Pathoma: Other disorders of hemostasis Flashcards

1
Q

What does HIT stand for?

A

heparin-induced thrombocytopenia

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2
Q

What is heparin-induced thrombocytopenia (HIT)?

A

platelet destruction post heparin therapy due to antibody formation

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3
Q

Why does heparin cause HIT?

A

Heparin can form complexes with platelet factor 4, and an IgG autoantibody can develop against this, leading to destruction in the spleen

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4
Q

What is the major complication of HIT and how does it work?

A

thrombosis due to platelet fragments activating other platelets

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5
Q

What is the treatment of HIT?

A

stop Heparin and give anticoagulant, but NOT COUMADIN

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6
Q

What is DIC?

A

pathologic (abnormal)activation of the coagulation cascade (as opposed to physiologic)

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7
Q

What is the result of DIC?

A

widespread microthrombi –> ischemia, infarction; also consumption of platelets and factors –> bleeding

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8
Q

Where will DIC pts bleed from?

A

IV sites, mucosal surfaces

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9
Q

DIC is almost always 2a to another disease process, such as _____, _____, _____, _____, and _____.

A
  1. obstetric complications
  2. sepsis
  3. adenocarcinoma
  4. APL
  5. rattlesnake bite
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10
Q

How do obstetric complications lead to DIC?

A

amniotic fluid contains a lot of tissue thromboplastin (TT), which is a strong activator of the coagulation cascade

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11
Q

How does sepsis lead to DIC?

A
  1. bacterial endotoxin can activate coag. cascade

2. cytokines produced by macs can activate coag. cascade

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12
Q

How does adenocarcinoma lead to DIC?

A

mucin produced by the adenocarcinoma can activate coag. cascade

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13
Q

How does APL lead to DIC?

A

Auer rods/primary granules activate coag cascade in circulation

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14
Q

How does a rattlesnake bite lead to DIC?

A

venom in circulation activates the coag cascade

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15
Q

What lab findings will be seen in DIC?

A
  1. decreased platelet count
  2. increased PT
  3. increased PTT
  4. decreased fibrinogen
    microangiopathic hemolytic anemia (schistocytes)
  5. elevated fibrin split products (D-dimer)*** best test
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16
Q

What is the product of lysing cross-linked fibrin?

A

D-dimer

17
Q

What is the tx for DIC?

A

address underlying cause, then transfuse or give cryoprecipitate

18
Q

What is fibrinolysis?

A

the removal of a thrombus

19
Q

What is plasmin?

A

a molecule that stops clotting and removes clots

20
Q

What does tPA do?

A

it converts plasminogen into plasmin

21
Q

What does plasmin do?

A
  1. cleaves fibrin
  2. cleaves serum fibrinogen and clotting factors
  3. blocks platelet aggregation
22
Q

What would overactive plasmin result in?

A

little to no blood clotting- a disorder of fibrinolysis

23
Q

What is alpha-2-antiplasmin?

A

molecule that inactivates plasmin

24
Q

How does radical prostatectomy cause overactive plasmin?

A

the procedure releases urokinase, which activates plasmin

25
Q

How does liver cirrhosis cause overactive plasmin?

A

causes reduced production of alpha2-antiplasmin, allowing increased plasmin

26
Q

How do the disorders of fibrinolysis present?

A

resembling DIC

27
Q

What are the lab findings in the disorders of fibrinolysis?

A
  1. increased PT
  2. increased PTT
  3. increased bleeding me
  4. normal platelet count
  5. increased fibrinogen split products WITHOUT D-dimer
28
Q

What is the tx for a disorder of fibrinolysis?

A

aminocaproic acid

29
Q

How does aminocaproic acid work?

A

it bocks the activation of plasminogen

30
Q

Where is alpha2-antiplasmin produced?

A

in the liver