thrombin inhibitors (PO)Dabigatran (Pradaxa)
Apixiban (Eliquis)
Rivaroxaban (Xarelto) - 109How do sequential compression devices (SCDs) work?improve venous return and induce fibrinolysis with compression (releases tPA from endothelium)
- 110How to reverse heparinProtamine
- 111Half-life of heparin60-90minutes
- 112How is heparin cleared from the system?Reticuloendothelial System (spleen, macrophages)
- 113Protamine ReactionCan occur in patients who are on NPH insulin or previous protamine exposure.
HoTN, Bradycardia, decreased heart fx - 114which anticoagulant is safer to use in pregnancy? and why? Heparin or WarfarinHeparin, it does not cross the placental barrier
- 115Low Molecular Weight HeparinEnoxaparin
lower risk of HIT compared to unfractionated
binds and activated antithrombin-III
increases neutralization of Factor Xa - 116Argatrobanreversible direct thrombin inhibitor
metabolized by proteinase enzymes in blood
half-life is 50minutes - 117Bivalirudin (Angiomax)reversible direct thrombin inhibitor, metabolized by proteinase enzymes in blood
half-life is 25minutes - 118Hirudin (Hirulog)From Leeches
irreversible direct thrombin inhibitor
Most potent direct inhibitor of thrombin - 119AncrodMalayan pit viper venom
stimulates tPA release - 1203 thrombolyticstPA
Streptokinase
Urokinase - 121Absolute Contraindications for Thrombolyticsactive internal bleeding; recent CVA or Neurosurgery (<3mo); intracranial pathology, recent GI bleed
- 122Major Contraindications to Thrombolytic UseRecent (<10d) surgery, organ biopsy, or obstetric delivery, left heart thrombosis, active peptic ulcer, recent major trauma, uncontrolled HTN, recent eye surgery
- 123Minor Contraindications to Thrombolyticsminor surgery, recent CPR, AFib with mitral valve disease, bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, pregnancy
Información
- Descripción
- Surgery - Absite Review Fichas sobre Hematology - Absite, creado por Jennifer Huber el 29/05/2018.
- Creado por
- Jennifer Huber
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