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Describe adhesion > aggregation > plt plug semi-detailed
- Adhesion: GP1B binds collagen (req. vWF) --release-->ADP, FV, fibrinogen, more
- Aggregation: ADP stims shape change, exposes GPIIb/IIIa --> GPIIb/IIIa binds fibrinogen
- Plt plug formation, limited to site by inhibitors
Draw the factor pathways for PT/PTT
- PTT: Collagen,MWK -> XII -> XI - IX -VIII-> X
- PT: TF (PF3) -> VII -> X
- Common: X -5-> 2 -> 1 <-XIII <- 2
- Refer to notes
- *note - XIIIa is what provides D-Dimers by crosslinking fibrin
Factors that are enzymes? Cofactors?
- Enzymes: II,VII,IX,X,XI,XII,XII
- Cofactors: III,V,VIII,HMWK
Contact, prothrombin, fibrinogen (groups) - factors, vit k dependent, consumed in clot?
- Contact: XI,XII,PK,HMWK / N / N
- Prothrombin: II,VII,IX,X / Y / only II
- Fibrinogen: I,V,VIII,XIII / N / Y
PT and PTT: ref range, pathways tested, drugs tested, reagents
- PT: <13s / extrinsic + common +vit K def / warfarin, coumadin / Tissue thromboplastin + CaCl2
- There's a single T because if it's EX.
- PTT: 20-40s / intrinsic, common / heparin / activator + phospholipid + CaCl2
Alt names of Factor II, Factor I? Their interaction?
- II = prothrombin
- IIa = thrombin which acts on I (and XIII)
- I = fibrinogen
- Ia = fibrin
Describe FV Leiden
- Normally Proteins C, S inactivate FV and FVIII
- FV Leiden is a conf change which resist ACP and therfore increases thrombosis
How does fibrinolysis occur?
- activators convert plasminogen -> plasmin
- plasmin cleaves fibrin strands producing FDPs, DDimers
INR = (PT/local mean)^ISI
Describe the thrombin time assay
- Excess thrombin to plasma, measure of fibrinogen
- Increased time - decreased fibrinogen, dysfunctional fibrinogen, heparin, etc
Describe D-Dimer's use
- NEGATIVE predictive value only (DVT, DIC, etc)
QUCIK REVIEW OF "SPECIAL TESTS" AREA NOTES
Russel's viper is for? Reptilase?
- Russel's viper: lupus anticoagulant
- Reptilase: thrombin time (meas of fibrinogen) but unaffected by heparin
briefly describe hemophilia A, B, C, vWD, Lupus anticoagulant, factor VIII inhib, Vit k def
- A: decreased VIII, sex-linked recessive, same symp as B
- B: decreased IX, sex-linked recessive, same symp as B
- C: decreased XI, inconsistant severity, increased in jews
- vWD: vWD defect resulting in decreased VIII, autosomal dominant, treat with DDAVP or cryo
- LA: IgG anti-phospholipid, prolonged PTT
- FVIII I: IgG anti-FVIII, prolonged PTT and mixing study
- Vit k def: decreased function II,VII,IX,X