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Clinic Pathology 2 > Hemostasis > Flashcards

Hemostasis Flashcards

1
Q

What is hemostasis?

A

bodys ability to maintain the integrity of the blood and blood vessels

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2
Q

Any deviation from normal hemostasis is=

A

disease

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3
Q

What responses are in primary hemostasis

A
  1. Vascular response
    2.Platelet response
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4
Q

What is the vascular response in hemostasis

A

vessel contract and almost immediately when injured, this narrows the lumen of the vessel, which decreases rate of blood loss and creates an area for platelets to adhere

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5
Q

What is the platelet response in hemostasis?

A

-become “sticky” (adhere to vessel wall and each other)
-this requires von Willebrand factor, which serves to stabilize the platelet plug
-granules become activated and release, which send a message to begin the Coagulation Cascade

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6
Q

What component is in secondary hemostasis?

A

Coagulation cascade

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7
Q

What happens in the coagulation cascade?

A

-these factors are made in the liver
-domino effect that eventually forms a stable fibrin clot

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8
Q

What is the ultimate purpose of primary and secondary hemostasis?

A

to form a clot and then dissolve that clot

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9
Q

Primary hemostasis is the formation of the _ _

A

platelet plug

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10
Q

Secondary hemostasis is formation of a stable _ _

A

fibrin clot

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11
Q

What is fibrinolysis

A

lysis of clot or thrombus through the activation of plasminogen into plasmin

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12
Q

What two components must be present for hemostasis?

A
  1. Vascular component
    2.Platelets, number and function
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13
Q

What 2 parts are in the vascular component of hemostasis?

A
  1. Vascular spasm
    2.Production of factor VIII and vonWillebrand’s factor by endothelial cells
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14
Q

Vascular spasm is _ but _ closure of blood vessel by contraction of smooth muscle

A

Immediate but temporary

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15
Q

Vascular spasm is stimulated by

A

nervous system response, platelets release thromboxane and serotonin

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16
Q

Platelet plug formation is stimulated by

A

vWF

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17
Q

vWF resides in the _, subendothelial metrix, and storage granules within endothelial cells and platelets

A

plasma

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18
Q

Platelets plug formation consists of

A
  1. adhesion of platelets
  2. aggregation of platelets
    3.secretion of platelets
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19
Q

The following is _ of platelets:
-Platelets stick to subendoethelial surface
-Sticking activates platelets

A

adhesion

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20
Q

The following describes _ of platelets:
-Forms platelet plug
-Thromboxane stimulates other platelets to join
-Platelet plug is very short-lived (secs-min)
-Only works on SMALL vessels

A

aggregation

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21
Q

The following describes _ of platelets:
-Platelets have lots of substances in them
-Caused by vasoconstriction and further platelet aggregation
-Some substances activate 2 hemostasis

A

Secretion

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22
Q

Defects in primary hemostasis may be _ or _ and may be defects in _ or _

A

hereditary or acquired; vascular component or platelet component

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23
Q

Acquired vascular component defects

A

vasculitis, collagen deficiency, extensive vascular injury

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24
Q

Inherited vascular component defects of primary hemostasis

A

vonWillebrand’s disease

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25
Q

What is the number one acquired defect of primary hemostasis?

A

thrombocytopenia

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26
Q

What is a defect in function of platelets called?

A

thrombopathia or thrombocytopathy

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27
Q

Acquired platelet component defects

A

drugs, DIC, uremia

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28
Q

Hereditary platelet component defect

A

vWB disease (most common inherited bleeding disorder). platelet fail to adhere to subendothelial collagen

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29
Q

What is vonWillebrand’s disease?

A

an inherited bleeding disorder caused by lack of vWF protein

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30
Q

What protein circulates in the blood stream and must be present at the site of blood vessel injury in order to control bleeding from that vessel?

A

vWF

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31
Q

vWD is a distinct disorder, it is not _

A

hemophilia

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32
Q

What breed is most commonly affected with the mildest form of vWD?

A

doberman

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33
Q

What breeds are affected with the most severe form of vWD?

A

Chesapeake Bay Retrievers and Scottish Terriers

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34
Q

What breeds have abnormally low concentrations of vonWillebrand factor?

A

Scottish Terriers and Shetland Sheepdogs

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35
Q

Many dogs w/ vWD never show outward evidence of having the disease, but when they do, what do those signs look like?

A

-Spontaneously hemorrhage from the nose, vagina, urinary bladder, or oral MM
-Prolonged bleeding after trauma or sx and bruising or bleeding after a spay/neuter may be first time noticed
-in affected dogs w/ uncontrollable bleeding, death may occur

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36
Q

Tx of a severe bleeding episode requires

A

transfusion of canine blood products

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37
Q

_ products can be transfused pre-operatively to prevent surgical hemorrhage

A

plasma

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38
Q

_ _ can also be used to improve hemostasis in dogs with mild subtype (Type 1) vWD

A

Desmopressin acetate (DDAVP)

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39
Q

Bleeding from minor injuries may be controlled using

A

sutures, bandages, or wound glue

40
Q

Dogs affected with vWD should not be given drugs that interfere with normal blood clotting mechanisms, These drugs include:

A

aspirin, sulfa-type antibiotics, and heparin

41
Q

Dogs having low plasma VWF-ag (below _) are predicted at risk of transmitting or expressing the vWD trait.

A

50%

42
Q

2 Hemostasis- Synopsis requires

A

coagulation factors and cofactors (calcium, tissue factors, vitamins)

43
Q

Coagulation factors all made in the _

A

liver

44
Q

Cascade=

A

conversion of inactive factors to active factors (like domino effect)

45
Q

Synopsis is _ lasting (minutes to hours)

A

long

46
Q

When do coagulation factors become activated?

A

when blood vessel or tissue injury occurs, or in co-operation with platelets, produce a clot at the site of injury

47
Q

There are _ different clotting factors. These factors are activated in a specific sequence following two different pathways or sequences

A

13

48
Q

What are the pathways of coagulation

A

intrinsic, extrinsic, and a final common pathway

49
Q

What pathway is described?
-ALL component needed for this pathway are present in the blood
-Outside tissue damage is NOT needed to stimulate this pathway
-Contact activation= activated by contact with collagen and some platelet products
-Has factors XII, XI, IX, VIII (cost $12 not $11.98)

A

Intrinsic

50
Q

What pathway is described?
-Requires a tissue factor for activation (tissue factor= thromboplastin)
-Thromboplastin is released from injured cells of any kind
-Reacts with factor VII

A

Extrinsic

51
Q

What pathway is described?
-Where intrinsic and extrinsic pathways converge
-Has 2 stages (prothrombin to thrombin and fibrinogen to fibrin)

A

Common

52
Q

What are the Vitamin K dependent factors?

A

II, VII, IX, X

53
Q

In 2 Hemostasis- production of coag factors, the liver synthesizes all factors except part of factor _

A

VIII (the endothelium produces part of VIII)

54
Q

2 Hemostasis defects may be _ or _

A

hereditary or acquired

55
Q

2 hemostasis hereditary defects

A

Hemophilias A (-VIII) B (-IX)

56
Q

What is the most common inherited blood clotting disorder in dogs

A

Hemophilia A

57
Q

What is the Hemophilia A

A

the result of a mutation of a specific gene, causing a deficiency of blood clotting Factor VIII, which interferes with the blood clotting cascade

58
Q

Clinical sign of hemophilia A

A

spontaneous bleeding

59
Q

Dx of hemophilia A

A

Lab test called APTT (activated partial thromboplastin time) can test for clotting disorders but cannot distinguish among the various types of hemophilia

60
Q

How to get a specific diagnosis of Hemophilia A

A

by measuring the activity of Factor VIII

61
Q

2 Hemostasis acquired defects

A

-Deficiency of Vitamin K-dependent factors
-Liver disease/failure
-DIC

62
Q

What is DIC

A

Disseminated intravascular coagulopathy
-small clots for throughout the body which results in consumption of coagulation factors and then hemorrhage occurs

63
Q

DIC is secondary to conditions like

A

heat stroke, viremia, endotoxemia, massive necrosis, trauma, septicemia, IV hemolysis

64
Q

Clinical signs of 2 hemostasis defects

A

-hematomas
-bleeding into muscles, joints, and body cavities
-delayed bleeding after venipuncture
-rarely see petechia or ecchymoses

65
Q

What is fibrinolysis

A

breakdown of the fibrin clot

66
Q

what is fibrinolysis-synopsis

A

lysis of a clot or thrombus through activation of plasminogen into plasmin

67
Q

What is plasminogen called when it binds with fibrin (clot) and becomes activated

A

plasmin

68
Q

Bound plasmin hydrolyses fibrin which produces

A

FDPs (fibrinogen degradation products)

69
Q

FDPs have _ activity; block thrombin and inhibit platelets

A

anticoagulant

70
Q

Fibrinolysis defects

A

Excessive FDP/FSP production (DIC and liver failure)

71
Q

DIC leads to increased levels of

A

FDP/FSP

72
Q

DIC leads to what due to obstruction of microcirculation

A

multiple organ dysfunction

73
Q

Clinical signs of DIC

A

signs of BOTH 1 and 2 hemostasis disorders

74
Q

_ hemostatic disorders are caused by failure of platelet plug formation due to quantitive or qualitative platelet disorders or due to von Willebrand factor deficiency

A

Primary

75
Q

Clinical signs of primary hemostatic disorders

A

petechia, mucosal hemorrhage, prolonged bleeding at site of injury

76
Q

Specific primary hemostatic disorders and diagnostic tests

A

-Thrombocytopenia: platelet count, platelet estimate from blood smear

-Platelet dysfunction: in vivo bleeding time, platelet aggregation, drug history and metabolic profile

77
Q

Secondary hemostatic disorders are caused by

A

failure of fibrin clot formation due to deficiency of one or more coagulation factors

78
Q

Tests to evaluate secondary hemostatic disorders

A

Rodenticide toxicity: aPTT, pT, vitamin K-dependent factors (II, VII, IX, X)

Liver failure: aPTT, PT, fibrinogen

Hemophilia: aPTT, factors VIII, IX

79
Q

What does buccal mucosal bleeding time (BMBT) evaluate

A

both aspects of primary hemostasis, evaluates interaction b/w platelets and endothelium that causes primary platelet plug to form

80
Q

What is normal BMBT for dogs and cats

A

1-5 mins

81
Q

> 5 min BMBT =

A

thrombocytopenia or platelet dysfunction

82
Q

What tube should be used for activated clotting time (ACT) method

A

DET tube which activates the intrinsic and common pathways

83
Q

Vitamin K should be given with

A

food

84
Q

What are the fat soluble vitamins

A

A, D, E, K

85
Q

Normal ACT in dogs

A

60-90 sec

86
Q

Normal ACT in cats

A

<65 sec

87
Q

PTT (partial thromboplastin time) tests _ and _ pathways

A

intrinsic and common

88
Q

OSPT, PT (prothrombin time) tests _ and _ pathways

A

extrinsic and common

89
Q

TT (thromboplastin time) detects

A

decreased fibrinogen

90
Q

FDP evaluates

A

fibrinolysis

91
Q

Tube used for platelet estimate and count

A

LTT

92
Q

Tube needed to measure von Willebrand’s factor

A

BTT- MUST BE FULL

93
Q

Mixing ratio for blue top tube

A

1 part citrate : 9 parts blood

94
Q

BTT is used for tests for coagulation factors of what pathways

A

intrinsic, extrinsic, and common pathways

95
Q

Extrinsic clotting factor

A

VII

96
Q

gray TT must be full and can be used for tests for what pathways

A

intrinsic and common

97
Q

RTT is used for what testing

A

chemistry profile of liver function

Clinic Pathology 2 (12 decks)

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