Hematology Coag

Created by tsevier78 

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Factor I

Fibrinogen; Genetic deficiency; Increase PT, PTT, TT
Decrease Fibrinogen Assay; Cryo is best source of fibrinogen

Factor II

Prothrombin, Rare, Increase PTT, PT; Treat with FFP or prothrombin complex

Factor III

Tissue thromboplastin; no deficiencies; Found in all tissues

Factor IV

Calcium; Low enough to interfere with clotting would be incompatible with live; only non protein factor

Factor V

Labile Factor; Mild systemic bleeding; Increase PT, PTT; treat with FFP

Factor VII

Stable factor; Moderate to severe bleeding; Increase PT, Normal PTT; Treat with FFP

Factor VIII

Antihemophili Factor; Hemophilia A; Normal PT and Bleed time; Increase PTT; Only factor produced by vessel endothelial cells instead of liver

Factor VIII: C

Coagulation; part of the intrinsic system

Factor VIII: VonWillibrand Factor

Cause platelets to adhere to vessel wall; Normal PT; sl. increase PTT, Increase Bleed time

Factor IX

Christmas factor; Hemophilia B; Normal PT; increase PTT

Factor X

Stuart-Prower factor, Rare; Increase PT, PTT; treat with FFP or PCC

Factor XII

Hageman Factor; Thrombosis not bleeding; Normal PT, Increase PTT; Treat with FFP

Factor XIII

Fibrin-Stabilizing factor; Mild bleeding; poor wound heeling;
All tests normal except abnormal urea solubility; treat with Cryo

Fitzgerald

High Molecular weight Kininogen, Usually no symptoms; Normal PT, Increase PTT

Fletcher

Pre Kallikrein; Kallikrein is best plasminogen activator; No symptoms; Normal PT, Increase PTT; PT corrects when Increase incubation time

Vitamin K Dependant

II, VII, IX, X
Inhibited by coumadin, absent in absorbed plasma

Consumed in clot

I, V, VIII, XIII
Not found in serum because are consumed in the clot

Labile factor

V and VIII

Intrinsic Path

VIII, IX, XI, XII
Measured by PTT

Extrinsic Path

VII, III
Measured by PT

Common Path

X, V, II, I
Factor V is a cofactor for Factor X which then converts prothrombin to thrombin
Measured by both PT and PTT

Present in Serum and Aged plasma

All but consumed factors

Factor present in Serum

VII, IX, X, XI, II

Serum lacks

I, II, V, VIII, XIII

Present in absorbed plasma

All but the vitamin K factors
I, V, VIII, XI, XII

Normal Plasma

Contains all factors

Coumadin/Warfarin

Vitamin K factors: II, VII, IX, X; VII affected first; Mostly extrinsic; Overdose give Vit K or FFP; can't be used on Pregnant women; takes days to affect

Aspirin

Inhibits formation of thromboxane A2 and platelet aggregation; affects plts; oral; GI bleeding; will prolong bleeding time

Heparin

Combines with AT and rapidly inhibits thrombin (IIa) and Xa, XIIa, XIa and IXa; stops clotting; Overdoses treated with protamine sulfate because it inactivates heparin. Does not work if pt has AT; PTT tests; Increase TT; Pt can be sl. increase;

TPA

Breaks up existing clot

PT

Rabbit Thromboplastin and Calcium; NR - 9-12.5 may vary by lab; Factors measured: I, II, V, VII, X; used to monitor coumadin

INR

2-3

PTT

Plasma mixed with commercial phospholipid substitute and activator of factor XII (actin) plus Ca. NR 20-35. Measures all factors except: VII and XIII

TT

Plasma mixed with thrombin; Less than 20; measures only the conversion of fibrinogen to fibrin

Reptilase Time

Snake venom converts fibrinogen to fibrin w/o thrombin
If the reptilase is normal and TT is increase heparin is present

FSP/FDP

Latex particles coated with FSP fragments D and E; detectes DIC, Thrombosis, primary fibrinogenolysis
Trypsin inhibitor to prevent invitro fibrinolysis

D Dimer

Crosslinked fibrin and therefor is positive only in secondary fibrinolysis; if D-dimer is neg and FSP is positive, pt has primary fibrinogenlysis; More specific for DIC and Thrombosis

Bleeding time

Reference range 212 minutes; prolonged in disorders of plt function such as vonWillibrand, bernard soulier, Glanzmann disorder, and aspirin ingestion

Mixing studies

If the prolonged PTT correct with the 1:1 mixture, a factor deficiency is suspected and appropriate factor assays should be performed. Aged serum corrects the PTT in factor IX, XI, and XII deficiencies; Absorbed plasma corrects the PTT in factor VIII: C; XI and XII deficiencies

Hemophilia A

Sex linked; Increas PTT, Normal PT; Factor VIII assay; Assay corrects with absorbed plamsa; Normal Bleed time

VIII:vWD

Normal and platelet function normal; autosomal deficiency;
Sl. Increase PT and normal PT; Increase Bleed time; no plt aggregation with ristocetin; treat with DDVAP or cryoprecipitate

Hemophilia B

Sex linked; Increase PTT, Normal PT; Factor IX assay; Not as severe as Hemo A

DIC

Increase PT, PTT, TT, FSP
decrease Fibrinogen, platelet count
+ D Dimer
Schistocytes on blood smear

Liver dz

Acquired; plasma production decrease; Increase PT and PTT
Liver function test; Factor VIII normal or increase; Treat with FFP

Vit K deficiency

Diet or antibiotic; PT eleveated; multiple factors present

Lupus Anticoagulants

Pt develops an autoantibody against phospholipds on plt surfaces. Increase PTT. 50:50 Mix of pt plasma with normal plasma doe snot correct; confirm with Plt Neutraliztion; DRVVT and anti-phospholipd assay

Protein C or S deficiency

Protein C binds to activated factors V and VIII and stops clotting. Act as natural anticoagulants, Both proteins are Vit K dependent so can't assay them til 2 weeks after stopping coumadin; associated with lie long blood clots that can be fatal

Factor V Leiden Mutation

W/O the ability to inhibit activated factors V and VIII, clots form; Most common genetic thrombophilia (excess clotting)

Antithrombin

Plasma is mixed with known excess of thrombin or Xa in the presence of heparin. Amount of thrombin left after neutralization inversely proportional to AT

Chronic/ Acute ITP

Chronic: Young women; Autoantibody to plts causes increased destruction by the spleen. Acute: Children after infection; Acquired

TTP

Toxic damage to endothelial cell. HUS seen in children after infection; Decrease Plt, schistocytes

Bernard Soulier disorder

Defective glycoprotein 1b; inhibits plt adhesion to vWF; Giant platelets

Glanzmann's thrombasthenia

Defective glycoprotein IIb/IIIa inhibits platelet aggregation; increase bleeding time; clot retraction absent

Chemotherapy

Plt count is reduced if pt is on methotrexate

Factor VIII level

can distinguish liver dz from DIC; low in DIC

Short draw

Will prolong coag test. Sodium Citrate will be present and not bound to calcium and will use up calcium in test.

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