4: Aualitative Disorders Flashcards
Plasma count in Platelet Rich Plasma
200-300 x 10^9/L
Sample used in Optical Platelet Aggregometry
PRP
Principle used in Optical Platelet Aggregometry
Light transmittance aggregometry
Baseline 0% transmission scaled down to 100% transmittance
Optical Platelet Aggregometry
5 phases of Optical Platelet Aggregometry
- Baseline
- Shape change
- Primary-wave aggregation
- ADP/ATP release
- Second-wave aggregation
Anticoagulant used in Whole Blood Aggregometry
Citrate
Sample used in Whole Blood Aggregometry
Whole blood
Principle used in Whole Blood Aggregometry
Electrical impedance
As platelet aggregate, platelets collect on the electrodes impeding the current. The change is amplified and recorded.
Whole Blood Aggregometry
Sample used in Platelet Lumi Aggregometry
WB and PRP
Principle used in Platelet Lumi Aggregometry
Chemiluminescence
What reagent is added in Platelet Lumi Aggregometry test that is oxidized by ATP which generates proportional chemiluminescence
Luciferin-luciferase enzyme
Typically the first agonist used in Platelet Lumi Aggregometry because it induces full secretion
Thrombin
Biphasic agonists
Thrombin
ADP
Epinephrine
Monophasic agonists
Collagen
Arachidonic acid
Ristocetin
What curve is related to the secretion of the granules
Biphasic curve
What curve only produces primary wave and is used to assess platelet aggregation
Monophasic curve
Receptors of thrombin
PAR1 & PAR4
GPIba & GPVI
Receptors of ADP
P2Y1 & P2Y12
Receptors of Epinephrine
A2-adrenergic
Agonist that is relatively unaffected by membrane disorders or enzyme deficiencies
Thrombin
Most commonly used agonist
ADP
Cannot induce aggregation in storage pool disorder or eicosanoid synthesis pathway defects no matter how high its concentration
Epinephrine
Does not work in WB aggregometry test for abnormalities of membrane binding sites and the eicosanoid synthesis pathway
Epinephrine
Receptors of Collagen
GPIa/GPIIa & GPVI
Receptos of Arachidonic acid
TPa and TPb
Receptors of Ristocetin
GPIb/IX/V with vWF
Loss of response of this agonist may indicate membrane abnormality, secretion defect or antiplatelet drugs
Collagen
Agonist that assess platelet eicosanoid synthesis pathway
Arachidonic acid
Agonist used for the diagnosis of BSS and vWD
Ristocetin
A disease that cannot be corrected by additional of normal plasma or cryo
Bernard-Soulier Syndrome (Giant platelet syndrome)
The most frequent forms of BSS involves defects in ______ synthesis or expression
GPIba
Variants of BSS:
- Normal but impaired functionality
- Mutation that cause poor binding
- Antibody to GPIb/V that case pseudo-BSS
Laboratory feature of BSS:
- Giant platelets
- Macrothrombocytopenia (plts are large and fewer)
- Prolonged bleeding time
Treatment of choice of BSS
Platelet transfusion
note: must be leukoreduced to reduce alloimmunization
What therapy should be avoided in BSS
Antiplatelet therapy
Therapy in BSS that is useful for mucosal bleeding
Antifibrinolytic therapy
Dominant type of BSS
BOLZANO TYPE
In Glanzmann Thrombasthenia, GPIIb/IIIa complex is responsible for binding
fibrinogen
vWF
fibronectin
and other adhesive ligands
0.5% of normal GPIIb/IIIa
Type 1 Glanzmann Thrombasthenia
10-20% of normal GPIIb/IIIa
Type 2 Glanzmann Thrombastenia
More severe type of Glanzmann Thrombastenia, with platelets lacking GPIIb/IIIa as well as intra platelet fibrinogen
Type 1
Highly recommend treatment for Glanzmann Thrombasthenia
Platelet transfusion
What should be avoided in the treatment of Glanzmann Thrombasthenia
Anticoagulant and antiplatelet agents
Treatment for Menorrhagia in Glanzmann thrombastenia
Hormonal therapy (Norethindrone acetate)
Clot retraction of Glanzmann and BSS
Glanzmann: Abnormal
BSS: Normal
Platelet glycoprotein defect of Glanzmann Thrombastenia
GPIIb/IIIa
Platelet glycoprotein defect of BSS
GPIb/IX/V
Chromosome 19 mutation
Hermansky-Pudlak Syndrome
Manifestations:
- Tryosinase positive oculocutaneous albinism
- Lysosomal dysfunction
- Ceriod-like depositions in the RES
- Profound platelet dense granule deficiency
Hermansky-Pudlak Syndrome
For extensive surgery and prolonged bleeding of Hermansky-Pudlak syndrome, administer
Packed red cells and platelets
Hallmark of Hermansky-Pudlak Syndrome
Swiss-cheese platelets
This abnormality consists of marked dilation and tortuosity of the surface-connecting tubular system
Swiss-cheese platelets
Mutations in Chromosome 1
Chediak-Higashi Syndrome
What gene is responsible for Chediak-Higashi Syndrome
CHY-LYST-1
Manifestations:
- Partial oculocutaneous albinism
- Frequent pyogenic bacterial infections
- Giant lysosomal granules
- Platelet dense granule deficiency
Chediak-Higashi Syndrome
Has severe pancytopenia
Chediak-Higashi Syndrome
Macrophage accumulation in tissues
Chediak-Higashi Syndrome
Usually results to death in early age
Chediak-Higashi Syndrome
Mutations in the WAS gene on the short arm of the X chromosome (Xp11.23)
Wiskott-Aldrich Syndrome
Classic form of WAS
Eczema-thrombocytopenia Immunodeficiency Syndrome
Manifestations of Eczema-thrombocytopenia Immunodeficiency Syndrome
- Immune dysfunction
- Microthrombocytopenia
- Severe Eczema
- Bleeding episodes
Hallmark of Wiskott-Aldrich Syndrome
TORCH infections
The platelets are small - Microthrombocytes
Wiskott-Aldrich Syndrome
Congenital absence of radial bones
Thrombocytopenia with Absent Radius Syndrome (TAR)
How many alpha granules are present in platelets
50-80
Characterized by large platelets
Gray Platelet Syndrome
Mutations in the NBEAL2 gene (614169) on chromosome 3p21
Gray Platelet Syndrome
Autosomal dominant bleeding disorder which results to a deficiency in multimerin
Quebec Platelet Disorder
Inhibits platelet aggregation and secretion in response to ADP, Epinephrine, and collagen
Aspirin
Inhibits prostaglandin synthesis by irreversible acetylation and inactivation of cyclooxygenase (COX-1) thereby inhibiting endoperoxide and thromboxane A2 which are necessary for platelet secretion
Aspirin
Binds specifically and irreversibly to the platelet P2Y12 purigenic receptor inhibiting ADP-mediated platelet activation and aggregation
Clopidogrel
Is reversible, competitive inhibitor of GP IIb/IIIa receptors, exerting its effects via the prevention of the binding of fibrinogen and other ligands, resulting in the inhibition of platelet aggregation
Tirofiban
A potent protease-activated receptor (PAR-1) antagonist targeting G-coupled receptor and modulating thrombin-platelet endothelial-interactions
Atopaxar (E5555) - Benzimidazole receptor (PAR1)