Chapter 12: disorders of hemostasis

Question 1

What are the two forms of hypercoagulability states?

Answer 1

conditions that increase platelet function

conditions that accelerate the coagulation system

Question 2

What are the 4 types of bleeding disorders?

Answer 2

1) thrombocytopenia
2) coagulation disorders
3) vascular causes
4) disseminated intravascular coagulation

Question 3

What is hemostasis?

Answer 3

stoppage of blood flow to prevent loss and hemorrhage

Question 4

What are the two types of abnormal hemostasis?

Answer 4

inappropriate clotting (hypercoagulability states)

insufficient clotting (bleeding disorders)

Question 5

What secretes the von Willebrand factor? What does this factor do?

Answer 5

It is secreted by endothelial cells

VWF allows platelets to adhere to the exposed collagen fibers

Question 6

What are the 5 stages of hemostasis?

Answer 6

1) Vessel spasm
- to initially constrict blood flow

2) Platelet plug forms
- adhesion by von Willebrand factor

3) Blood coagulation
- via coagulation cascade

4) Clot retraction
- actin and myosin in platelets

5) clot lysis
- converting of plasminogen to plasmin which breaks down the clot

Question 7

What organ synthesizes most coagulation factors?

Answer 7

the liver

Question 8

What two minerals are coagulation factors dependent on?

Answer 8

Ca for end intrinsic and the extrinsic pathway

K for intrinisic

Question 9

What is fibrinolysis? Describe what is involved

Answer 9

the process of clot dissolution.

Plasminogen circulates in the blood, gets converted to plasmin which then digests the fibrin

Question 10

What are the two ways that you can have hypercoaguability states?

Answer 10

inc platelets (thrombocytosis)

Inc clotting activity

Question 11

How might you get increased platelets?

Answer 11

reactivie disorders (iron-def anemia, splenctommy, Ca)

MYELOPROLIFERATIVE disorders:
acquired genetic anomaly
polycythemia vera

Question 12

What are the 4 categories of conditions that would give you a hypercoagulability state?

Answer 12

INHERITED or ACQUIRED disorders altering coagulation factors

ENDOTHELIAL DMG

DEC ANTI COAGULATION FACTORS

Question 13

Give some examples of acquired increased clotting activity.

Answer 13

bed rest
immobility
meds
malignancy

Question 14

Explain why endothelial dmg makes coagulation easier. what are some things that can cause this?

Answer 14

it makes platelet adhesion easier

• artherosclerosis
• smoking

Question 15

What are the two categories that can cause thrombocytopenia?

Answer 15

DEC PRODUCTION

INC destruction

IMPAIRED FUNCTION

Question 16

What are some things that can cause dec production of thrombocytes?

Answer 16

anemia

bone marrow malignancy/depression

Question 17

What are a few things that can cause inc destruction of thrombocytes?

Answer 17

antiplatelet antibodies

drug induced

immune/idiopathic thrombocytopenic purpura (ITP)

Question 18

What is idiopathic thrombocytopenic purpura (ITP)

Answer 18

an autoimmune disorder that destroys platelets

may be primary or secondary

more common in children

Question 19

What are some things that can cause impaired function resulting in thrombocytopenia?

Answer 19

inherited deficiencies of VWF

acquired factors: disease, meds (ASA/NSAIDS)

Question 20

What are the three signs of thrombocytopenia?

Answer 20

bruising/bleeding of skin and mucous membrane of nose, mouth, GI tract, uterine cavity

PURPURA (large but spotty purple)

PETECHIAE (tiny little dots)

Question 21

List three inherited coagulation disorders

Answer 21

von Willebrand disease

hemophilia A (deficiency of VIII)

hemophilia B (deficiency of IX)
- less common

Question 22

give an example of an acquired coagulation disorder

Answer 22

vit k deficiency

Question 23

Describe what von willebrand disease is

Answer 23

deficiency in vWF (usually inherited)

• platelets cannot adhere properly, can result in spont bleeding

has normal platelet count

Question 24

Describe what hemophelia A is

Answer 24

X - linked that primarily affects males

factor VIII deficiency

Bleeding in soft tissues, can have joint bleeding when child begins to walk which leads to inflammation, pain, and swelling

Question 25

What causes vascular disorder bleeding?

Answer 25

it is due to weak vessel walls

causes:
structure, inflammation, dmg
- scurvy, cushing

Question 26

Describe the manifestations of vascular disorder bleeding

Answer 26

normal blood values

easy bruising

petechiae/purpura of skin and mucous membranes

Question 27

Describe what disseminated intravascular coagulation (DIC) is

Answer 27

it is a secondary condition where the coagulation sequence is being activated by another disorder.

Question 28

Describe the process of disseminated intravascular coagulation disorder (DIC) is

Answer 28

coagulation activated

fibrin deposits and thrombi formation throughout body

leads to ischemia, hemolytic anemia from fragmented RBC

results in depletion of factors and therefore bleeding later

poor chance of recovery if not caught early

Question 29

List 5 risk factors for DIC

Answer 29

Obstetrics (50 percent)
Ca
infection
trauma/surg
heamtologic

Question 30

How is DIC treated?

Answer 30

management of original disease

replace clotting factors/components

anticoagulants