Term
| Four Components of Hemostasis |
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Definition
Vascular integrity
Platelets
Coagulation cascade
Finrinolysis |
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Term
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Definition
| Vasoconstriction. Slow down rate of blood flow |
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Term
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Definition
| Rush into the area. Make temporary plug. Platelets are unstable. Easily broken off. DIFFERENT than coagulation cascade. |
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Term
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Definition
| Complex cascade of intrinsic/ extrinsic. Forms thrombin (end product of cascade) |
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Term
| Prodcuts of coagulation cascade |
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Definition
| Thrombin. (takes fibrinogen->fibrin which stabalizes the clot) |
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Term
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Definition
| TPA all break down clot. Must get rid of clots, this step is essential. Premature degredation can happen. |
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Term
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Definition
Anti-coagulant
Alcohol
Anti-cancer drugs
Aspirin
Anti-biotics |
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Term
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Definition
| Coumadin-Vitamin K antagonist |
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Term
| Alcohol related to bleeding |
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Definition
| Liver problems. Cofactors made there |
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Term
| Anti-cancer drugs and bleeding |
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Definition
| Chemotherapy, killing most rapidly dividing cells (platelets effected) |
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Term
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Definition
| Blocks COX, which blocks TXA2 |
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Term
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Definition
| Effects vitamin K dependency factors. Gut flora, which are resp. for absorbing vit. K) |
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Term
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Definition
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Term
| Most important thing about pre-operative assesment history? |
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Definition
Abmormal bleeding?
-unusual resp to minor
-spontaneous hemmorrhage
-dental extractions |
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Term
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Definition
Platelet count-
Platelet function
PTT
PT |
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Term
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Definition
| How many platelets/ml blood |
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Term
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Definition
| in forming platelet plug. NOT for clotting rate |
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Term
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Definition
Intrinsic + Common
(8,9,11,12) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| All clotting factors but what are formed in the liver? |
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Definition
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Term
| Why do you ask patient if hepatitis, jaundiced, or alcohol? |
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Definition
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Term
| Why is it important to ask patient about hypertension? |
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Definition
| Diastolic >120 = contradiction even in minor. B/c that is minumum pressure body exposed to after surgury. Regardless if good hemostatic mechanisms, high chance for post op bleeding. |
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Term
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Definition
Thrombin which helps
Fibrinogen->Fibrin which
Stabalizes the platelet plug |
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Term
| What activates intrinsic pathway? |
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Definition
| XII binding to subendothelial collagen. |
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Term
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Definition
| Partial Thromboplastin count |
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Term
| Extrinsic factors are activated by what? |
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Definition
| By tissue thromboplastin which reacts w/ factor 7 and Ca to initiate 10. |
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Term
| Is tissue thromboplastin synthesized in the liver? |
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Definition
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Term
| Intrinsic Bleeding Disorders |
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Definition
Hemophilia A
Hemophilia B
von Willebrand's Disease |
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Term
| Acquired Bleeding Disorders |
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Definition
| Thrombocytopenia, Liver disease, Systemic disease |
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Term
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Definition
X- linked recessive
1/10,000 male births
Extremely rare in females (turner's disease) |
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Term
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Definition
| Deficiency of functional factor VIII. |
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Term
| Lab test Features for hemophilia |
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Definition
Abnormal (prolonged) PTT
Normal PT, platelet count, function test |
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Term
| What should definite diagnosis of hemophilia A be based on? |
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Definition
| Low result of functional factor VIII assay. |
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Term
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Definition
| Deficiency of functional factor IX |
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Term
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Definition
Essentially the same as w/ classic hemophilia.
IX is deficient |
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Term
| Hemophilia sons of affected males? |
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Definition
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Term
| Hemophilia daughters of affected males? |
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Definition
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Term
| Sons of carriers hemophilia? |
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Definition
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Term
| Daughters of carriers hemophilia? |
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Definition
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Term
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Definition
| 1/100 of competent. Spontaneous bleeds from infancy, spontaneous hemarthrosis. |
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Term
| What could jumping do to someone w/ severe hemophilia? |
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Definition
| Cause bleeding in the joints, get fibrin in there, can't bend/move the joints. Hemarthrosis |
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Term
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Definition
| 2-5% of normal. Hemorrhage from trauma or surgery. Spontaneous hemarthrosis. |
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Term
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Definition
| 6-60% of normal. Hemorrhage from trauma or surgery, spontaneous hemarthroses are rare. Lead fairly normal lives. |
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Term
| Von willebrand's disease genetics |
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Definition
| Autosomal = dominant and recessive |
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Term
| Von Willebrand's disease etiology |
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Definition
Deficiency or absence of vWF, this also fVIII-vwf (for platelet adherence)
Deficiency of FVIII procoagulat activity |
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Term
| What will tests of VWD look like? |
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Definition
| Look like classic hemophilia (prolonged) b/c VIII deficiency. Hemophilia will NOT affect platelet function test. Platelet count, PT= normal.= |
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Term
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Definition
Insufficient platelet level
>100,000 adequate for surgury
50,000-100,000 may be adquate
<50,000 may require transfusions of platelets
<20,000 spontaneous bleeding or petechia common. |
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Term
| Auto-immune thrombocytopenia (HIT) |
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Definition
| May not respond to transfused platelets. |
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Term
| Vitamin K deficiency states examples |
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Definition
Broad spectrum anti-biotics
Malabsorption
Liver disease
Coumadin
Fistulas |
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Term
| Broad Spectrum anti-biotics |
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Definition
| Kills gut bacteria that synthesize our vitamin K |
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Term
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Definition
| Our Vit. K made i nthe intestine and must be absorbed as a fat-soluble vitamin. Problem in a newborn, gall stones or cystic fibrosis |
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Term
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Definition
| Can't absorb it b/c sterile gut |
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Term
| Cystic fibrosis/Gallstones and vitamin K |
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Definition
| Bile needed for fat absorption |
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Term
| Liver disease and vitamin K deficiency |
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Definition
| Carboxylation of clotting factors 2, 7,9,10 occur here (require KH2) |
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Term
| Coumadin / Vitamin K deficiency |
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Definition
| competitive inhibitor of vitamin K reductases that recycle KH2 from KO to enable gly carboylation reaction to continue |
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Term
| How can vitamin K be given? |
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Definition
| Orally or IV if urgent to restore hemostasis in 6 hours |
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Term
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Definition
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Term
| How long off aspirin before surgure, how long after? |
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Definition
10 Days prior (he says just a few days in recording; only need some platelets)
One day after |
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Term
| If at home and your chest is hurting what can you take? |
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Definition
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Term
| Why wait 10 days before surgery for aspirin? |
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Definition
| Platelets have no nuclei and can not do protein synthesis to replace inactivated enzyme, takes about 10 days to replace platelets. |
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Term
| How long off coumadin before surgery, how long after |
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Definition
2 days prior
On the day of the surgury |
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Term
| Why off coumadin 2 days prior to surgury |
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Definition
| need time to replenish vitamin KH2, carboxylate and release normal clotting factors and clear uncarboxylated ones. |
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Term
| If on coumadin and PT is less than 1.5 control? |
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Definition
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Term
| Why can you restart coumadin on the day of the surgury? |
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Definition
| It will take longer to make the new factors, |
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Term
| INR is less than 3, what should you do? or PTT is @ or less than 1.5? |
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Definition
| DONT stop coumadin, buts in hypercoagulation state. May increase the rate of HA/stroke. |
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Term
| Are people on coumadin b/c of heart attack or stroke? |
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Definition
| NO. They are on it to prevent thromboses, which can cause HA or stroke. |
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Term
| How long off heparin before surgery, how long after |
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Definition
6 hours prior
Start back on it once a good clot has formed |
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Term
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Definition
| Heparin enhances the inhibatory effect of AT3, which takes 6 hours to get out of the system. |
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Term
| What can reverse heparin's effects faster if needed? |
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Definition
| Protamine, binds to heparin and prevents it from binting to AT3 |
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Term
| If a person is on coumadin, and you're concerned to take them off of it what do you do? |
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Definition
| Take them off of it, take them to the hospital, put them on heparin, because you can reverse it quickly. |
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Term
| Can you reverse coumadin? |
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Definition
| Yes, with vitamin K. But it takes more time than heparin. |
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