Term
| Liver Disease results in the _____ production of coagulation factors |
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Definition
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Term
| Liver Disease results in Impaired removal of _____, ____ ____, or ____ |
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Definition
Inhibitors
Activated Factors
FSP |
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Term
Diagnostic Lab Tests:
Increased PT, APTT
Decreased PLTs
Liver Function Tests abormal |
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Definition
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Term
| ______ is often the cause of death in severe cases of Liver Disease |
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Definition
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Term
| Immature liver of newborns can cause them to have ___ ___ of ____ |
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Definition
| hemorrhagic disease of newborn |
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Term
| This hemorrhagic disease of newborn is caused by a deficiency in |
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Definition
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Term
| All preemies should be given what substance? |
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Definition
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Term
Other causes of ___ ___ ___:
Malabsorption
Antibiotic therapy - wipes out flora
Diet (Rare) |
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Definition
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Term
Laboratory findings:
Increased PT
APTT Increased to a lesser extent
Factors II, VII, IX, X deficient |
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Definition
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Term
| Which factors will be deficient in Vitamin K Deficiency |
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Definition
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Term
| 2 Types of Inhibitors of the coagulation process |
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Definition
Specific circulating anticoagulants
Non-specific circulating anticoagulants |
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Term
| Specific circulating anticoagulants are ___ __ _ ___ ___ |
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Definition
| specific to a certain factor |
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Term
| Non-specific circulating anticoagulants will interfere with the ___ _ __ ___ ___ ___ |
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Definition
| cascade or will react with phospholipids |
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Term
| Use ___ ___ to screen for Inhibitors |
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Definition
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Term
| Use ___ ___ to confirm for Inhibitors |
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Definition
|
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Term
| Most commonly the Specific circulating anticoagulant will be targeting |
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Definition
| Clotting portion of factor VIII |
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Term
| Most likely to see Specific Circulating Anticoagulants in patients who are |
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Definition
|
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Term
| AKA Lupus anticoagulants (LA) |
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Definition
| Non-Specific Circulating Anticoagulants |
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Term
Usually does not cause bleeding issues but will cause clotting issues.
More patients have an autoimmune disorder |
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Definition
| Non-Specific Circulating Anticoagulants |
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Term
| Non-Specific: Spontaneously occurring ABY that reacts against _______ |
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Definition
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Term
T or F: Non-Specific Circulating Anticoagulants
APTT is elevated and does NOT correct with normal plasma |
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Definition
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Term
| Interfere with the clotting mechanism of the blood by blocking one or more of the factors in the coagulation cascade |
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Definition
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Term
| What does Anticoagulant Therapies prevent? |
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Definition
| Formation of additional blood clots |
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Term
| Responsible for gamma-carboxylation of a series of glutamic acids causing coagulation proteins to bind ionic calcium and cell membrane phospholipids |
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Definition
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Term
| Vitamin K antagonist that suppresses the gamma-carboxylation of glutamic acid |
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Definition
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Term
| Warfarin takes ____-____ hours to work |
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Definition
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Term
| Warfarin affects factor ___ first |
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Definition
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Term
| After affective factor VII, Warfarin will then affect __, __, __ |
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Definition
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Term
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Definition
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Term
| Use for deep vein thrombosis, pulmonary embolus, and prophylaxis for hip surgery |
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Definition
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Term
| Warfarin is orally administered to patients requiring long term therapy and as a ____ for those prone to clots |
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Definition
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Term
| PT should be __-___ times the baseline for Therapeutic monitoring or Warfarin |
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Definition
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Term
| _____ standardizes different reagents |
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Definition
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Term
|
Definition
| International normalized ratio |
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Term
| ______ action is mostly anti-thrombin |
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Definition
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Term
| Heparin combines with _____ to inhibit thrombin |
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Definition
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Term
Used primarily in:
Acute thromboembolism
Pulmonary embolism
Acute MI |
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Definition
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Term
| Start ___ and ___ together when clot diagnosis occurs |
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Definition
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Term
| When ______ increases, discontinue Heparin |
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Definition
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Term
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Definition
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Term
| Therapeutic level of Heparin is APTT __ - __ times baseline |
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Definition
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Term
| Heparin should not be given longer than ____ days |
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Definition
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Term
| Most serious disorder in the developed countries |
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Definition
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Term
| Most heart attacks and strokes are ___ ___ ___ |
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Definition
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Term
| Activation of _____ to form ___ ___ occurs at inappropriate time or place (thrombosis) |
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Definition
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Term
| When ____ occurs there is a breakdown in balance between coagulation and its inhibition |
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Definition
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Term
| Thrombosis is most often due to a |
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Definition
| lack of proper inhibitors to coagulation |
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Term
| Culmination of physical, biochemical, and possibly infectious assaults to the artery can lead to the development of |
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Definition
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Term
| Pathology is now centered on tissue damage as a result of the occlusion - AKA |
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Definition
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Term
| Due to abnormalities of vessel wall or alterations found in rapid blood flow |
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Definition
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Term
| Arteriosclerosis or plaque formation results from |
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Definition
| platelets interacting with endothelial cells damaged and separated by rapid blood flow or lipid deposits |
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Term
| White clots are composed of ___ and ___ |
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Definition
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Term
|
Definition
|
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Term
| Biggest problem of Arterial Thrombosis |
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Definition
| occlusion and lack of O2 to tissue past the clot |
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Term
| Treat patient with ______ to inhibit platelets (Arterial Thrombosis) |
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Definition
|
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Term
| Occurs with slow blood flow that traps RBCs causing a red clot |
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Definition
| Venous Thrombosis (DVT & PE) |
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Term
| Venous Thrombosis is associated with ____ or blood |
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Definition
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Term
| ______ is the biggest problem of Venous Thrombosis |
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Definition
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Term
| Venous Thrombosis is secondary to |
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Definition
| damaged tissue releasing thromboplastin and starting coagulation |
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Term
| Up to ______ people die each year from PE |
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Definition
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Term
| _____ of those who have hip surgery will die of PE/year |
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Definition
|
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Term
| 4 Inherited Factors affecting Excess Blood Clotting |
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Definition
ATIII deficiency
Protein C & S deficiencies
Factor V-Leiden mutation
Prothrombin Variant |
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Term
| ____ forms irreversible complex with protease stopping coagulation |
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Definition
|
|
Term
| 80% of ___ ___ ___ is by AT-III |
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Definition
| serine protease inhibition |
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Term
| Inactivation of AT-III is increased 2000-fold by |
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Definition
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Term
| If a patient is deficient in AT-III, ____ does NOT work in standard doses for clots |
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Definition
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Term
| Why does Heparin not work when AT-III is deficient? |
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Definition
| Nothing for Heparin to bind to |
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|
Term
| May use ______ concentrate in patients with sepsis induced DIC |
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Definition
|
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Term
| Protein C & S are ____ ___ ___ ___ |
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Definition
| Vitamin K Dependent proteins |
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Term
| What activates protein C to Activated Protein C (APC)? |
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Definition
| Thrombomoduling/thrombin complex on endothelial surface |
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Term
| Protein C and S Deficiencies are ____ deficiencies of both proteins |
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Definition
|
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Term
| Use what to measure Protein C & S Deficiencies? |
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Definition
Immunologic (ELISA)
Functional assays |
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Term
| APC inhibits coagulation by binding to which 2 factors? |
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Definition
|
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Term
| Protein ____ is a co-factor for the APC inhibition reaction |
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Definition
|
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Term
| T or F: People with Protein C & S Deficiencies should NOT take oral contraceptives |
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Definition
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Term
| T or F: People with Protein C & S Deficiencies may take coumadin for the rest of their life |
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Definition
|
|
Term
| Factor V-Leiden Mutation is ____ common than C, S, or AT-III deficiencies |
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Definition
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|
Term
| Normally Factor V is converted to ____ |
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Definition
|
|
Term
|
Definition
| cofactor for Xa that converts fibrinogen to fibrin |
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Term
| As thrombin is generated it activates protein C that in turn shuts does coagulation by cleaving ___ and ____ |
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Definition
|
|
Term
| For Factor V-Leiden Mutation, factor V works find to form the clot but is resistant to ____ _ _____ _ |
|
Definition
|
|
Term
| Factor V-Leiden Mutation leads to a |
|
Definition
|
|
Term
| Normally, the APTT is ______ in the presence of APC due to its anticoagulant activity |
|
Definition
|
|
Term
| Those who are deficient in Factor V will ___ ___ ___ ___ ___ |
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Definition
| NOT have a prolonged APTT |
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|
Term
| Factor V is _______ to APC |
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Definition
|
|
Term
| Factor V-Leiden Mutation Confirmation testing is with |
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Definition
|
|
Term
| ____ is the leading cause of inherited hypercoagulable state |
|
Definition
|
|
Term
| Those with the Factor V-Leiden Mutation should take ______ for life |
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Definition
|
|
Term
| A nucleotide substitution at position 20210 in the prothrombin gene causes an elevation of prothrombing leading to increased thrombosis |
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Definition
|
|
Term
| Only available test for Prothrombin Variant is |
|
Definition
|
|
Term
| Non-Inherited Factors related to Excess Clotting |
|
Definition
Lipoprotein (a) or Lp (a) resembles LDL
C reactive protein
Homocysteine
Oral contraceptives
Lupus anticoagulants
Malignancy
Pregnancy
Trauma |
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|
Term
| May compete with plasminogen in the regulation of fibrinolysis |
|
Definition
| Lipoprotein (a) or Lp (a) |
|
|
Term
Blocks plasmin generation
Helps deposit cholesterol to the injured vessel |
|
Definition
|
|
Term
| Only pharmaceuticals will reduce ___ and ___-____ ____ |
|
Definition
niacin
post-menopausal estrogen |
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|
Term
|
Definition
|
|
Term
| Studies indicate _______ is a chronic inflammatory disease |
|
Definition
|
|
Term
| Formed in the metabolism of dietary methionine |
|
Definition
|
|
Term
| Formation of homocysteine is regulated by 3 enzymes, if any of the enzymes are deficient, homocysteine will |
|
Definition
|
|
Term
| Dietary deficiencies of ___ __, __, and __ __ can contribute to increased levels of homocysteine in those with the genetic variations |
|
Definition
| vitamin B6, B12, and folic acid |
|
|
Term
|
Definition
|
|
Term
| T or F: Higher risk of heart attack or venous thrombosis is compounded when two factors are present - Leiden plus homocysteine |
|
Definition
|
|
Term
| Oral contraceptives increase which factors? |
|
Definition
|
|
Term
| T or F: Oral contraceptives - fibrinolysis decreases |
|
Definition
|
|
Term
| Many of the found ABYs (Lupus Anticoagulants Anti-Phospholipid Syndrome) are anti-cardiolipin ABYs- these interefere with |
|
Definition
| in-vivo phospholipid-dependent clotting assays |
|
|
Term
| Lupus Anticoagulants Anti-Phospholipid Syndrome Causes |
|
Definition
| venous and arterial clotting, spontaneous abortion, and fetal demise in women |
|
|
Term
| APTT is going to be _____ in test analysis of Lupus Anticoagulants Anti-Phospholipid Syndrome |
|
Definition
|
|
Term
| Screen Lupus Anticoagulants Anti-Phospholipid Syndrome with ___ ____ |
|
Definition
|
|
Term
| With the 50:50 Mix of patient plasma and normal plasma if there is a factor deficiency is will become |
|
Definition
|
|
Term
| With the 50:50 Mix of patient plasma and normal plasma if there is LA |
|
Definition
| the ABY will inactivate the phospholipid in the normal plasma so APTT will remain elevated |
|
|
Term
Diagnosis Criteria:
Increased APTT
must be evidence of an inhibitor
Inhibitor must be phospholipid dependent
Inhibitor must be confirmed |
|
Definition
| Lupus Anticoagulants Anti-Phospholipid Syndrome |
|
|
Term
Confirmation test:
Tissue Thromboplastin Inhibition Test
Dilute Russell viper venom time
Platelet neutralization procedure |
|
Definition
| Lupus Anticoagulants Anti-Phospholipid Syndrome |
|
|
Term
| High number of those in trauma unit develop |
|
Definition
|
|
Term
| ___ is only one to dissolve clot by activating plasminogen to plasmin for clot lysis (by passes fibrinogen) |
|
Definition
|
|
Term
| Acquired Defects are _____ common than genetic disorders |
|
Definition
|
|
Term
T or F:
With Acquired Defects often more than one factor is involved |
|
Definition
|
|
Term
| 6 Types of Acquired Defects |
|
Definition
DIC
Liver Disease
Vitamin K deficiency
Inhibitors
Anticoagulant therapy
Thrombosis |
|
|
Term
| Inappropriate, uncontrolled fibrin formation throughout the body, not in a localized area |
|
Definition
| Disseminated Intravascular Coagulation Consumption Coagulopathy |
|
|
Term
T or F:
DIC - something other than vessel injury or trauma is causing coagulation to start |
|
Definition
|
|
Term
|
Definition
PLTs are caught in fibrin
Factors I, V, VIII, XIII are consumed
Activation of lytic system with increased FSP |
|
|
Term
| 5 Causes of Initial Clotting in DIC |
|
Definition
Tissue or blood cell injury
Endothelial injury
Sepsis
Obstetrical problems
Trauma |
|
|
Term
| Thromboplastin-like substance activates extrinsic pathway (factor ____) |
|
Definition
|
|
Term
Endothelial injury:
Activates intrinsic pathway (factor ______) |
|
Definition
|
|
Term
| Sepsis-toxins damage endothelium (factor ____) |
|
Definition
|
|
Term
Clinical Presentation:
Thrombosis - blocks vessels
Bleeding - factors and plts are consumed |
|
Definition
|
|
Term
| T or F: Chronic DIC from malignant will have fewer symptoms than other disorders |
|
Definition
|
|
Term
Laboratory Diagnosis:
Decreased PLT count
Schistocytes
Increased PT, APTT, TT
Decreased firbinogen
Increased FSP |
|
Definition
|
|
Term
|
Definition
Support Therapy - plt and blood products
Heparin
Rarely use fibrinolysis inhibitors
Remove underlying problem |
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|
