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1/25: Bleeding Patient

1. Have an understanding of the aspects of the medical history and physical that will assist in theevaluation of the pt with a hemorrhagic disorder.

2. Learn the basic coagulation cascade and its relationship to the general assays of hemostatic function3. Learn the sequence of events in the formation of the primary platelet plug.

1/25 Coagulation tests

1. Discuss the use of laboratory testing in the evaluation of bleeding risk.2. Describe how the screening tests for evaluation of primary and secondary hemostasis are performed.3. Identify the strengths and weaknesses of different screening tests of coagulation.4. Outline the algorithms used to evaluate a prolonged PT and aPTT.5. List the medical conditions associated with prolongations of the various coagulation tests

1/25: Formation of Hemostatic plug

1. Have a general understanding regarding the principles of normal hemostatic regulation in vivo(Hemostasis) and how this differs from the clotting cascade (Blood clotting).

2. Understand the physiologic sequence of events that lead to the formation of a stable hemostatic plugafter injury to a blood vessel.

3. Understand how abnormalities in specific steps of hemostatic plug formation in vivo can result ineither pathologic clot formation (thrombosis) or excessive bleeding

1/28:

Case 32:

1. List the vitamin K dependent coagulation proteins and their roles/functions in the intrinsic and extrinsicpathways of coagulation

2. Discuss the mechanisms by which vitamin K produces functional coagulation proteins and howwarfarin affects the synthesis of the vitamin K dependent proteins

Case 33:

1.

List the coagulation proteins which are synthesized in the liver.2. Know how to determine in an abnormal coagulation assay; (ie: PT, aPTT, or TT) is the result of adeficiency of a coagulation protein or due to an inhibitor of a coagulation enzyme

3. Know how to distinguish between coagulation abnormalities due to liver disease versus vitamin Kdeficiency.

Case 34:

1. Know the difference between a hereditary and acquired coagulation disorder2. Understand the reasons for an isolated prolongation of the PTT or the PT, or both3. Know the reasons for attempting to correct a prolonged coagulation test with normal plasma4. Understand the conditions in which a prolonged coagulation test might be corrected with normal

plasma and the conditions in which it will not be corrected.

5. Know the six different acquired disorders of blood coagulation and fibrinolysis1/28: platelet functions and platelet kinetics

1. Platelet and megakaryocyte microanatomy2. Platelet production, distribution and life span3. Regulation of platelet production4. Function of platelets in hemostasis

a. Physiology of platelet adhesionb. Physiology of platelet activationc. Physiology of platelet secretion

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d. Physiology of platelet aggregation5. Formation of hemostatic plugs6. Interaction with coagulation proteins7. Maintenance of endothelial cell integrity8. The normal platelet count9. Significance of prolonged bleeding time10.Causes and recognition of a low platelet count

a. Increased destructioni. Immune thrombocytopeniaii. Non-immune thrombocytopenia

b. Decreased productioni. Neoplastic disease of bone marrowii. Aplastic anemia

iii. Chemotherapyc. Ineffective production

i. Megaloblastic anemiad. Redistribution (hypersplenism)e. Dilution of washout

11.Clinical recognition and evaluation of a patient with thrombocytopeniaa. Causes of high platelet count

12.Primary causes (myeloproliferative disorders)a. Secondary causes

1/29: Platelet functions and defects

1. Explain the biologic nature and function of the platelet2. Discuss the essential components of primary hemostasis3. Know the platelet receptors and ligands that are involved in primary hemostasis4. Discuss the diseases characterized by defective primary hemostasis5.

Describe different types of von Willebrands disease and the clinical and laboratory diagnosis ofvWD6. Distinguish between different inherited defects of primary hemostasis

a. Bernard Soulier vs. Glanzmanns vs. vWD7. Tell your father how his aspirin is working8. Identify non-hematologic illnesses which may interfere with normal primary hemostasis

1/30: Anticoagulant

1. Learn the names and functions of the major natural anticoagulants.2. Learn the names and functions of the major fibrinolytic proteins and their inhibitors.3. Learn the principles of how the natural anticoagulants and the fibrinolytic proteins balance the

prothrombotic pathways that lead to the formation of the hemostatic plug.

1/30: DIC

1. Definition of DIC2. Pathogenesis and pathophysiologic mechanisms3. Laboratory abnormalities

a. Diffferneces between acute and chronic DIC4. Causes of DIC

a. Disseminatedb. Localized

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5. Consequences of DIC itself6. Concepts regarding management7. Pathophysiologic mechanisms involved and trigger mechanisms

1/30: Hypercoagubility: SPP

1. Identify the symptoms and signs associated with venous thrombosis2. Identify the symptoms and signs associated with pulmonary embolism.3. Know the frequency of thrombosis within the population.4. Know congenital and acquired risk factors that predispose patients to venous thromboembolic events.5. Know how to confirm clinical suspicion of thrombosis with objective testing.6. Know and understand the mechanism of action, how to dose and monitor anticoagulant medications.7. Know the side major effects of the various anticoagulant medications.8. Understand concept of how drug interactions and drug metabolism affect various anticoagulant

medicines.

9. Know when and how to use anticoagulants for the prevention of thrombosis.

1/31: Platelet-endothelial interaction: arterial thrombosis1. Understandthe role of the atherosclerotic plaque in the induction of arterial and coronary thrombosis.2. Understand the differences in platelet function in the venous system versus the arterial system.3. Understand the importance of the platelet in the development of arterial thrombosis.4. Understand the role of antiplatelet agents in the management of arterial thrombosis.

1/31: review

1. Platelet production, distribution and survival2. Approach to patient with thrombocytopenia3.

Causes of a low and high platelet count4. Platelet function

5. Hereditary and acquired qualitative platelet disorders6. Platelet-vessel wall interaction in the development of arterial thrombosis7. Pharmacologic intervention in the treatment of arterial thrombosis8. Hereditary disorders of blood coagulation and fibrinolysis causing excessive bleeding9. Hereditary disorders predisposing to thrombosis10.Acquired disorders of blood coagulation and fibrinolysis causing excessive bleeding11.Acquired hemostatic disorders predisposing to thrombosis12.Hereditary and acquired hemostatic disorders associated with excessive bleeding