Hematology Pimp Session. 1. What is the sequence of the intrinsic pathway of coagulation?.
1. What is the sequence of the intrinsic pathway of coagulation?
Prekallikrein+ HMW kininogen + factor XII + exposed collagen → activates Factor XI → activates Factor IX +Factor VIII → activates Factor X + Factor V → converts prothrombin (Factor II) to thrombin → thrombin converts fibrinogen to fibrin
2. What is the sequence of the extrinsic pathway of coagulation?
Factor VII + tissue factor → activates Factor X +Factor V → converts prothrombin to thrombin → thrombin converts fibrinogen to fibrin
3. Which factors are known as the labile factors (i.e. activity lost in stored blood)?
Factors V and VIII
Factors II, VII, IX, and X and proteins C and S
6. Which factor is the convergence point for both the extrinsic and intrinsic pathways of coagulation?
Factor X extrinsic and intrinsic pathways of coagulation?
7. PT measures the function of which factors? extrinsic and intrinsic pathways of coagulation?
Factors extrinsic and intrinsic pathways of coagulation?II, V, VII, and X and fibrinogen
8. PTT measures the function of extrinsic and intrinsic pathways of coagulation?which factors?
Factors extrinsic and intrinsic pathways of coagulation?II, V, VIII, IX, X, XI, and XII and fibrinogen
9. What 2 electrolytes are required for the formation of a platelet plug?
Calcium platelet plug?and Magnesium
10. What is the sequence platelet plug?of physiologic reactions that mediate hemostasis following vascular injury?
1. Vasoconstriction platelet plug?
2. Platelet activation/adherence/aggregation
3. Thrombin generation
11. Uremia leads to a platelet plug?downregulation of?
GpIb platelet plug?, GpIIb/IIIA, and vWF
12. What is the treatment of choice for uremic coagulopathy? platelet plug?
Dialysis platelet plug?
13. platelet plug?Which drug can be given to help correct platelet dysfunction from uremia, bypass, or ASA?
Desmopressin platelet plug?(DDAVP)
14. DDAVP and conjugated estrogens stimulate the release platelet plug?of?
Factor platelet plug?VII and vWF
15. platelet plug?What platelet count is needed before surgery?
> platelet plug?50,000/mL
16 platelet plug?. What platelet count is associated w/ spontaneous bleeding?
< platelet plug?20,000/mL
17. platelet plug?What platelet count suggests the prophylactic transfusion of platelets?
<10,000 platelet plug?
18. What is Virchow’s triad? platelet plug?
Stasis platelet plug?, endothelial injury, and hypercoagulability
19. platelet plug?What is the most common cause of acquired hypercoagulability?
Smoking platelet plug?
20. platelet plug?What is the most common inherited hypercoagulablestate?
Factor platelet plug?V Leiden
21. What platelet plug?is the treatment for hyperhomocysteinemia?
Vitamin platelet plug?B-12 and folate
22. Name platelet plug?the prothrombin gene defect causing spontaneous venous thrombosis?
Prothrombin platelet plug?gene defect G20210A
23. What is the normal platelet plug?life of a platelet?
7-10 platelet plug?days
24. platelet plug?What electrolyte is most likely to fall after the infusion of stored blood?
Ionized platelet plug?calcium (citrate in stored blood binds serum calcium)
25. How long can PRBCs be stored? platelet plug?
~ platelet plug?42 days or 6 weeks
26. platelet plug?What is the most common blood product to contain bacterial contamination?
Platelets (stored at room temperature) platelet plug?
27. What platelet plug?type of bacteria is usually found in contaminated platelets?
Gram-positives platelet plug?
28. platelet plug?What is the most common bacteria found w/ blood product contamination?
Gram platelet plug?negative rods (E. coli)
29 platelet plug?. Who would you transfuse with leukocyte reduced packed red blood cells?
Patients platelet plug?with multiple reactions despite premedication with antipyretics, patients needing long term platelet support, and transplant candidates in order to prevent formation of HLA antibodies
30. platelet plug?What are the indications for blood transfusion?
Hgb platelet plug?< 10 w/ h/o CAD/COPD, Healthy symptomatic pt. w/ Hgb < 7, acute blood loss
31. platelet plug?What is the approximate formula to convert Hct to Hgb?
Hct platelet plug?/ 3 = Hgb
32. 1 U PRBC should increase the platelet plug?Hgb and Hct by this much?
Should platelet plug?increase Hgb by 1 g/dL and Hct by ~3-4%
33. What happens during a type and screen? platelet plug?
Patient's platelet plug?blood is screened for antibodies and blood type is determined
34. What happens platelet plug?during a type and cross?
Pts platelet plug?. blood is sent to the blood bank and cross-matched for specific donor units for possible transfusion
35. What fluid cannot be infused with PRBC and why? platelet plug?
Lactated platelet plug?Ringer's; Calcium in LR may result in coagulation w/in IV line
36. Most common cause of transfusion hemolysis platelet plug??
Clerical platelet plug?error leading to ABO incompatibility
37. platelet plug?What is the treatment for transfusion hemolysis?
Stop platelet plug?transfusion; fluids; Lasix; alkalinize urine w/ bicarbonate; pressors as needed
38. How long does it take for Vitamin K to take effect? platelet plug?
39 platelet plug?. How long does it take for FFP to work?
Immediately platelet plug?
40. platelet plug?How long do the effects of FFP last?
41. What does cryoprecipitate contain? platelet plug?
vWF platelet plug?, Factor VIII, and fibrinogen
42. What does FFP contain? platelet plug?
All platelet plug?factors including labile Factors V and VIII, AT-III, protein C and S
A bleeding? complete history and physical exam
Von bleeding? Willebrand's disease
45. bleeding? What factor is deficient in hemophilia A?
Factor bleeding? VIII
46. bleeding? What is the preoperative treatment for hemophilia A?
Factor bleeding? VIII infusion to 100% normal preoperative levels
47. bleeding? What factor is deficient in Hemophilia B?
Factor bleeding? IX
48. What is the treatment for bleeding? hemarthrosis in a pt. w/ hemophilia A?
Initial bleeding? therapy includes Factor VIII, joint rest, cold packs (3-5 days) and a compression dressing (3-5 days); Followed by active range of motion exercised 24 hrs. after Factor VIII therapy.
49. What receptor deficiency is found in bleeding? Glanzmann's thrombocytopenia?
GpIIb bleeding? /IIIareceptor deficiency; platelets can not bind to each other
50. What receptor deficiency is found in Bernard bleeding? Soulier disease?
GpIb bleeding? receptor deficiency; platelets can not bind to collagen
51. What are the desired platelet counts and bleeding? Hct for a pt. with polycythemia vera before an elective operation?
Plt bleeding? < 400,000/mL and Hct < 48%
52. bleeding? What protein does Heparin bind to for its anti-coagulation effects?
Anti-thrombin bleeding? III; Heparin-antithrombin III complex then binds factor IX, X, XI
53. bleeding? What is the half-life of heparin?
60-90 bleeding? minutes
54. bleeding? What is the dose of protamine to reverse 100 U or 1 mg of heparin?
1-1.5 bleeding? mg
55. bleeding? What signs will you see in a protamine reaction?
Bradycardia bleeding? , hypotension, and decreased heart function
56. bleeding? How does warfarin induced skin necrosis occur?
Protein bleeding? C and S have a shorter half life than Factors II, VII, IX, and X. Coumadin leads to a decrease in Protein C and S before the other factors leading to a hypercoagulable state
57. Pts. with this deficiency are at increased risk for Warfarin induced skin necrosis?
Protein Warfarin induced skin C deficiency
58. What is the desired activated clotting time for routine anticoagulation?
150-200 anticoagulation? seconds
59 anticoagulation? . What is the desired activated clotting time for cardiopulmonary bypass?
400 anticoagulation? seconds
60. What anticoagulation? INR is a contraindication to intramuscular injection?
INR anticoagulation? > 1.5
61. What are the absolute contraindications to the use of anticoagulation? thrombolytics?
Recent anticoagulation? CVA (<2 months), intracranial pathology, and active internal bleeding
62. What are the indications for an IVC filter? anticoagulation?
Pts anticoagulation? . who have undergone a pulmonary embolectomy, pts. with documented PE while anticoagulated, pts. with free floating femoral, ileofemoral, IVC DVT, pts. with contraindication to anticoagulation, and pts. at high risk for DVT (head injured/orthopedic injured on prolonged bed rest)"
63. What is anticoagulation? Argatroban?
A anticoagulation? synthetic direct thrombin inhibitor derived from L-arginine
64. What is anticoagulation? Hirudin?
An anticoagulation? irreversible direct thrombin inhibitor derived from leeches
65. What is anticoagulation? Ancrod?
Malayan anticoagulation? pit viper venom that stimulates tPA release