Clotting workshop

• What are the naturally occuring anti-coagulant proteins

  C and s.
• Which factors doe Protein C and S inactivate

  V and VIII
• What is the pathology of a defieciency in protein c or s

  It results in a hyper-coagulable state
• What are the risks with a hyper-coagulable state [state the conditions]

  Thrombus, deep vein thrombosis or a pulmonary embolism.
• What is thrombomodulin

  a protein attached to endothelial cells within a blood vessel.

  It binds to thrombin as well as protein C and S.

  Protein C acts as a protease on factors V and VIII.
• What is the method of inheritence for protein c and s deficiency

  Autosomal dominant. This can be type 1 or 2.
• What is type 1 protein c/s deficiency

  This is caused by a lack of production of these proteins.
• What is type 2 protein c/s deficiency

  The proteins produced are not functional
• Who gets acquired protein c and s deficiency

  Patients with liver disease, taking warfarin or nephrotic syndrome due to the loss of proteins in their urine.
• What are the tests used for haemostasis

  Prothrombin time.

  Activated partial thromboplastin time.

  Thrombin time.

  Mixing studies.
• What is the normal time for PT

  12 seconds
• What is the normal time for aPTT

  25 to 39 seconds
• What does an elevated PT indicate

  An issue in the extrinsic pathway.
• How does warfarin contribute to protein C and S deficiencies

  It blocks the enzyme required for Vitamin K synthesis which is required to make Protein C and S.
• What is thromboplastin

  Tissue Factor III
• What is the INR

  This is the international normalised ratio and is used with Prothrombin time.

  It is a ratio of prothrombin time to a control. It's used for patients taking warfarin and vitamin K antagonists.
• What is activated partial thrombin time

  This relates to the intrinsic or common pathways.
• What is thrombin time

  This is the time taken to clot in the common pathway.
• What are mixing studies with normal blood

  If no coagulation happens then the patient has an inhibitor.
• What is mixing studies with barium sulphate absorbed plasma

  It lacks factors II, VII, IX, X.

  It has factors I, V, VIII, XIII.
• What are mixing studies with serum

  Lacks I, V, VIII and XIII.

  Has factors II, VII, IX, X.