Hypercoagulable States and CPB / Test 3/3 Flashcards Preview

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Flashcards in Hypercoagulable States and CPB / Test 3/3 Deck (63)
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1

“Hypercoagulability” can be broadly defined as a risk of ______1_______ in circumstances that would not cause thrombosis in a normal subject.
It can be either ____2____ or ___3_____.

1.) Thrombosis
2.) Inherited
3.) Acquired

2

A hereditary tendency to thrombosis, irrespective of its cause has been referred to as ?

Thrombophilia

3

2 factors that accelerate clot formation ?

Factor VIII & Factor V

4

3 factors that Inhibit clot formation ?

Protein C, Protein S, Thrombomodulin
Antithrombin III

5

What inhibits thrombin and other serine proteases ?

Natural Anticoagulant Antithrombin III

6

What inhibits Factor V and VIII ?

Natural Anticoagulant
Protein C

7

Cofactor for protein C ?

Natural Anticoagulant
Protein S

8

What does the (Natural Anticoagulant) Tissue Factor Pathway Inhibitor bind to ?

binds factor Xa and VII-tissue complex

9

True hypercoaguable states can only be determined after RULING OUT other causes…

Pregnancy
Recent surgery Immobilization (stasis)
Obesity
Malignancy

Fracture

Heart failure
Oral contraceptive use

10

CRITERIA for True hypercoaguable state ?

- Recurrent thrombosis
- thrombosis in Unusual sites (cerebral veins, hepatic veins, renal veins, IVC, mesenteric veins)

- First time thrombosis at age

- Family history of thrombosis

11

What can make a patient PRONE to coagulability ?

-Protein C deficiency
-AT III deficiency
-Protein S deficiency
-Activated Protein C (APC) resistance
- Mutation of factor V that makes it resistant

12

Quantitative or Qualitative abnormalities of individual, specific coagulation factors that directly produce a pro-thrombotic state describes what state of hypercoagulability ?

Primary Hypercoagulable State

13

Represents a diverse group of clinical disorders that are associated with a thrombotic tendency

Secondary Hypercoagulable State

14

Mutations of one of the physiological antithrombotic factors which leads to a quantitative deficiency or loss of function?

Inherited

15

Hypercoagulable States
that are sometimes inherited, but are more commonly ACQUIRED ?

Acquired:

Cancer
Liver Problems
Birth Control Pills > PE

16

Antithrombin/Heparin Disorder ?

Antithrombin deficiency

17

Protein C/Protein S Disorders
?

Protein C deficiency
Protein S deficiency
Resistance to activated protein C

18

Fibrinolytic Disorders

Hypoplasminogenemia
or
Dysplasminogenemia

19

Prevalence of deficiencies of hemostatic factors responsible for hereditary thrombotic disease.

AT III
Protein C
Protein S
APC Resistance

AT III 1%
Protein C 8%
Protein S 10%
APC Resistance 17%

20

Characterized by proportionate reductions in activity and antigen levels, each to about 50% of normal in heterozygous individuals, indicating synthetic abnormality of a functionally normal molecule describes what deficiency ?

Antithrombin III Deficiency Type 1

21

Normal or near normal antigen levels are accompanied by low activity levels, indicating a functionally defective molecule.
- Affecting heparin binding
- impaired reactive site function
- multiple abnormalities
causing both abnormal
heparin binding and
abnormal protease inhibition

Antithrombin III Deficiency
Type 2

22

Suspected ATIII DefieciencyCPB Management & Action.
ACT

Repeat Bolus
ACT still low
- Give 2 units FFP … or
- Give Thrombate
Recheck ACT

23

A naturally occurring anticoagulant which preserves blood fluidity and limits clot formation to the sites of vascular injury.

Protein C

24

Rare but fatal hereditary condition (Inherited autosomal disease) manifested by massive disseminated intravascular coagulaopathy and purpura fulminans in the neonatal period?

Homozygous Protein C deficiency

25

Prevalence is 0.1 to 0.5% in the general population, the vast majority remain symptom free.

Inherited autosomal disease
Heterozygous Protein C deficiency

26

Patients with heterozygous PC deficiency are at lifelong risk for thrombosis, but the episodic nature of clinical thrombosis suggests that an _____ ______ _____ may be necessary to trigger a clinically significant thrombotic event.

acquired thrombogenic stimulus

27

Protein C is activated upon

the production of thrombin.

28

Thrombin generation promotes clot formation by

cleaving fibrinogen into fibrin
and also activates the protein C system.

29

Activated protein C subsequently suppresses further thrombin generation and enhances what?

fibrinolytic potential

30

Activated protein C, along with protein S, act to inhibit the intrinsic coagulation pathway by inactivating what factors?

factors Va and XIIa