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absite heme

what's initial response to vascular injury vasoconstrict, plt adhesion, thrombin generation
steps of intrinsic coag pathway exposed collagen, prekallikrein, HMW kininogen+F12 ->11,9,8 then 10 and 5 (then common)
steps of extrinsic coag pathway tissue factor from injured cells+F7 -> 10 and 5
common steps of intrinsic/extrinsic pathway 10/5 converts prothrombin (F2) to thrombin, which converts fibrinogen to fibrin
components of prothrombin complex F10,5, platelet factor, Ca++, prothrombin --> this then catalyzes thrombin
what does tissue factor inhibitor do inhibits F10
plt plug composed of plts and fibrin
what does F13 do crosslink fibrin
what does thrombin do (2) converts fibrinogen to fibrin and fibrin spit products, activates plts
what does AT3 do inhibits thrombin, inhibits F9,10,11…key bc heparin binds to this
what does protC do degrades F5,8 and fibrinogen
what does protS do protC cofactor
what are steps of fibrinolysis tissue plasminogen activator (TPA) is rel from endothel and converts plasminogen to plasmin, that degrades F5,8,fibrinogen and fibrin that causes plt plug to degrade
what is alpha2 antiplasmin inhibitor of plasmin, released from endothelium
which coag F has shortest t1/2 F7
which coag factor not synthesized in liver F8
which factors are labile and lost in stored blood but not FFP F5,8
vit K dependent factors F2,7,9,10, prot C,S
how long does FFP coagulation last 6hrs and effect is immediate
prothrombin is aka F what? F2
t1/2 of RBC 120d
where is prostacyclin made? Role? Aka, what does it antagonize PGI2, endothelium, decreases plt aggreg and promotes vasodilation (antagonizes TXA2)
where is TXA2 made? Role? Aka, what does it antagonize plts, increases plt aggreg and vasoconstrict, triggers rel of Ca++ in plts exposes GpIIb/IIIa and causes plt-plt binding and plt-coll binding; activates PIP to further incrs Ca++
when use Cryoppt VWD and hemoA bc VWF and F8
what's in FFP basically all coag factors, AT3
what do DDAVP and conjugated estrogens do? cause rel of F8 and VWF from endothel
PT measures which factors extrinsic, 7 + common 2 (prothrombin), 5, 10, fibrinogen
PTT measures which factors most F exc 7, 13
goal PTT for most anticoag 60-90
ACT for most anticoag, for CPB 150-200, 460
INR contraindication for surgery; INR for central line, perQ needle bx, eye surgery 1.5; 1.3
4common causes incrsd PTT Hemophilia A, VWD, DIC (also incrsd PT, BT, etc), anticardiolipin but won't correct w mixing
common causes incrsd PT liver dz, DIC (also warfarin)
what does thrombin time measure fibrinogen
when is ristocetin plt aggreg decrsd vWD, Bernard Soulier
when is ADP, epi, collagen time abnl Glanzmann
MC causes abnl bleeding incomplete hemostasis
what does VWF do link GpIb R on plts to collagen
labwork in VWD nl PT, long BT, ristocetin test abnl and does resolve w plasma
VWDI and tx I: AD, MC, mild sympt w decrsd quantity VWF, tx=DDAVP
VWDII and tx AD, defect in molecule itself, tx: recombinant F8;vWF, cryo
VWDIII and tx AR, more severe bleeding, reduced quantity, tx=DDAVP, recombinant, cryo
labwork in HemoA, which F defic? long PTT, F8 defic (but this F crosses placenta so circumcision could be nml)
what levels req'd HemoA preop, postop preop need be 100%, post op 30%
what is christmas dz hemoB (F9) defic
inheritence HemoB sexlinked recessive (like HemoA)
tx HemoB recombinant F9 or FFP
labwork in F7 defic long PTT, nml PT
tx F7 defic F7 concentrate, FFP
at what level of F7 defic does spont bldg occur <1%
2 MC causes of acquired thrombocytopenia H2 blockers, heparin
problem in Glanzmann's, tx GpIIb/IIIa so plts can't bind to ea other, tx=plts
problem in Bernard-Soulier, tx GpIb plts can't bind to coll, tx=plts
how ticlodipine works, tx decrses ADP in plts, prevents exposure of GpIIB/IIIA (for plt aggreg), tx=plts
how dipyridamole works, tx inhibits cAMP ->decrses ADP induced plt aggreg, tx=plts
how pentoxifylline works, tx inhibits plts aggreg; tx=plts
how does clopidogrel (Plavix) work ADP R antagonist, tx=plts
how do PCN and cephalo affect plts binds plt so can incrs bldg time
what plt# nec before surgery, after 50K before, 20K after
what happens to coag s/p prostate surgery, why? Tx? rel of urokinase activates plasminogen leading to thrombolysis, tx=amicar
best way to predict bldg risk H&P
which Ab is in HIT IgG PF4 ab to plts
characteristics of DIC (labwork); tx low fibrinogen, high fibrin split products, high D dimer, decrsd plt, long PT and PTT…often initiated by tissue factor. Tx=underlying cause
MC hypercoag inherited F5 leiden, resistance to activated prot C
tx F5 leiden heparin, warfarin
name 7 hypercoag states F5Leiden, hyperhomocysteinemia, prothrombin defect, Prot C/S, AT3 defic, polycythemia vera, Lupus
tx AT3 defic can't use hep, need recombinant AT3 of FFP followed by heparin or hirudin, warfarin
what goal Hct, Plts for Polycythemia vera; tx Hct<48, plts <400; tx=ASA
what is the gene defect in prothrombin G20210A
what's the tx for most inherited procoag; what are the exceptions heparin, warfarin, exc are homocys (folate, b12) and polycyth vera (ASA)
tx for homocysteinemia folate, B12
labwork for lupus anticoag long PTT, +Russell viper venom, false + syphillis RPR
if >55 and venous thrombotic lab/gene w/u negative you should CT scan for cancer
what is w/u arterial thrombosis venous w/u + TTE w bubble looking for shunt, lipid panel and lipoprotein a
what causes hypercoag state s/p CPB F12 (hageman) activation
what is cause of warfarin induced skin necrosis protC and S have short t1/2
key elements of venous thrombosis Virchow's triad: stasis, endothel injury, hypercoag
key element arterial thrombosis endothelial injury
tx DVT depending on whether provoked provoked=3-6mo, unprovoked 1st: 6mo, 2nd 1yr or life
inherited thrombotic dz and no h/o DVT, tx? What if DVT no tx if no DVT, otherwise anti coag
indications greenfield contraindications to anti coag, PE while on anti coag, s/p pul embolectomy, free floating ileofemoral, IVC or femoral DVT
how many of + V/Q have negative U/S 1/3
mech of warfarin prevents vit K dependent decarbosxylation of glutamine residues on vit K dependent coag factors
which crosses placenta: hep or warfarin warfarin
where does hirudin come from? Type of anticoag? leeches, direct thrombin inhibitor
longterm SE heparin osteoporosis, alopecia
protamine cross reacts w what in DM pts NPH insulin
which is a revesible direct thrombin inhib bivalirudin
which pts be careful of argatroban in liver pts
where does ancrod come from? What does it do? from Malayan pit viper venom, stimulates tPA
how does amicar work, when is it used an antifibrinolytic that inhibits plasmin, used in DIC and s/p CPB
name 3 thrombolytics, which has highest antigenicity streptokinase (high Ag), urokinase, tPA
how does dextran work as anticoag inhibits plts and coag factors
how reverse hep (Dose) protamine 1-1.5/100U or 1mg hep
how is hep cleared reticuloendothelial system
Created by: ehstephns
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