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