Hereditary and Acquired Thrombotic Disorders Flashcards Preview

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Flashcards in Hereditary and Acquired Thrombotic Disorders Deck (34)
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1

What are the three components of Virhow's triad?

1. Decreased blood flow
2. Inflammation of or near the blood vessels
3. Intrinsic alterations in the nature of the blood itself

2

What are arterial thrombi composed of?

Primarily of aggregated platelets, containing small amounts of fibrin and few red cells making them appear a white color.

3

When do venous thrombi form?

They typically develop under conditions of slow blood flow.

4

What are venous thrombi composed of?

Large amounts of fibrin containing numerous red cells (red thrombi)

5

What is phlegmasia cerulean dolens?

An extremely swollen, blue, and painful leg due to the complete obstruction of a proximal vein

6

Lesser degrees of obstruction of a leg can produce what symptoms?

Pain, pitting edema of the distal extremity, and a warm, dusky, reddish-blue discoloration of the skin

7

Describe postthrombotic syndrome.

Syndrome due to chronic venous insufficiency and chronic venostasis. Extremities become chronically swollen and painful and show dark skin discoloration. Cutaneous ulcers can also develop.

8

What are the classical signs and symptoms of a PE?

Sudden chest pain, dyspnea, anxiety, cough, syncope and cyanosis.

Uncommonly hemptysis

Patients can present with cardiac arrest and death

9

What are the sighs and symptoms someone can develop with recurrent PE?

Chronic dyspnea
Chronic pulmonary hypertension
Elevated right heart pressure

10

How do you diagnose a PE?

Useful screenings are
-D-dimer-indirect measure
Very sensitive but not specific

-Venous ultrasound Doppler
>95 specificity and sensitivity

-Spiral CT

-Ventilation/perfusion (V/Q)

11

What would you use to treat an arterial thrombi in an acute setting?

Heparin and a fibrinolytic agent such as tPA

Long term: antiplatelet since arterial thrombi are mostly platelets
---Aspirin
---thienopyridines
---clopidogrel
---glycoprotein IIb/IIIa inhibitors

12

What would you use to treat a venous thrombi in an acute setting?

Unfractionated r low molecular weight heparin

Long-term: low molecular weight heparin or warfarin

13

What is the inheritance pattern of Facto V Leiden?

Autosomal dominant

14

What phenotype is produced in Factor V Leiden?

Partial resistance to inactivation through proteolytic cleavage by protein C leading to increased risk of thrombosis

15

Should asymptomatic Factor V Leiden patients be treated?

No they should be informed of what activities cause increase risk

16

What is the inheritance pattern of prothrombin G20210A?

Second most common inherited predisposition to hypercoagulability and has an autosomal dominant pattern

17

What is elevated in patients with prothrombin G20210A?

Elevated concentrations of plasma prothrombin

18

What is the role of protein C?

When it becomes activated it inactivates factor Va and VIIIa to inhibit coagulation

19

What is the inheritance pattern of Protein C Deficiency?

Autosomal dominant

20

Heterozygotes make ____% of normal protein C levels?

50%

21

What happens in homozygous deficient protein C patients?

This condition leads to neonatal purpura fulminans, an often fatal disease associated with extensive venous or arterial thrombosis at birth and levels of protein C

22

A patient with protein C deficiency is at risk of developing what condition when taking warfarin?

Skin necrosis

23

What is the inheritance pattern of protein S?

Autosomal dominant. They have risk of venous and arterial thrombosis

24

What are some similarities between protein C deficiency and protein S deficiency?

Both can be seen with neonatal purpura fulminans and warfarin-induced skin necrosis

same treatment

25

What is the role of antithrombin III?

Regulates coagulation by inactivating thrombin as well as factors Xa, IXa, XIa and XIIa

26

What is the inheritance pattern of antithrombin deficiency?

Autosomal dominant

27

What are the symptoms of someone who is homozygous deficient for antithrombin?

Fatal in utero

28

Can you use heparin to treat antithromin deficiency?

No because lack of AT-III limits the therapeutic effectiveness of heparin

29

Should asymptomatic antithrombin deficient patients be put on anticoagulant therapy?

no

30

Describe hyperhomocyteinemia

-Inherited or acquired
-incereased risk for thrombosis may be enhanced platelet activation and adhesiveness due to endothelial cell injury