Clin Dx Hemostasis
Terms
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Coag factor names:
x,xi,xii,xiii -
stuart
plasma thromboplastin antecedent
hageman
fibrin stabilizing factor -
Measures extrinisic factors that are K dependant
(i,ii,V,Vii,x)
Monitor warfarin - Prothrombin time
- Drawn in blue top, have correct ratio of blood to anticoag, not older than 12 hours
- Prothrombin time
- INR of prothrombin
- 2-3
- Interfere with Prothrombin time
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Long-alcohol,diarrhea
Short-fat diet,benadryl -
Used post hip/knee surgery,a fib,PE,DVT,TIA
Slow acting
Reversed with Vit. K - Warfarin(Coumadin)
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Measures intrinsic system (all factors but iii and vii)
Monitor Heparin - Partial Thromboplastin time(PTT)
- Interfere with PTT
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short - malignancy
long - antihistamine,vit.c,salicylates -
Short lived
Inactivates prothrombin by acceleration of antithrombin
Checked with PTT every 6 hours - Heparin
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Inhibits conversion of fibrinogen to fibrin
Replaced by D-dimer
Inc'd in thromboembolic conditions - Fibrin Split Products
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Most specific test of DIC
Inc'd in DIC,PE,DVT
Produced by the break down of fibrin by plasmin - Fibrin D-dimers
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90min to 6 hours
Primary/secondary fibrinolysis detected - Euglobin Lysis Time
- Associated with primary fibrinolysins-measured by euglobin lysis time
- proteins in malignancies/shock/sepsis and secondarily work on fibrin thru fibrinogen
- Associated with secondary fibrinolysins-measured by euglobin lysis tim
- proteins in normal response to blood clotting and primarily work on fibrin
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Adults 200-400
<100 results in spontaenous bleeding
Acute phase reaction protein
Part of common coagulation cascade - Fibrinogen
- Low levels of this in large volume blood transfusions
- Fibrinogen
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NL 8-12 sec
Plasma sample + thrombin
Assesses final stage of cascade
Used to detect Heparin,dec'd fibrinogen, or evaluation of prolonged PTT - Thrombin time
- Pt who easily bruises has a short or long prothrombin time?
- Long
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NL 18-22 sec
Pit viper venom used in Thrombin time test - Reptilase time
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Natural occuring anticoagulant, inactivates thrombin
Deficiency may lead to thrombosis - Antithrombin iii
- Deficiencies in these two proteins can lead to hypercoaguable states and thromboembolic disease.
- S and C they are Vit k dependant
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Involves excessive repetitive bleeded
Congenital or acuired - Bleeding disorders
- Lab tests for bleeding disorders
- CBC,platelet,bleeding time, PT,PTT,TT
- Dec'd number of platelets
- thrombocytopenia
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Common in children with URI
Onset of petechiae/purpura
Dec'd platelets
Resolves spontaneously - Acute idiopathic thrombocytopenia purpura(ITP)
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More common in women, autoimmunity present
Dec'd platelets
Tx:corticosteroids,gamma globulin - Chronic ITP
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Prolonged PTT,PT,TT
Dec'd platelets,fibrinogen
Shistocytes on smear
Inc'd D-dimer
Widespread deposition of thrombi - Platelet consumption syndrome(DIC)
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Key symptom is bleeding
Treat underlying cause
Use FFP to replace clotting factors
Ddimer test,Fibrin split products - DIC
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rare,fatal
Severe thrombocytopenia with purpura
Hemolytic anemia
Neg. Coombs
Tx:corticosteroids,FFP,plasmapheresis - Thrombotic thrombocytopenia purpura (TTP)
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Associated with Ecoli
In children,
Similiar to TTP, limited to kidney - Hemolytic uremic syndrome
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Pregnancy induced-(preeclampsia/eclampsia,htn)
Abnormal prostaglandin metabolism
Reversed by delivery - Hemolysis, elevated liver enzymes, low platelets (HELLP)
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Congenital or acquired
Acquired from ASA/NSAID use
Seen in alcoholism
NL platelet count with abnormal bleeding times
tx:dialysis,discontinue drug use - Platelet dysfunction
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X-linked
Excessive bleeding everywhere
Prolonged PTT,PT
Factor viii reduced - HEmophilia A
- Tx: for hemophilia A
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FFP
DDAVP
cryoprecipitate -
Less frequent than hemophilia A
Christmas disease - Hemophilia B
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Congenital, autosomal dominant
Nasal,vaginal,Gi,sinus,hemarthroses bleeding
dec'd factor viii -
Vonwillebrands disease
Tx: FFP,DDAVP,cryoprecipitate -
Common aquired coagulopathy
Malnutrion/malabsorption
NL bleeding time - Vit k deficiency
- Labs for platelets
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count
bleeding time - Labs for coagulation
- PT,aPTT,TT,fibrinogen
- Labs for fibrinolysis
- euglobin lysis time
- Labs for clot degradation
- D-dimer,FDPs