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Med Surg: Hem/Onc PPT 3 - Coagulation Disorders
Fall Semester - 2010 (Hem/Onc Test 1)
46
Medical
Graduate
12/02/2010

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Term
What chemicals are released by normal endothelial cells that are adjacent to a clot to help limit the clot formation?
Definition
Thrombin and t-PA
Term
What factor do damaged endothelial cells, platelet adhesion, activation and aggregation encourage the formation of?
Definition
VWF (Von Willebrand Factor)
Term
What is the norm value for platelet count?
Definition
Platelet Count = 150,000 - 350,000
Term
At what platelet value does thrombocytopenia occur?
Definition
Thrombocytopenia occurs at <50,000 platelets
Term
What pathway is activated by tissue damage?
Definition
Extrinsic Pathway
Term
What pathway is activated by damaged blood cells or contact with foreign particles?
Definition
Intrinsic Pathway
Term
What factors are involved in the extrinsic pathway? What electrolyte is also necessary?
Definition
VII - III - X - V
Ca
Term
Which factors are involved in the Intrinsic Pathway? What electrolyte is also necessary?
Definition
XII - XI - IX - VIII - X - V
Ca
Term
Which pathway is the fastest?
Definition
Extrinsic Pathway
Term
How do platelets assist in retraction of the clot?
Definition
By expressing serum
Term
What components form a blood clot?
Definition
RBCs, platelets, Fibrin, Plasma
Term
Which platelet consumptive syndrome is an autoimmune IgG disorder?
Definition
ITP - Idiopathic Thrombocytopenic Purpura
Term
Which consumptive platelet disorder is not caused by drugs or toxin?
Definition
ITP - Idiopathic Thrombocytopenic Purpura
Term
Which consumptive platelet disorder sometimes occurs following an URI?
Definition
ITP - Idiopathic Thrombocytopenic Purpura
Term
What are the signs and symptoms of ITP (Idiopathic Thrombocytopenic Purpura)?
Definition
Petechiae and Purpura
Oral/Gingival Bleeding
Epitaxis
Menorrhagia
Splenomegaly (Rarely)
Term
What lab test values are significant for ITP (Idiopathic Thrombocytopenic Purpura)?
Definition
Increased BT
Decreased platelet count <50,000
anti-platelet antibodies
Term
What is the treatment for ITP (Idiopathic Thrombocytopenic Purpura)?
Definition
Corticosteroids
Platelet Transfusion
Term
With TTP (Thrombotic Thrombocytopenic Purpura), what will be seen on a peripheral smear?
Definition
Shistocytes
Term
What are the lab findings characteristic of TTP (Thrombotic Thrombocytopenic Purpura?
Definition
Normal Coagulation
Increased LDH (Lactate Dehydrogenase is released when RBCs are destroyed)
Increased bilirubin
Term
What are the symptoms of TTP that differentiate it from ITP?
Definition
TTP - affects the CNS so there will be neurological symptoms, there will also be fever, and possible renal dysfunction
Term
What is HUS (Hemolytic Uremic Syndrome) associated with?
Definition
An infection of E. Coli 0157:H7 found in hamburger meat, raw milk, alfalfa sprouts, lettuce, etc
Term
How do the symptoms of HUS (Hemolytic Uremic Syndrome) differ from TTP (Thrombotic Throbocytopenic Purpura)?
Definition
HUS will not have neurologic symptoms where as TTP will. (HUS can be differentiated from ITP because there will be no petechiae)
Term
What will a peripheral blood smear show on a patient with HUS (Hemolytic Uremic Syndrome)?
Definition
multiple helmet cells
fragmented blood cells
reduced platelet number
Term
Which is more likely to cause Renal Failure, HUS or TTP?
Definition
HUS
Term
If a patient presents with symptoms including N/V/D, mild fever, weakness, HA, confusion, coma, abdominal pain, arrhythmias, and a decreased platelet count, what conditions should be suspected?
Definition
HUS and TTP
Term
What is the tx for HUS or TTP?
Definition
Plasma Exchange
Dialysis may be required
Term
What condition produces both thrombosis and hemorrhage simultaneously?
Definition
DIC
Term
What are some common causes of DIC?
Definition
Sepsis
CA
Crush Injury
Pregnancy Complication
Burns
Liver Disease
Term
What are the components of HELLP Syndrome?
Definition
intravascular Hemolysis (H)
Elevated Liver enzymes (EL)
Low Platelet count (LP)
Term
In what trimester do HELLP patients generally present? What symptoms do they have on presentation?
Definition
Present in early 3rd trimester
Present with RUQ pain and N/V
Term
What type of patients are at risk for developing HELLP syndrome?
Definition
Patients with preeclampsia or eclampsia
Term
What is the most common congenital coagulopathy?
Definition
vWD (von Willebrand's Disease)
Term
What type of trait is vWD?
Definition
Autosomal Dominant or Recessive
Term
What is the "dual defect" in vWD?
Definition
inadequate platelet aggregation
decreased or defective factor VIII
Term
What labs will be significant for vWD?
Definition
Increased PTT
Increased BT
normal/low factor VIII
decreased vWD antigen
Term
Which factor is deficient in Hemophilia A?
Definition
factor VIII
Term
What factor is deficient in Christmas disease?
Definition
Factor IX deficiency
Term
What are the signs and symptoms characteristic of hemophilia?
Definition
repeated, spontaneous bleeding
hemarthroses (very painful - bleeding into the joint)
epitaxis
intracranial bleed
hematemesis
melena
Term
What labs are characteristic of Hemophilia A?
Definition
Increased PTT
decreased factor VIII
Term
How is Hemophilia A and Hemophilia B treated?
Definition
A - Factor VIII given
B - FFP given
Term
What factors are K dependent factors?
Definition
II, VII, IX, X
Term
What labs are significant for a K deficient coagulopathy?
Definition
Increase PTT and PT
Term
Which factor mutation causes an increased risk for developing a DVT?
Definition
Factor V Leiden
Term
How is Heparin reversed?
Definition
Protamine sulfate
Term
What is the drug of choice for treatment of thromboembolytic disease during pregnancy?
Definition
LMW Heparin
Term
Which anti-coag med blocks vitamin K reductase and inhibits the vitamin K dependent clotting factors (II, VII, IX & X)?
Definition
Coumadin (Warfarin)
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