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Liz's Hemostasis/Coagulation > 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 (1st)
  • Platelets (2nd)
  • Plasma coagulation factors (3rd)
  • Fibrinolytic system (4th)
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2
Q

Process by which the body (upon vessel injury) spontaneously stops bleeding and maintains blood in the fluid state w/in the vascular system

A

Hemostasis

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3
Q

Prevents blood loss from injuries by the formation of a thrombus, and reestablish blood flow during the healing process

A

Hemostasis (formal definition)

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4
Q

Process of clot formation

A

Coagulation

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5
Q

A blood clot w/in the vascular system; “platelet plug”

A

Thrombus

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6
Q

Refers to formation of blood clot or thrombus, but usually considered to be an abnormal finding

A

Thrombosis

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7
Q

Which system is responsible for primary hemostasis?

A

Platelets (2nd system)

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8
Q

Which system is responsible for secondary hemostasis?

A

Plasma coagulation factors (3rd system)

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9
Q

Define fibrinolysis

A

Breakdown of fibrin

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10
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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11
Q

Damaged endothelial cells secrete ____

A

von Willebrand factor (vWF)

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12
Q

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

A

Plasma coagulation system

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13
Q

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

A

Platelet plug

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14
Q

What three consequences leads to the formation of fibrin?

A

Coagulation, inflammation, and tissue repair

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15
Q

Two stages of hemostasis

A

Primary and secondary hemostasis

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16
Q

Primary hemostasis

- Function

A

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

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17
Q

Primary hemostasis

- Short vs. long-term effect

A

Short-term → temporarily arrests bleeding

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18
Q

Primary hemostasis

- Associated systems

A
  • Vascular intima

- Platelets

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19
Q

Primary hemostasis

- “Type” of tests used to differentiate

A

Platelet tests

  • Platelet count
  • Bleeding time
  • Platelet fxn analyzer (PFA)
  • Platelet aggregation
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20
Q

Secondary hemostasis

- Function

A

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

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21
Q

Secondary hemostasis

- Short vs. long-term effect

A

Long-term → strengthens the platelet plug

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22
Q

Secondary hemostasis

- Associated systems

A

Coagulation and fibrinolysis

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23
Q

Secondary hemostasis

- “Type” of tests used to differentiate

A

Coagulation tests

  • PT (prothrombin time)
  • APPT (activated partial thromblastin time)
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24
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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25
Q

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

A
  • Petechiae
  • Purpura
  • Epistaxis
  • Hematemesis
  • Menorrhagia
  • Telangiectasia
  • Mucosal bleeding
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26
Q

Pinpoint hemorrhages from arterioles or venules

A

Petechiae

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27
Q

Purple discoloration of skin cuased by many petechiae (small bruises)

A

Purpura

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28
Q

Nosebleeds

A

Epistaxis

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29
Q

Vomiting blood

A

Hematemesis

30
Q

Abnormal, prolonged menstruation

A

Menorrhagia

31
Q

Spider-like dilations of small blood vessel

A

Telangiectasia

32
Q

List 3 types of bleeds associated w/ disorders of coagulation (problem w/ secondary hemostasis)

A
  • Ecchymoses
  • Hemarthrosis
  • Delayed bleeding and oozing from wounds
33
Q

Very severe bleed(s) into deep tissues/muscles (large bruises)

A

Ecchymoses

34
Q

Joint bleed(s) characteristic of hemophilia

A

Hemarthrosis

35
Q

Hemostasis is a combination of ____ and ____

A

Cellular; biochemical events

36
Q

List 2 types of mechanisms in enzyme systems

A

Coagulation and fibrinolysis mechanisms

37
Q

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

A

Cellular component of hemostasis

38
Q

What occurs when hemostatic systems are out of balance?

A

Thrombosis or hemorrhage or both may occur

39
Q

What is the preferred venipuncture method?

A

Evacuated Tube System (ETS)

40
Q

List three venipuncture methods

A
  • Evacuated tube system
  • Butterfly/syringe
  • Indwelling catheter
41
Q

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

A
  • MUST HAVE GOOD VEINS

- Assures correct blood: anticoagulant ratio

42
Q

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

A
  • Used w/ small, fragile veins

- Pose additional needle stick risk when transferring blood into tube

43
Q

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

A

Indwelling catheter

44
Q

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

A
  • Flush line w/ saline
  • Withdraw 5-10 mL blood and discard
  • Collect specimen
45
Q

Most common anticoagulant used

A

3.2% sodium citrate (PT/APPT)

46
Q

Blood: anticoagulant ratio

A

9:1 need a full tube draw

47
Q

Chelates (binds) free plasma calcium to prevent clotting

A

3.2% sodium citrate

48
Q

Specimen collection and handling requirement for 3.2% sodium citrate tube

A

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

49
Q

What is 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
50
Q

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

A

To prevent contamination w/ the previous tube’s anticoagulant

51
Q

Why don’t we use EDTA tube to collect blood for coag?

A

EDTA chelates calcium to prevent blood from clotting and it also binds reagent calcium in clot testing, so CANNOT USE!

52
Q

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

A
  • Increased hct in plasma vol relative to whole blood decreases plasma: anticoagulant ratio
  • Excess anticoagulant may then bind to the CaCl (added during the testing procedure) prolonging the clotting time
53
Q

List five unacceptable specimens

A
  • Clotted
  • Hemolyzed
  • Lipemia
  • Short draw sodium citrate tubes
  • Increased hematocrit (before reporting results)
54
Q

Explain how the clotted specimen will affect routine coagulation testing?

A
  • Many factors, platelets, and RBCs are consumed in clotting.
  • Be sure to gently invert tube after venipuncture (4-6X) to prevent clots
55
Q

Would clotted specimens be falsely prolonged or falsely shortened clotting times?

A

Falsely prolonged clotting times

56
Q

Would hemolyzed specimen have falsely prolonged or falsely shortened clotting times?

A

Falsely shortened clotting times

57
Q

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

A

Activate clotting pathways

58
Q

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

A
  • Prolonged tourniquet application
  • Excessive needle manipulation
  • Mixing blood too vigorously
  • Forcing blood through a small bore needle
  • Pulling too hard on a syringe
59
Q

What results are given when specimens are lipemic?

A

Additional light scatter from lipid droplets gives erroneous results

60
Q

Would lipemic specimen be falsely prolonged or falsely shortened?

A

Falsely prolonged clotting times

61
Q

Why are short drawn 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 CaCl
  • 9:1 ratio must be maintained
62
Q

Would short drawn specimens be falsely prolonged or falsely shortened?

A

Falsely prolonged clotting times

63
Q

What are transportation and storage requirements for specimens?

A
  • Keep tube stoppered and in upright position to maintain proper pH
  • Samples should not be chilled (chilled WB may activate platelets, Factors VII/VIIa, and contact system)
  • Transport to the lab at RT
64
Q

Never refrigerate blood/plasma for ____; and test w/in ____ hours

A

PT; 24 hours

65
Q

May refrigerate blood/plasma for ____; but need to test w/in ____ hours plus must spin and/or remove plasma w/in ____ if patient is on heparin

A

APTT; 4 hours; 1 hour

66
Q

Platelet rich plasma (PRP) is slow spun and used for _____

A

Platelet aggregation studies

67
Q

Platelet poor plasma (PPP) is spun faster and used for ____

A

Used for all routine coagulation assays such as PT and APTT

68
Q

Do PT and APTT measure platelets?

69
Q

Platelet free plasma (PFP) is spun faster, plasma is removed, and re-spun and is used for ____

A

Heparin or heparin-induced Ab

70
Q

What does APTT stand for?

A

Activated partial thromboplastin time

71
Q

What does PT stand for?

A

Prothrombin time

Liz's Hemostasis/Coagulation (10 decks)

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