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Hemostasis/Coag > Introduction to Hemostasis; Specimen collection > Flashcards

Introduction to Hemostasis; Specimen collection Flashcards

1
Q

List the four major systems involved in maintaining hemostasis.

A

Vascular system
Platelets
Plasma coagulation factors
Fibrinolytic system

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2
Q

Process by which the body (upon vessel injury) spontaneously stops bleeding & maintains blood in the fluid state within the vascular system.

A

Hemostasis

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3
Q

Prevents blood loss from injuries by the formation of a thrombus, and re-establish blood flow during the healing process.

A

Hemostasis

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4
Q

The process of clot formation

A

Coagulation

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5
Q

A blood clot within the vascular system; “platelet plug”

A

Thrombus

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6
Q

Also refers to the formation of a blood clot or thrombus, but usually considered to be an abnormal finding.

A

Thrombosis

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7
Q

Name of the first system

A

Vascular system

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8
Q

Name of the second system

A

Platelets

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9
Q

Name of the fourth system

A

Fibrinolytic system

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10
Q

Name of the third system

A

Plasma coagulation factors

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11
Q

Which system is responsible for primary hemostasis?

A

Platelets (2nd system)

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12
Q

Which system is responsible for secondary hemostasis?

A

Plasma coagulation factors (3rd system)

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13
Q

Define Fibrinolysis

A

Breakdown of fibrin

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14
Q

Reduces blood flow to area of injury to minimize blood loss and also draws platelets close to the injured vessel wall.

A

Vasoconstriction.

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15
Q

Damaged endothelial cells secrete___________.

A

Von Willebrand (vWF) factor

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16
Q

What is activated by exposure of tissue thromboplastin/tissue factor (TF)?

A

Plasma coagulation system

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17
Q

Platelet adhesion, aggregation, and, secretion is necessary to form ______

A

Platelet plug

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18
Q

What system is initiated it by TF (tissue thromboplastin)?

A

Plasma coagulation system/ “cascade”

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19
Q

What three consequences leads to the formation of fibrin?

A

Coagulation, inflammation, and tissue repair

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20
Q

List two stages of Hemostasis.

A

Primary and secondary hemostasis

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21
Q

What is the function of primary hemostasis?

A

Platelets interact with injured vessels (and other platelets) to seal the wound. and form a primary platelet plug.

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22
Q

Does primary hemostasis have short term or long term effect?

A

Short term - temporarily arrests bleeding

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23
Q

What two systems are associated with primary hemostasis?

A

Vascular intima and Platelets

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24
Q

What type of test is used to diagnose a defect in primary hemostasis?

A

Platelet tests

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25
Q

What is the function of Hemostasis?

A

Thrombin generated via coagulation cascade, in turn, generate fibrin. and forms secondary hemostatic plug.

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26
Q

Does secondary hemostasis have short term or long term effect?

A

Long term- strengthens the platelets plug

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27
Q

What two systems are associated with secondary hemostasis?

A

Coagulation and fibrinolysis

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28
Q

What type of test is used to diagnose a defect in secondary hemostasis?

A

Coag tests

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29
Q

Briefly describe an overview of hemostasis… beginning with the initial damage to the blood vessel. and ending with fibrinolysis.

A
  • Vessel injury
  • Collagen exposed/vWF secreted..platelet adhesion
  • ADP secreted from granules- platelet aggregation= 1* hemostasis
  • platelet plug reinforced by fibrin= 2* hemostasis
  • Thrombus dissolved by fibrinolytic system
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30
Q

List 7 types of bleeds associated with a platelet or vascular defect. (problem with primary hemostasis).

A

Petechiae, Purpura, Epistaxis, Hematemesis, Menorrhagia, Telangiectasia and also mucosal bleeding

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31
Q

List the 3 types of bleeds associated with disorders of coagulation. (problem with secondary hemostasis)

A

Ecchymoses, and Hemarthrosis, and also delyaed bleeding an dozzing from wounds

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32
Q

Type of bleed that leads to pinpoint hemorrhages from arterioles or venules (no platelets)

33
Q

Type of bleed that leads to purple discoloration of the skin usually caused by many petechiae (small bruises)

34
Q

Type of bleed that leads to nosebleeds.

35
Q

Type of bleed that leads to vomiting blood.

A

Hematemesis

36
Q

Type of bleed that leads to abnormal, prolonged, menstruation.

A

Menorrhagia

37
Q

Type of bleed that leads to spider like dilations of small blood vessels

A

Telangiectasis

38
Q

Characteristic with disorders of platelets or vessels and causes soft tissue bleeding.

A

Mucosal bleeding

39
Q

Characteristic with disorders of coagulation

A

delayed bleeding and oozing from wounds

40
Q

Type of bleed that leads to very severe bleed (s) into deep tissues/ muscles (large bruises)

A

Ecchymoses

41
Q

Type of bleed that leads to joint bleed (s).

A

Hemarthrosis

42
Q

Hemostasis is a combination of ________ & _______

A

cellular and biochemical events

43
Q

List two types of mechanisms in Enzyme systems

A

Coagulation and fibrinolysis mechanisms

44
Q

This includes vascular intima, platelets, erythrocytes, neutrophils, and monocytes

45
Q

What occurs when hemostatic systems are out of balance?

A

Thrombosis or hemorrhage or both may occur

46
Q

What is the preferred venipuncture method?

A

Evacuated Tube system (ETS)

47
Q

List three venipuncture methods.

A
  • Evacuated tube system
  • syringe or butterfly/syringe
  • indewelling catheter
48
Q

What is the correct specimen collection and handling requirement for Evacuated tube system?

A
  • Assures correct blood; anticoagulant ratio

- Must have good veins!!!

49
Q

What is the correct specimen collection and handling requirements for syringe or butterfly/syringe?

A
  • Used with small, fragile veins

- Pose additional needle stick risk when transferring blood into tube

50
Q

This method is discouraged as heparin contaminates sample and prologs clotting times if not properly flushed.

A

Indwelling catheter

51
Q

What is the correct specimen collection and handling requirement for Indwelling catheter?

A
  • Flush line with saline
  • Withdraw 5-10 ml blood & discard
  • then, collect specimen
52
Q

What is the most common anticoagulant used?

A

3.2% Sodium citrate (PT/APTT)

53
Q

What is the blood:anticoagulant ratio?

A

9:1 so need a full tube draw

54
Q

Chelates (binds) free plasma calcium to prevent clotting.

A

3.2% sodium citrate

55
Q

Specimen collection and handling requirement for collection tube type- 3.2% sodium citrate

A

Must be plastic or siliconized glass and mix tube well by gentle inversion–DO NOT shake.

56
Q

What is the order of blood draw?

A
  • ALWAYS use a non-additive discard tube with a winged needle (butterfly) collection.. “dead space”
  • Always draw blue top after a non-additive tube.
57
Q

Why do we always draw blue top after a non-additive tube?

A

To prevent contamination with the previous tube’s anticoagulant.

58
Q

EDTA (purple top) also chelates calcium to prevent blood from clotting, but why do we not use EDTA tube to collect blood?

A

It also binds reagent calcium in clot testing so cannot use!!!

59
Q

How does increased hematocrit (>55%) affect routine coagulation (PT/APTT)?

A
  • Decreased in plasma vol relative to whole blood decrease the plasma to anticoagulant ratio
  • This excess anticoagulant may then bind to the Calcium chloride (added during the testing procedure) to prolong the clotting time.
60
Q

List four unacceptable specimens

A

Clotted, hemolyzed, lipemia, under-filled sodium citrate tubes, increased hematocrit

61
Q

Explain how the clotted specimen will affect routine coagulation testing?

A

Many factors platelets, and RBCs consumed in clotting. So be sure to gently invert tube after venipuncture (4-6X) to prevent clots

62
Q

Would clotted specimen be falsely prolong or falsely shorten?

A

Falsely prolong clotting times

63
Q

Would hemolyzed specimen be falsely prolong or falsely shorten?

A

Falsely shortens clotting times

64
Q

In hemolyzed specimens procoagulant substances released from cells and tissues to ______

A

Activate clotting pathways

65
Q

Hemolyzed specimens can be in vitro or in vivo. What causes hemolyzed specimen in vitro?

A
  • Prolonged tourniquet application
  • excessive needle manipulation
  • mixing blood too vigorously
  • forcing blood through a small bore needle
  • pulling too hard on a syringe
66
Q

What causes specimens to be lipemic plasma?

A

Additional light scatter from lipid droplets gives erroneous results

67
Q

Would Lipemia specimen be falsely prolong or falsely shorten?

A

Falsely prolongs clotting times

68
Q

Why are short draws specimens not acceptable?

A

If tube is under filled, excess anticoagulant remains in the plasma layer after spinning. This excess anticoagulant may then bind to the calcium chloride . 9:1 ratio must be maintained.

69
Q

Would short draws specimen be falsely prolong or falsely shorten?

A

Falsely prolong clotting times

70
Q

What are transportation and storage requirements for specimens?

A
  • Keep tube stoppered & in upright position to maintain proper pH
  • Samples should not be chilled. transport to the lab at RT; chilling whole blood may activate: platelets, factor VII & VIIa, contact system.
71
Q

Never refrigerate blood/plasma for ____; and test within ____ hours

A

PT; 24 hours

72
Q

May refrigerate blood/plasma for ____; but need to test within ____hours. plus must spin and/or remove plasma __- hour if patient is on heparin.

A

APTT; 4 hours; 1 hour

73
Q

Platelet Rich Plasma (PRP) is slow spin and used for _______.

A

Platelet aggregation studies.

74
Q

Platelet Poor Plasma (PPP) is faster spin and used for ______

A

Used for all routine coagulation assays such as PT and APTT.

75
Q

Do PT and APTT measure platelets?

76
Q

Platelet Free Plasma (PFP) is faster spin, remove plasma, and re-spin and is used for ______

A

Heparin or heparin-induced antibody (HIT)

77
Q

What does APTT stand for?

A

Activated partial Thromboplastin Time

78
Q

What does PT stand for?

A

Prothrombin Time.

Hemostasis/Coag (14 decks)

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