Hematology - Absite

Description

Surgery - Absite Review Flashcards on Hematology - Absite, created by Jennifer Huber on 05/29/2018.
Jennifer Huber
Flashcards by Jennifer Huber, updated more than 1 year ago
Jennifer Huber
Created by Jennifer Huber almost 6 years ago
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Resource summary

Question Answer
What are the 3 initial responses to vascular injury? vascular vasoconstriction platelet adhesion thrombin generation
Intrinsic Pathway contact activation pathway most often initiated when factor XII (Hageman factor) Activates VIII, IX, XI
Extrinsic Pathway tissue factor pathway quicker responding and more direct releases Factor III + Ca Factor VII is activated
Common Pathway Intrinsic and Extrinsic converge with Factor X. Fibrin is produced to seal off the vessel
Prothrombin Complex X, V, Ca, Platelet factor 3, prothrombin forms platelets catalyzes formation of thrombin
What does fibrin do? links platelets together(binds GpIIb/IIIa molecules) to form platelet plug hemostasis
What does Factor XIII do? helps cross-link fibrin
Effects of Thrombin Fibrinogen --> Fibrin + split products Activates factors V and VIII Activates platelets
Effects of Antithrombin III Binds and inhibits Thrombin Inhibits factors IX, X & XI
Effects of Heparin on Antithrombin III heparin activated antithrombin III up to 1000x normal activity
Protein C Vitamin K dependent degrades factors V and VIII degrades fibrinogen
Protein S vitamin K dependent protein C co-factor
Molecules associated with fibrinolysis tissue plasminogen activator plasmin alpha-2 antiplasmin
Tissue Plasminogen Activator released from endothelium and converts plasminogen to plasmin
Plasmin degrades factors V and VIII, fibrinogen and fibrin. Lose Platelet Plug
Alpha-2 Antiplasmin Natural Inhibitor of Plasmin released from endothelium
Factor with the shortest half-life Factor VII
What factors are lost in stored blood but not FFP? Factor V and VIII
Which factor is not synthesized in the liver? Where is it synthesized? Factor VIII, it is synthesized in the endothelium along with vWF
Which Factors are Vitamin K dependent? II, VII, IX, and X; protein C and S
How long does it take for Vitamin K in IV form take to have an effect? 12 hours
What is Factor II? Prothrombin
Normal half-life of RBC 120days
Normal half-life of platelets 7 days
Normal Half-life of PMNs 1-2days
Prostacyclin - where is it from? - what effects does it have? from endothelium decreases platelet aggregation promotes vasodilation antagonistic to TXA2 increases cAMP in platelets
Thromboxane (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
GpIIb/IIIa receptor when activated, causes platelet-to-platelet binding
GpIb Receptor When activated, platelet-to-collagen binding
Cryoprecipitate - 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
FFP Fresh Frozen Plasma high levels of all coagulation factors protein C+S, AT-III
DDAVP and conjugated estrogens release which factors? causes release of Factor VIII and vWF from endothelium
What does prothrombin time (PT) measure? Factors II, V, VII, and X Fibrinogen best for liver synthetic function
What 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
Activated Clotting Time we want for routine A/C vs for cardiopulmonary bypass routine ACT: 150-200sec Cardiopulm Bypass ACT: >480sec
relative contraindication to performing surgical procedures (INR) >1.5
Relative contraindication for placing a central line, percut. needle biopsies, and eye surgery INR >1.3
MCC of surgical bleeding incomplete hemostasis
MC congenital bleeding disorder von Willebrand's Disease
MC symptom associated with vWD epistaxis
Which type(s) of vWD are autosomal dominant? Type I and II
Which type(s) of vWD are autosomal recessive? Type III
Effects of vWF links GpIb receptor on platelets to collagen
Effects of vWD on PT and PTT PT normal PTT normal or abn
Effects of vWD on bleeding time Long bleeding time Ristocetin Test
MC type of vWD Type I, mild symptoms
Which type of vWD is most severe? Type III
What is Type I vWD? and it's treatment reduced quantity of vWF Tx: recombinant VIII:vWF, DDAVP, cryoprecipitate mostly DDAVP
What is Type II vWD? what is its treatment? defect in vWF molecule, vWF doesn't work well Tx: recombinant VIII:vWF, cryoprecipitate and DDAVP
what is Type III vWD? Treatment? complete vWF deficiency Tx: Recombinant VIII:vWF, cryoprecipitate NOT: DDAVP
What is Hemophilia A? MC symptom? VIII deficiency Sex-linked recessive MC symptom: hemarthrosis
PT and PTT in Hemophilia A PT: normal PTT: prolonged, follow this 8hrs after surgery
What to do for Hemophiliac joint bleeding ice, keep joint mobile, factor VIII concentrate or cryoprecipitate
Treatment for Hemophiliac epistaxis, ICH, or hematuria recombinant factor IX or FFP
Hemophilia B and treatment IX Deficiency, Christmas Dx sex-linked recessive Tx: recombinant factor IX or FFP
PT and PTT in Hemophilia B PT: normal PTT: prolonged
Factor VII deficiency PT & PTT, and treatment PT: prolonged PTT: normal bleeding tendency Tx: recombinant factor VII or FFP
Symptoms associated with Platelet Disorders bruising, epistaxis, petechiae, purpura
What can cause acquired thrombocytopenia H2 blockers Heparin
What is Glanzmann's Thrombocytopenia? Its treatment GpIIb/IIIa-R deficiency on plts platelets can't bind together Tx: platelets
Bernard Soulier and its treatment GpIb-R Deficiency on platelets cannot bind to collagen Tx: platelets
Uremia and its effect on platelets Treatment BUN >60-80 inhibits plt fxn, mainly but inhibiting release of vWF Tx: HD, for acute reversal use DDVAPm cryoprecipitate for moderate to severe bleeding
Antibody associated with HIT syndrome anti-heparin antibodies or IgG heparin-PF4 antibody
Difference between HIT and HITT HIT: heparin induce thrombocytopenia HITT: thrombosis
Clinical Signs of HIT Platelets <100 or drop in platelets >50% admission levels or thrombosis while on heparin
Type a clot that is formed associated with HIT syndrome white clot
Diagnostic Testing for HIT syndrome ELISA for heparin Abs Serotonin Release Assay
Treatment of HIT syndrome stop heparin start agatroban (direct thrombin inhibitor) avoid giving plts
What 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
Treatment for DIC treat the underlying cause
When do you stop aspirin before surgery? 7days before surgery
MoA and Effects of aspirin inhibits cyclooxygenase in plts and decreases TXA2 Causes prolonged bleeding time
When to Stop Clopidogrel (Plavix) before surgery 7 days prior to surgery
MoA of clopidogrel ADP receptor antagonist
How to treat someone for bleeding while on Clopidogrel/Plavix Platelets
What to do for a patient with coronary stent and need to stop Plavix for elective surgery? bridge with Integrilin (eptifibatide) GpIIb/IIIa inhibitor
Treatment for bleeding in a patient on Coumadin Vit K and FFP
When to stop Coumadin prior to surgery 7days prior
Platelet levels prior to surgery and after surgery prior >50,000 after >20,000
Effects of prostate surgery on coagulation It can release urokinase, activate plasminogen and cause thrombolysis
Best way to predict bleeding risk H&P
MC congenital hypercoagulability disorder Factor Leiden V Mutation
Effects of Factor Leiden V mutation causes venous thromboses resistance to activated protein C defect on Factor V
Tx for Factor Leiden V mutation heparin, warfarin
Effects of hyperhomocysteinemia and treatment for it hypercoagulability Tx: folic acid and B12
Prothrombin gene defect G20210A gene mutation in which a guanine (G) is changed to a adenine (A) at position 20210 in prothrombin gene causes DVT and PE
Treatment of G20210A Heparin, Warfarin
Treatment of Protein C or S deficiency Heparin, Warfarin
Polycythemia Vera BM overproduction can get thrombosis
What platelet and Hct levels are expected in patients with Polycythemia Vera prior to surgery? Hct <48 Platelets <400
Treatments for Polycythemia Vera Phlebotomy ASA Hydroxyurea
Symptoms with Anti-phospholipid antibody syndrome thromboses and loss of pregnancy
Antibodies associated with anti-phospholipid antibody syndrome cardiolipin (mitochrondria) lupus anticoagulant (cell membrane)
Diagnostic Tests for Anti-phospholipid Ab Syndrome (not antibodies) prolonged PTT, not corrected with FFP (+) Russell viper venom time false positive RPR
Treatment for anti-phospholipid antibody syndrome heparin, warfarin
MC factor for acquired hypercoagulability TOBACCO
Name 10 Causes of Acquired Hypercoaguable states Tobacco, Malignancy, Inflammatory States, IBD, Infections, OCP, Pregnancy, RA, Post-op patients, myeloproliferative disorders
Warfarin-induced skin necrosis when someone is on Coumadin without being heparinized first, d/t short t1/2 of proteins C&S. Esp. in protein C deficiency patients
Tx of Warfarin-induced skin necrosis heparin, otherwise best to just prevent with heparin before starting
Virchow's Triad elements for venous thromboses stasis, endothelial injury, hypercoagulability
Key element in the development of arterial thrombosis Endothelial injury
Indications for IVC filter placement contraindications for A/C PE while on A/C free-floating IVC, ilio-femoral or deep femoral DVT recent pulmonary embolectomy
How 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
MC origin for PE ilio-femoral region
Aminocaproic Acid (amicar) MoA inhibits fibrinolysis by inhibiting plasmin
When to use Aminocaproic Acid DIC, persistent bleeding following cardiopulmonary bypass, thrombolytic overdoses
MoA of Warfarin prevents vitamin-K dependent decarboxylation of glutamic residues on vitamin K dependent factors
List 3 direct thrombin inhibitors (PO) Dabigatran (Pradaxa) Apixiban (Eliquis) Rivaroxaban (Xarelto)
How do sequential compression devices (SCDs) work? improve venous return and induce fibrinolysis with compression (releases tPA from endothelium)
How to reverse heparin Protamine
Half-life of heparin 60-90minutes
How is heparin cleared from the system? Reticuloendothelial System (spleen, macrophages)
Protamine Reaction Can occur in patients who are on NPH insulin or previous protamine exposure. HoTN, Bradycardia, decreased heart fx
which anticoagulant is safer to use in pregnancy? and why? Heparin or Warfarin Heparin, it does not cross the placental barrier
Low Molecular Weight Heparin Enoxaparin lower risk of HIT compared to unfractionated binds and activated antithrombin-III increases neutralization of Factor Xa
Argatroban reversible direct thrombin inhibitor metabolized by proteinase enzymes in blood half-life is 50minutes
Bivalirudin (Angiomax) reversible direct thrombin inhibitor, metabolized by proteinase enzymes in blood half-life is 25minutes
Hirudin (Hirulog) From Leeches irreversible direct thrombin inhibitor Most potent direct inhibitor of thrombin
Ancrod Malayan pit viper venom stimulates tPA release
3 thrombolytics tPA Streptokinase Urokinase
Absolute Contraindications for Thrombolytics active internal bleeding; recent CVA or Neurosurgery (<3mo); intracranial pathology, recent GI bleed
Major Contraindications to Thrombolytic Use Recent (<10d) surgery, organ biopsy, or obstetric delivery, left heart thrombosis, active peptic ulcer, recent major trauma, uncontrolled HTN, recent eye surgery
Minor Contraindications to Thrombolytics minor surgery, recent CPR, AFib with mitral valve disease, bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, pregnancy
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