-Use of Cumarine (spice which is converted to anticoagulant via some fungi)
-Hemophelia A(fVIII def)/B(fIX def)
Role of Antithrombin III
Inactivates thrombin (IIa), factors IXa and Xa
Role of Protein C
Inactivates Va and VIIIa
Role of Protein S
Activates Protein C
Factors requiring vitamin K for proper function
II, VII, IX, X, C, S
What is factor V Leiden?
A defect in factor V means it is not inactivated by Protein C - it is the most common hypercoagulability disorder among Eurasians and is especially dangerous for PREGNANT women and women who take OCPs
What is ITP
Idiopathic Thrombocytopenia Purpura - abnormally low platelet count (nl 150-400,000/uL - ITP occurs when less than 20,000/uL). Occurs in two forms - acute (usually begins in children) and chronic (usually begins in older children). Usually due to auto-immune reaction following a viral infection.
When is bone marrow testing necessary with ITP?
When Thrombopoetine is elevated (recall: Thrombopoetine is the protein which stimulates production of platelets by the bone marrow)
Tx for ITP
Grade 1: Observe and if necessary, give a fibrinolysis blocker
Grade 2: Corticosteroids and IV IgG
Function of von Willebrand's factor
Connecting exposed collagen to platelets and deactivating factor VIII
Types of von Willebrand disease
Type 1: Reduction in amount of vWF
Type 2: Reduction in action of vWF
Type 3: Total lack of vWF
Diagnosis of vWF disease
Measure vWF levels and activity - by type 1 and type 3 is the level lower and by type 2 is there a discrepancy between the two. Also measure APTT (Activated Partial Thromboplastin Time - measures intrinsic and common pathways) to test for lack of factor VIII (because in activated form, it leaves the circulation)
Tx for vWF disease
Desmopressine for type 1 and 2 (form of vasopressin) which induces release of stored vWF. Also, for some f**king reason, give Hepatitis B vaccine.
Diagnosis of DIC
Low platelets, fibrinogen and a higher APTT
Tx of DIC
Treat underlying cause if possible - give blood clotting factors, platelets and eventually heparin (potent anticoagulant)