Chapter 14

what is a normal INR

1

anticoagulant usage should have INR more than

1 ( usually 2-3)

three major steps of hemostasis

1) vasoconstriction 2) platelet plug formation 3) coagulation (clot)

increased activation of the coagulation system is caused by

1. stasis of blood flow 2. procoagulation factors 3. decrease in anticoagulation factors

normal platelet levels

150,000-400,000

the life span of platelets is

7-10 days

Which of the following are NOT commonly associated with bleeding disorders? A: Decreased prothrombin time B: Purpura C: Petechiae D: Bleeding from the gums

A

Which of the following laboratory tests examine clotting time? Select all that apply. A: Prothrombin time B: Activated partial thromboplastin time C: Alanine aminotransferase D: Parathyroid hormone E: Aspartate aminotransferase

A, B

Which of the following is true regarding hemostasis? A: Von Willebrand factor activates fibrin to fibrinogen. B: Platelet plug and clot formation are synonymous. C: Fibrinolysis is the destruction of clots. D: The intrinsic and extrinsic clotting pathways share no common points.

C

clotting time of the intrinsic pathway can be measure by

activated partial thromboplastin time (aPPT)

this is a condition associated w/ the formation of multiple clots.

antiphospholipid syndrome

this is the most common antiplatelet drug

aspirin

main agents to prevent arterial clots area (anticoagulants for venous clots)

aspirin and hydroxyrurea

there is a high prevalence in people with ... for antiphospholipid syndrome

autoimmune disease

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Alcohol abuse and liver damage Clotting disorder OR bleeding disorder

bleeding disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Antibodies against platelets Clotting Disorder OR Bleeding Disorder

bleeding disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Immune Thrombocytopenic Purpura (ITP) Clotting Disorder OR Bleeding Disorder

bleeding disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Petechiae Clotting Disorder OR Bleeding Disorder

bleeding disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Von Willebrand disease Clotting Disorder OR Bleeding Disorder

bleeding disorder

what else is needed for coagulation

calcium and vit K

increase in coag factors: tumor cells may secrete prothrombotic factors

cancer

coagulation is what kind of reaction

cascade

clot formation is balanced by process of

clot dissolution (fibrinolysis)

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Malignant tumors and high estrogen Clotting Disorder OR Bleeding Disorder

clotting disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Primary and secondary thrombocytosis Clotting Disorder OR Bleeding Disorder

clotting disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Smoking and blood flow stasis Clotting Disorder OR Bleeding Disorder

clotting disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Treatments include aspirin and thrombolytic agents Clotting Disorder OR Bleeding Disorder

clotting disorder

This or That? Determine if the characteristics provided are of a clotting disorder or a bleeding disorder. Treatments include heparin and warfarin Clotting Disorder OR Bleeding disorder

clotting disorder

anticoags prolong

clotting time

extrinsic pathway

damage outside vessel

intrinsic pathway

damage to inside of vessel

the following are... (inherited disorders) hemophilia A & B von willebran disease (vWD)

deficiencies in clotting factors

the coagulation pathways are triggered by dif events but do what

end in the same final pathway (synthesizes fibrin)

increase in coag factors: woman 35+ may need to consider other alternatives to oral contraceptives

estrogen

hemostasis has two types of problems associated w/ it

excessive bleeding and clotting

this pathway is stimulated by trauma to a blood vessel occur from external injury (laceration)

extrinsic pathway

secondary hemostasis is

fibrin clot formation

process in which blood clots are dissolved

fibrinolysis

thrombosis is the

generation of an occlusive clot

this suppresses platelet production in bone marrow

hdroxyrurea

the stopping of bleeding

hemostasis

Anticoagulants: these are the characteristics of... activates anti-thrombin (AT) acts to limit the extension of a clot, though it does not prevent clot formation responses vary among people requires careful monitoring with aPTT

heparin

what are the two coag pathways

intrinsic and extrinsic

this pathway is stimulated by tissue damage to the endothelial lining of a blood vessel (inflammation, atherosclerosis) it can also be triggered by stasis of blood (like in AFIB).

intrinsic pathway

the most common acquired deficiency of coag factors occurs in

liver disease (alcoholic cirrhosis)

anticoagulants: these are characteristics of... shorter half-life/fewer side effects than unfractionated heparin activates anti-thrombin (AT) more predictable response usually SUBQ once/twice a day coag monitoring is not required

low molecular weight heparin (LMWH)

what gives rise to platelets

megakaryocytes

enzyme responsible for fibrinolysis

plasmin

primary hemostasis is

platelet plug formation

this is when there's a life-threatening elevation in platelets and they are removed from blood

plateletpheresis

this is used to neutralize bleeding if it occurs on a pt taking heparin *can be given IV and SUBQ

protamine sulfate

step that both pathways end in

the activation of factor x-converts prothrombin to thrombin. and fibrinogen to fibrin

less that 100,000 per microliter is

thrombocytopenia

more that 750,000 per microliter is

thrombocytosis

this is from the liver and stimulates platelet formation.

thrombopoietin.

this can occur in response to injury/ sluggish or stagnant blood flow

thrombus formation

this enzymatically changes plasminogen into plasmin

tissue plasminogen activator tPA

these all describe this which is formed by stasis of blood flow while immobile, sedentary, atrial fibrillation. DVT

venous thrombus formation

In which disorder are fibrin clots formed rapidly, using up coagulation factors, resulting in increased risk of bleeding? A: Primary thrombocytosis B: Immune thrombocytopenic purpura C: Hemolytic-uremic syndrome D: Disseminated intravascular coagulation

D

Which of the following may increase the risk of clotting? A: Use of heparin B: Thrombocytopenia C: Hemophilia diagnosis D: Primary thrombocytosis

D

DVT can cause what

PE

since anti coags prolong clotting time, these should be higher than normal

PT, INR, aPTT

the clotting time of the extrinsic pathway can be measured by

Prothrombin time (PT) or the international normalized ratio (INR)

some coag factors require this for normal function. this deficiency can cause the liver to produce dysfunctional clotting factors

Vit K