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Coagulation Factors and Disorders

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Term
Definition
Prolonged APTT with normal PT and TT   Deficiency of Factor XII, XI, IX, VIII  
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Prolonged PT with normal APTT and TT   Factor VII deficiency  
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Prolongation of APTT and PT with normal TT   Factor X, V or II deficiency, patients receiving Warfarin or with liver disease  
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Prolongation of APTT, PT and TT   Heparin therapy (activated antithrombin III) or a complex deficiency state (DIC, abnormal fibrinogen, fibrinogen deficiency)  
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Dense platelet granules contain...   Calcium and ADP  
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Alpha granules   Secondary mediators of coagulation  
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Primary platelet activation   Platelet monolayer attached to vWF or collagen on the subendothelial layer  
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Secondary platelet activation   Release of calcium, ADP and synthesis of thromboxane A2 to activate surrounding platelets. Cross-linking with fibrinogen  
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Von Willebrand's Factor   Large multimeric protein found in the subendothelium, made by the endothelium. Carrier for FVIII in the blood  
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Desmopressin   Releases vWF from endothelial cells for the treatment of vWF deficiency  
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Factor V and VIII   Clotting cofactors  
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Coagulation cascade: Initiation   Release of TF, binds FVII in blood, activates FX which causes the production of a small amount of thrombin  
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Coagulation cascade: Amplification   Positive feedback by thrombin activates extrinsic pathway  
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Coagulation cascade: Clot Formation   Large amounts of thrombin are present, fibrinogen is broken down to fibrin monomers.  
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Antithrombin III   Directly inactivates thrombin and FX  
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Tissue plasminogen activator   Released when a clot is formed, or conditions that promote clotting (stasis, hypoxia). Converts plasminogen to plasmin  
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Mucocutaneous bleeding   vWF deficiency, platelet dysfunction  
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Haemarthrosis   Haemophilia  
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Purpura   Thrombocytopenia  
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Bleeding into hair follicles, gingival bleeding   Scurvy  
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Telangiectasia   Vascular abnormality (hereditary haemorrhagic telangiectasia)  
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Venous thrombosis   Fibrin based (surgery, trauma, pregnancy, cancer)  
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Arterial thrombosis   Platelet based (smoking, diabetes, hyperlipidaemia, obesity)  
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Venous stasis eczema   Complication of deep vein thrombosis and varicose veins  
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Normal prothrombin time   12-13 seconds  
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Normal INR   1  
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Normal INR on patient on warfarin   2-3.5  
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Mildly prolonged APTT   vWF deficiency (FVIII low)  
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50:50 plasma mix does not correct APTT   Clotting factor inhibitor  
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Binding site of unfractionated heparin   Thrombin and Xa  
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Binding site of LMWH   Factor Xa  
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Factors that decrease effectiveness of warfarin   High intake of green leafy vegetables, administration of vitamin K  
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Factors that inctrase effectiveness of warfarin   Poor diet, antibiotics (roxithromycin), NSAIDs, liver disease or congestion  
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Dabigatron   Thrombin inhibitor  
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Haemophilia A   X-linked recessive deficiency of Factor VIII  
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Haemophilia B   X-linked recessive deficiency of Factor IX  
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Severe haemophilia   <1% of normal factor levels  
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Mild haemophilia   >5% of normal factor levels  
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Moderate/severe haemophilia   3-5% of normal factor levels  
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Treatment of mild haemophilia A   Desmopressin  
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vWF Disease   Autosomal dominant inheritance (not complete penetrance) in 1% of population.  
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Delayed bleeding   Clotting factor deficiency (haemophilia), chronic liver disease, warfarin or heparin therapy  
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Immediate bleeding   Platelet problem - thrombocytopenia, vWF deficiency, NSAID, corticosteroid use (vascular fragility)  
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Transexamic acid   Anti-fibrinolytic drug that stabilises clots. Used for dental surgery in high risk patients, menorrhagia in vWF disease, trauma  
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Clotting factors made in the liver   I, II, V, VII, IX, X, XII  
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Thrombocytopenia in liver disease   Toxic effect of alochol on megakaryocytes  
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Pulmonary embolism   Dyspnoea, pleuritic chest pain  
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Decreased platelet count with deficiency of all clotting factors   Disseminated intravascular coagulopathy  
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D-dimers   Breakdown products of fibrin, marker of fibrin formation in vivo and its subsequent breakdown by plasmin  
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Risk of spontaneous coagulation   INR>5  
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