ICM: Hematology, Coagulation

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ICM: Hematology, Coagulation
2012-10-29 18:30:42
Hematology Coagulation

Hematology, Coagulation
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  1. Hemostasis and thrombosis is dependent on 3 factors.  Name them.
    • Vascular endothelium
    • Platelets
    • Coagulation system
  2. 3 Important things to garner in history in regards to bleeding.
    • Personal or family history (of bleeding)
    • When (the bleeding epsiode started)
    • Medications
  3. Quinine and quinidine can contribute to___
    excessive bleeding
  4. In your physical exam, you want to look for signs related to?
    Capillary fragility
  5. Petechia that do no blacnh with pressure
  6. Petechiae that are not palpable
  7. What type of bleeding defects generally have imediate onset of bleeding after trauma?  (predominantly in skin, mucous membranes, nose, GI tract, urinary tract)
    Platelet Defects
  8. What type of bleeding defects have "deep" bleeding (in joint spaces, muscles, and retroperitoneal spaces)?  How are these observed on exam?
    • Coagulation defects
    • Observed on exam as hematomas and hemarthroses
  9. Name the Vit. K dependent factors.
    2, 7, 9, 10
  10. Does prolonged bleeding time predict excess surgical blood loss?
  11. Measures rate of fibrinogen conversion to fibrin.
    Thrombin Time
  12. Rare congenital abnormalities on synthesis or release of secretory granules.
    Inherited platelet disorder
  13. Platelets with no alpha granules.
    Gray platelet syndrome
  14. Inherited platelet disorders:
    Large platelets
    Neutrophils- What are these known as?
    • May-Hegglin
    • Neutrophils = Dohle bodies
  15. Inherited Platelet Disorders:
    Congenital deficiency or abnormality of GPIIb-IIIa
    Glanzmann's thrombasthenia
  16. Inherited Platelet Disorders:
    Congenital deficiency or abnormality of GP Ib
    Bernard-Soulier Syndrome
  17. Name 3 acquired platelet disorders.
    • Decreased production
    • Increased destruction
    • Poor aggregation
  18. Name 2 Non-immune mediated types of platelet destruction.
    • DIC
    • Microangiopathic hemolytic anemia
  19. _____ is a diagnosis of exclusion.
  20. ITP tx
  21. Inherited Coagulation Factor Bleeding Disorders (2)
    • vWF
    • Hemophilia (A & B)
  22. Most common hereditary coagulation disorder, AD
  23. Where is von Willebrand Factor synthesized?
    endothelium and megakaryocytes
  24. What factor does vWF carry?
  25. What anchors platelets to subendothelium and forms a bridge between platelets?
  26. vWD: Partial quantitative deficiency
    Type I (decreased)
  27. vWD:  Qualitative deficiency
    vWF antigen is______, vWF activity is _______
    • Type 2 (abnormal)
    • Normal, decreased
  28. vWD:  Total quantitative deficiency
    Type 3 (absent)
  29. DDAVP is not used to treat what type of vWD?
    Type 2
  30. vWD tx:
    Cryoprecipitate (source of fibrinogen, factor VIII and vWF)

    Factor 8 concentrate (Humate-P or Koate-HS)
  31. Only plasma fraction that consistently contains vWF multimers.
  32. Prolonged bleeding after surgery or dental extractions
  33. Hemophilia B tx:
    High purty factor IX, recombinant human factor IX
  34. Deficiency of Hb.
  35. What is a good standard minimum of hemoglobing for men?  women?
    • Men = 14
    • Women = 12
  36. What images do you use to study RBCs?
    Blood smear
  37. Disorder of globin synthesis (can't make alpha and beta chains correctly)
  38. Can't make membrane correctly.
    Hereditary spherocytosis, hereditary elliptocytosis
  39. Problems synthesizing heme
  40. Impaired DNA synthesis due to a vitamin deficiency.
    Megaloblastic anemia
  41. Make faulty, dysfunctional hemoglobins.
  42. Key quantitative counts of CBC?
    RBC, Hb, Hct
  43. Key descriptive elements of CBC?
    MCV, RDW (red cell distribution width)
  44. Microcytic Anemias
    • Iron-deficiency
    • Thalassemia
    • Long-standing anemia of chronic disease (mildly microcytic --> lots of time normocytic)
  45. Most important test for Iron-deficiency anemia.
  46. Megaloblastic Anemias describe smears with
    hypersegmented neutrophils and oval macrocytes (B12, folate deficiency)
  47. Causes of Nonmegaloblastic macrocytosis
    • Liver disease
    • Alcohol
    • MDS (Myelodysplastic Syndrome)
    • Hypothyroidism
    • COPD
  48. Neurologic deficits can occur prior to
    B12 and folate anemia (B12 levels can be normal despite a tissue deficiency)
  49. Are indicated for borderline/equivocal values of B12 & folate.