MMSC423 Exam 2 (final)

What are the normal reference values for PT?

12.6-14.6 seconds

What are the normal reference values for APTT?

25-35 seconds

What are the normal reference values for Fibrinogen?

200-400mg/dL

What are the normal reference values for Thrombin Time?

< 21 seconds

What are the normal reference values for D-dimer?

110-240 ng/mL

What are the normal reference values for PFA-100 collagen/EPI?

78-199 sec

What are the normal reference values for PFA-100 collagen/ADP?

55-137 sec

What are the normal reference values for APC-Resistance Test

ratio>2.0

What does bleeding time measure?

platelet function

What are the normal reference values for bleeding time?

2-9 minutes

Is bleeding time in vivo or in vitro?

in vivo

what does bleeding time prevent the risk of?

intraoperative hemorrhage

What are the reagents used in the bleeding time test

• automated lancet (to make incision)

• white filtered paper (to blot)

What are the diseases associated with bleeding time

• vWD

• Bernard-spoulier

• Galnzamann's Thromboasthenia

• Afibrinogenemia

What does the PFA-100 assess?

closure time which assesses platelet function

is PFA-100 In vivo or in vitro?

in vitro

What reagents are used in PFA-100?

test cartridges containing either collagen/EPI or collagen/ADP to stimulate PLT aggregation

What diseases are associated with PFA-100?

• vWD

• Bernard-spoulier

• Galnzamann's Thromboasthenia

• Gray Platelet Syndrome

What does TEG stand for?

thromboelastography

What does TEG measure?

status of patients coagulopathy

what does coagulopathy mean?

a condition in which the blood's ability to coagulate is impaired

What reagents are used in TEG?

• kaolin

• heparinase (patients on heparin)

• tissue factor

What specimen is used in TEG?

citrated whole blood

What are the 5 parameters used in TEG?

• R-Time

• K-Time

• Alpha Angle

• MA

• LY30

What does R-Time stand for

Reaction time

what is the normal range for R-time?

5-10 minutes

what does elevated results indicate in R-time?

decreased clot formation

when R-time results are increased, what is used for treatment?

FFP (fresh frozen plasma)

What does MA stand for

maximus amplitude

what is the normal range of MA

56-70 mm

what does a decreased MA result indicate?

deficient platelets

what percentage of platelets is MA made up of?

80%

what percentage of fibrinogen is MA made up of?

20%

how would you treat a decreased MA?

administer platelets

What does LY30 stand for?

lysis at 30 minutes

What is the normal range for K-time?

1-3 minutes

what does increased K-time results indicate?

deficient fibrinogen

when K-time results are increased what do you treat with?

Cryoprecipitate

What is cryoprecipitate a concentrated form of?

fibrinogen

What is the normal ranges for Alpha Angle?

53-72 degrees

What does a decreased value of alpha angle indicate?

deficient fibrinogen

How would you treat decreased alpha angle?

Cryoprecipitate

what is the normal range for LY30?

0-8%

what does an increased LY30 result indicate?

excess fibrinolysis

how would you treat an increased LY30?

antifibrinolytic (tranexamic acid)

What is TEG's coagulation index for hypocoagulable?

< -3

What is TEG's coagulation index for hypercoagulable

> 3

what does PT stand for?

prothrombin time

what does APTT stand for?

activated partial thromboplastin time

what does TT stand for?

thrombin time

What is PT?

time required for formation of fibrin clot after PPP is added to thromboplastin-calcium reagent

what does PPP stand for?

platelet poor plasma

what does PRP stand for?

platelet rich plasma

What factors does PT measure?

I, II, V, VII, X

What does PT indicate?

factor deficiencies

what specimen is used in PT?

sodium citrate PPP

What factor does PT NOT measure?

FXIII (13)

what pathway does PT measure?

extrinsic and common

what factors does APTT measure?

Factors I, II, V, VIII, IX, X, XI & XII (1,2,5,8,9,10,11,12)

what factor does APTT NOT measure?

FXIII (13)

what pathways does APTT measure?

intrinsic and common

what does APTT screen for?

inhibitors and patients on UFH

what does UFH stand for?

unfractionated heparin

what specimen does APTT use?

sodium citrate PPP

How many reagents does APTT use and what are they

2 reagents

what are reagents used in APTT?

• activator

• calcium chloride (CaCl2)

What reagent is the activator in APTT?

Kaolin

What is thrombin time?

the time thrombin converts fibrinogen to fibrin

what is thrombin time affected by?

• abnormal levels of fibrinogen

• dysfibrinogenemia

• presence of heparin

what is APTT prolonged in?

factor deficiencies

what test is preformed when the PT or APTT is prolonged and you want to determine if a factor(s) is/are deficient or the patient has an inhibitor?

Mixing study

What specimen does D-dimer assay use?

sodium citrate PPP

what is the principle of D-dimer?

monoclonal antibody to D-dimer attached to latex beads

If D-dimer is present, what is seen?

agglutination

What is another name of Factor Xa assay?

Anti-Xa

when is Anti-Xa used?

in patients on low blood weight heparin

what are the reagents on Anti-Xa

patient plasma and AT are added to reaction well along with FXa substrate and chromophore

what binds at AT and inhibits FXa

LMWH or UFH

what will the residual FXa cleave

substrate releasing chromophore

what can the chromophore be measured at

405 nm

what is a reflex test

any test that automatically results in the order of one or more secondary tests based on preset criteria applied to the initial test

What is plateletworks an adaptation of

platelet aggregometry

what specimen does plateletworks use

whole blood

what is the reference value for collagen in plateletworks

70-100%

what is the reference value for ADP in plateletworks?

86-100%

what tube does plateletworks use?

EDTA

what is the formula for plateletworks?

%Aggregation=Baseline PLT-Agonist PLTx 100 /Baseline PLT

what is fibrinogen assay method?

Diluted PPP exhibits an inverse relationship with bovine thrombin when the fibrinogen is 100 to 400mg/dL

what specimen is used in fibrinogen assay?

sodium citrate PPP

what does diluting the patient sample minimize the effects of?

heparin and FDPs

What type of plasma does platelet aggregometry use?

PRP

what temperature is platelet aggregometry preformed at?

37ºC

what is ADP in platelet aggregometry?

a platelet agonist

what does platelet aggregometry measure?

percent light transmittance

What is the disease associated with Platelet aggregometry?

Glanzmann's Thromboasthenia

What is the deficiency of Glanzmann's Thromboasthenia?

Glycoprotein 2B3A

Is the relationship between transmittance and percent aggregation inverse or direct?

direct

What does INR stand for?

international normalized ratio

what is the formula for INR??

(Patient's PT/control PT) ^ISI

What is the therapeutic range for INR?

2-3 (in people on coumadin)