The sticky business of clotting: riddles to make coagulation stick.

Abstract

I'm cleaving factor V, So it can't stay alive. Except if it has Leiden, My cleavage site is hidin'. Who am I? When wounds appear, I get in gear, And stick to them like glue. I bind to VIII and collagen, And GPIb too. Who am I? ADAMTS can chop me, But no one else can stop me, On a gel no one can top me, I'm big and strong and ultra long. Who am I? An amino acid mimic, I'm often used in HIT. Make sure you check the PTT And adjust my rate a bit. Who am I? Five sugars I contain, Blocking Xa is my game. I'm short and sweet and indirect, Can you guess my name? In DIC a lot of me Is surely on the make. Fibrin clot will form and break, And that will leave me in its wake. Who am I? Some call me factor I. But substrates I have none. I'm important for the clot. An enzyme I am not. Who am I? I'm a test that helps for VTE, But not for ruling in. I'm only used for ruling out, That's really what I'm all about. Who am I? Head trauma may cause DIC, ‘Cause brain contains a lot of me. A number I have not, But I really start the clot. Who am I? When the liver just begins to fail, I'm the factor that gets low. I have the shortest half life, So the PT starts to go. Who am I? If the liver is completely shot, The coags will prolong a lot. I'm the only factor that's still okay, Endothelium makes me anyway. Who am I? Put tissue factor in a tube, Add patient plasma too. Phospholipid and calcium, That's all you need to do. I'm the time to form the clot I'm a test that's done a lot. Who am I? I've been called a nuisance By those with little taste. Whether I'm important Varies case by case. I prolong the PTT. I can be temporary. But if I stick around, Then clots just may be found. Who am I? I tend to strike the elderly, And I prolong the PTT. I'm a very scary IgG. Check one factor to test for me. Bleeding can be severe, Whenever I am here. Who am I? I'm a factor that goes by just one letter, When I'm around things are better, ‘Cause complement stays in check. If you take me away, Your kidneys will pay, ‘Cause HUS comes on deck. Who am I? I used to be a red cell, But the capillary choked me. In that little tiny vessel, The fibrin strands they broke me. Who am I? In my disease you know The platelet count is low. But if you transfuse platelets, That number will not grow. Who am I? Answers: Activated protein C, von Willebrand factor (vWF), ultra large vWF multimers, argatroban, fondaparinux, D-dimer, fibrinogen, D-dimer, tissue factor, Factor VII, Factor VIII, prothrombin time, lupus anticoagulant, acquired Factor VIII inhibitor, Factor H, schistocyte, ITP. Lisa Senzel1,2,3* 1Hematology Laboratories, Stony Brook University Medical Center, Stony Brook, New York; 2Transfusion Services, Stony Brook University Medical Center, Stony Brook, New York; 3Department of Pathology, Stony Brook University Medical Center, Stony Brook, New York