LAV EVAL - PRIMARY HEMOSTASIS Flashcards by CHARLENE SAN JOSE

test under the plt aggregation test

epinephrine
collagen
adp
ristocetin

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test for plt adhesiveness

salzman

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test for retraction time

hirschboeck
macfarlene
stefanini-dameshek

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test for bleeding time

duke’s
ivy’s

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serves to immediately limit bleeding through the formation of a platelet plug

primary hemostasis

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platelets play a key role in the rapid response to blood vessel by

adhering to the endothelial wall at the site of injury
releasing potent anticoagulant compounds
aggregating to form a plug
providing a phospholipid surface for activated coagulation enzyme complexes

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defects in primary hemostasis are generally associated with ____ bleeding

mucocutaneous bleeding

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mucocutaneous bleeding is characterized by __

epistaxis, ecchymosis, genitourinary or gingival bleeding

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A typical patient with defective primary hemostasis might
experience profuse bleeding from small cuts and require the
application of pressure for a prolonged period to stop the
bleeding

true or false

true

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LABORATORY METHODS FOR THE STUDY OF
HEMOSTASIS

tests for primary hemostasis
tests for secondary hemostasis
test for inhibitors of coagulation (circulating anticoagulants )

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what are the Tests for primary hemostasis

Bleeding Time
Platelet Count
Tests for specific platelet functions
Clot Retraction Time
Capillary fragility or capillary resistance test

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this test for primary hemostasis provides assessment of platelet count and
function

bleeding time

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it measures plt plug formation

bleeding time

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factors that affect the bleeding time

elasticity of cut tissue
ability of the blood vessel to contract and retract
mechanical and chemical action of plt in the formation of the hemostatic plug

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Methods of Bleeding Time Determination

duke’s method
modified ivy’s method
coply lalitch method
adelson-crosby method
macfarlane’s method
aspirin tolerance test

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best method to assess platelets. It is considered to be the best screening
test available for platelet’s role in hemostasis.

Modified Ivy’s Method

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Both methods involve
immersion of the wound finger
in a sterile NSS warmed at 37̊C
until bleeding stops

coply lalitch method
adelson-crosby method

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same principle with Adelson-Crosby method but it only uses ear lobe as the site of
puncture

macfarlane’s method

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assesses the effect of a
standard dose of aspirin on the Duke’s Bleeding Time

aspirin tolerance test

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ref range for duke’s method

1-3 mns

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ref range for modified ivy’ method

3-6 mns

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template method ref range

3-6 mns

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coply lalitch method ref range

170-340 seconds

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Adelson-Crosby Method (NV:__ seconds)

170-340

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the 3 method of assessing bleeding time that has the same normal values

copy lalitch method adelson crosby method macfarlane's method 170-340 seconds

factors that causes with prolonged bleeding time:

when plt are reduced injury of capillary wall prothrombin deficiency slightly prolonged in severe anemia

conditions whereas plt are greatly reduced causing prolonged bleeding

thrombocytopenia purpura acute leukemia aplastic anemia

conditions whereas the capillary wall are injured causing prolonged bleeding

scurvy toxins (infection, chemical, snake venom)

conditions wherein there's prothrombin deficicency are injured causing prolonged bleeding

destructive disease of the liver hemolytic disease of the newborn

Direct Methods for platelet count

guy and leake method rees and ecker method brencher-cronkite method

inDirect Methods for platelet count

fonio's method dameshek method

platelets are counted in their relationship to red cells on a fixed-stained smear

indirect method

This method is NOT RELIABLE because the results depend upon the distribution of platelets and on the red cell count

indirect method of counting PLT

reagents used in Fonio's method

14% MgSO4 + 1ggt of blood + Wright Stain.

reagents used in dameshek method

Brilliant Cresyl Blue, Sodium Citrate, sucrose and formalin; counter stain with Wright’s Stain.

indirect method plt counting formula

plt/ul = plt X rbc count/1000

platelets are counted in a hemocytometer as in erythrocytes and leukocyte

direct method

guy and leake's solution component

diluent is made of sodium oxalate, 40% formalin and crystal violet.

formula for guy and leake

Platelets/uL= platelet counted X 5 X 10 X 10

rees and ecker solution components

diluent is made up of sodium oxalate, brilliant cresyl blue, formalin and distilled water

calculation for rees and ecker

Platelets/uL= Platelets counted X 10 X 200 divide by 4

this method of counting plt is when red cells must first be removed from whole blood, either by sedimentation or by controlled centrifugation

electronic method

Electronic Method has 2 ways of counting

voltage-pulse counting electro-optical counting

test for adhesion of platelets

borchgrevink method salzman method

- platelets are enumerated in the capillary blood oozing from a bleeding time puncture

borchgrevink method

it is expressed as a percentage of the venous plt count

borchgrevink method

test for the retention of plt within glass beads columns

salzman method

venous blood is aspirated directly from the bein through a bead column and into a vacutainer

salzman method

platelet aggregation test employs the use of various __

aggregometers

measures the changes in optical density of a platelet suspension under conditions of constant temperature and continuous agitation

platelet aggregation test

platelet aggregation test is studied in suspensions of __

citrated plasma (PRP)

why do we perform plt aggregation test

evaluation of suspected hereditary and acquired disorders of platelet function

. Hereditary platelet function disorders include

❑ Defects of adhesion (Bernard Soulier syndrome) ❑ Defects of aggregation (Glanzmann thrombasthenia) ❑ Defects of secretion (Alpha or Dense Granule Deficiency, Aspirin-Like Defects).

Acquired platelet function disorders

❑ drug-induced platelet dysfunction (aspirin, clopidogrel, antibiotics) ❑ uremia ❑ myeloproliferative disorders

depends on normal number of contractile platelets, the presence of calcium and ATP, and a normal concentration of fibrinogen

Clot Retraction Time

Methods under clot Retraction time

1. Hirshboek Method or Castor Oil Method 2. Stefanini Method 3. Macfarlane Method

Platelet deficiency a. Thrombocytopenia give the clot characteristics

clot nonretractile or retracts poorly

Platelet deficiency b. Thrombasthenia give the clot characteristics

clot edematous/friable

Afibrinogemia give the clot characteristics

blood does not clot

Fibrinogenopenia give the clot characteristics

clot is normal, increase red cell fall out

Increase in Blood Constituents a. Thrombocythemia b. Polycythemia give the clot characteristics

defective retraction, clot flabby/friable increased red cell fall out

Hyperproteinemia give the clot characteristics

layered clot clot may not retract or may retract poorly rapid sedimentation of red cell

- tests the stability of the small blood vessels to retain the red cell in their lumen under conditions of stress and trauma

capillary fragility or capillary resistance test

. Tourniquet or Rumpel –

Leede or Hess Test

by partially obstructing the venous blood, the capillary pressure is increased and will give rise to intravasation of blood which will be manifested in the form of small hemorrhage called

petechiae

1+ of petechiae in qualitative interpretation

few petechiae on the anterior part of forearm

quantitative interpretation of 1+ petechiae

0-10

2+ qualitative interpretation of petechiae means

many petechiae on the anterior part of the forearm

2+ quantitative interpretation of petechiae means

10-20

3+ qualitative interpretation of petechiae means

multiple petechiae over the anterior and the back of the hand

3+ quantitative interpretation of petechiae means

20-50

4+ qualitative interpretation of petechiae means

confluent petechiae over the anterior and the back of the hand

4+ quantitative interpretation of petechiae means

>50

this method has positive pressure technique

tourniquet or rumpel

this method has negative pressure

suction cup or petechiometer method

- employs the use of a modified da Silva Melle instrument

Suction Cup or Petechiometer Method

the cup is applied to the surface of the arm for a period of one minute at 200 mmHg

Suction Cup or Petechiometer Method

the resistance of the capillaries is expressed as the least negative pressure required to produced macroscopic petechiae

Suction Cup or Petechiometer Method

ref range of Suction Cup or Petechiometer Method

less than 4 petechiae

Indications of Increase Capillary Resistance Test

1. Thrombocytopenia 2. Thrombocythemia 3. Vascular purpura 4. Scurvy 5. Senile purpura