Midterm Topic 1 Flashcards
Bleeding time diagnose what?
vWD
The result is directly affected by plt count and the plt’s ability to form a hemostatic plug
Bleeding time
Factors that affect bleeding time
Elasticity of cut tissue
Ability of the blood vessels to constrict and retract
Mechanical and chemical action of plts in the formation of hemostatic plug
Screening for plt functions
Ivy’s method
Modification of Ivy method. Cut is exactly 9mm long and puncture is 1 mm
Template Method
Considered best screening test
Template method
Incision is 5 mm long and deep is 1 mm. Similar to template method. Difference is the use of an instrument to produce a standardized incision.
Simplate method
Both methods involve immersions of the warmed wounded finger in a sterile NSS at 37 until bleeding stops
Copy Lalitch Method
Adelson-Crosby method
Normal value for Coply Lalitch Method and Adelson-Crosby Method
179-340 seconds
Similar with Adelson Crosby, only it uses the ear lobe as the site of puncture.
Aspirin Tolerance Test
Def. of Vit. C
Scurvy
Abnormally low plt count
Less than 100,000/ uL
Severe spontaneous bleeding plt count
Less than 5000/uL
Bleeding possible with trauma plt count
30,000/uL - 50,000 /uL
Spontaneous bleeding possible plt count
Less than 30,000/uL
Measures the adhesion of platelets to the wound surface.
Borchgrevink
Borchgrevink uses?
Capillary blood and Venous blood
Retention of plts within glass bead columns.
Salzman method
In Salzman method in does not interfere with adhesion.
Heparin
Normal Value of Salzman method
26-60%
PRP containing EDTA is assessed for adhesion collagen in the absence of aggregation.
Test for adhesion of plts to collagen fibers
Estimated qualitatively by microscopic techniques.
Plt aggregation test
A machine that uses a light beam is passed off through the suspension. Monitored by changes in light transmission
Platelet aggregometer
Discoid to spheroid shape
Decrease in transmittance
Formation of plt clumps
Increase light transmittance
Facilitates the ability of plasma to clot by providing a surface to clot. A functional concept rather than a discrete molecular substance.
PF3 Availability Test
Activates the plt.
Kaolin and Epinephrine
Normal Value for PF3 Availability test
37-51 seconds
Depends on normal number if contratile platelets, the presence of calcium and ATP, and a normal conc. of fibrinogen. A normal plt and fibrinogen or fibrin
Determination of Clot retraction
Universal test for platelet function
Bleeding time
Serial dilutions of plasma are clotted with thrombin
Fibrinogen test
Rapid slide test based on agglutination of fibrinogen-coated red blood cells by the latex anti-human fibrinogen regent
Fi-test (immunologic test)
NV of fibrindex test
Normal plasma
begins to clot after 5-10 seconds
NV of fibrindex test
Firm clot
Formed without serum after 30-60 sec
Thrombin is available commercially as
Fibrindex
When added to plasma containing fibrinogen, thrombin produces clotting
Fibrindex test
Fi test
Normally, presence of fibrinogen is indicated by
Agglutination
Fibrinogen is usually converted into fibrin which id quantitated by
Gravimetric Nephelometric Chemical Immunologic Precipitation methods
Methods for assay o plasma fibrinogen
Ellis and stransky method Stirland's method Turbidimetric method of Parfantev et.al Tatniff and menzie method Fibrin clot method
1 drop of blood and caster oil then observe for 30 sec. for clotting.
Hirschboek kr Caster Oil Method
Qualitative test that uses blood in a test tube for clotting time determination is saved and left at room temp in order to note retraction, red cell fall-out and clot lysis.
Single Tube Method
Normal value for the quantitative tests for determination of clot retraction
30-69 min. and complete in 18-24 hrs.
Thrombocyte Deficiencies
Thrombocytopenia
Thrombosthenia or Glanzmann’s dse
Clot characteristics:
Clot nonretractile or retracts poorly. Clot edematous/friable, but coagulates normally.
Thrombocytopenia, Thrombosthenia or Glanzmann’s dse
Fibrinogen dse
Afibrinogemia
Hypofibrinogemia
Fibrinolysis
Dysfibrinogemia
Clot characteristics:
Small clots; increased red cell expressed from the clot
Dysfibrinogemia
Clot characteristics:
Blood does not clot
Afibrinogemia
Clot characteristics:
Clot is normal; increased red cell fall-out
Hypofibrinogemia
Clot characteristics:
Clot is absent or moth eaten and frayed; increased red cell fall-out; serum will lyse normal clots
Fibrinolysis
Increased in blood constituents
Thrombocythemia or Polycythemia
Hyperproteinemia
Clot characteristics:
Rapid sedimentation of red cells; layered clot; clot may not retract or may retract poorly
Hyperproteinemia
Clot characteristics:
Defectivd retraction; clot flabby/fragile; increased red cell fall-out
Thrombocythemia or Polycythemia
Delayed Clotting
Severe “hemaphiloid” state: hemophilia
Increase in anticoagulants
Clot characteristics:
Slow clotting time with sedimentation of red cells; clot retraction is normal
Hemophilia
Clot characteristics:
Increase in red cells and in fluid fall-out; clot may reform after initial partial clot removed
Increase in anticoagulants
Similar with single tube method but it does not use graduated
Stefanini Method
Blood is allowed to clot in a test tube containing a glass rod and retraction is observed.
MacFarlane Method
It 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
In capillary fragility test they are important in the maintenance of normal capillary integrity or resistance.
Plts and Vit. C
According to Brown other name for Tourniquet or Hess Tesr
Rumpel-Leede
Normal Value for Quick’s Method:
0-5 petechiae
+
Normal Value for Quick’s Method:
++++
51 and above petechiae
Normal Value for Quick’s Method:
21-50 petechiae
+++
Normal Value for Quick’s Method:
++
6-10 petechiae
Normal value for Gothlin’s Method
0-8 petechiae
Present it scarlet fever
Vascular purpura
Collagen def.
Senile purpura
Tests the composite action of all plasma factors acting simultaneously.
Coagulation test
Micro methods of the coagulation tests
Slide or Drop Method
Capillary or Dale and Laidlaw’s method
Normal Value for Capillary or Dale and Laidlaw’s method
2-6 minutes
These methods are superior for there is less contamination of the plasma with tissue fluids when blood is drawn from a vein
Macro method
The whole blood clotting time is the time required for freshly collected blood to form a firm clot in standardized glass tubes at 37C
Lee-White or Whole blood clotting time
Normal value for Lee-White or Whole Blood Clotting Time
5-10 mins
Normal Value for Howell’s Method
10-30 mins
This method is similar to Lee-White Method
Howell’s Method
The whole blood clotting time is a measure of the integrity if the intrinsic system.
Lee-White or Whole Blood Clotting Time
This method is the same as the whole blood clotting time except the test is performed in Silicone-coated tubes
Silicone Tube Method - Tocantin’s and Kazal Method
Normal Value for Silicone Tube Method - Tocantin’s and Kazal Method
1-2 mins
In Plasma recalcification time the plasma contains all intrinsic coagulation factors except what?
Calcium and plts.
It is more sensitive method than the coagulation time of whole blood.
Plasma Recalcification Time
Normal Value for Activated Recalcification Time
Less than 50 seconds
Simple test of the intrinsic and common pathways of coagulation.
Partial Thromboplastin Time
In PTT it measures all factor deficiency of intrinsic and common pathway except
Factors 7, 13, and plts.
Normal value for PTT
40-100 seconds
It used to monitor IV anticoagulant therapy
PTT
Prolonged in PTT deficiencies
Factors 12, 11, 9, 8, 10, 7 and 1 Prekalikrein and HMWK
Shortened in PTT
Patients with activated coagulation system
Similar to PTT except that a standardized foreign surface is introduced to the plasma w/c allows activation of Factors 12, 11.
Activated Partial Thromboplastin (APTT)
APTT allows the activation of Factors?
12, 11
Example of activators of APTT
Celite, Kaolin, Ellagic Acid and tannic acid
They are useful for screening procedures of coagulation deficiencies/disorders in the intrinsic and common systems except for plt and factor 13.
PTT and APTT
APTT and PTT are useful in screening procedures of intrinsic and common system except what?
Platelets and factor 13
APTT and PTT detects the deficiencies of what factors?
1,2,5,8,9,10,11, and 12 as well as prekalikrein and HMWK
Abnormally shortened APTT caused what?
Cause by partial clotting of the blood.
Abnormally shortened APTT results in?
Traumatic venipuncture, high levels of factor 3, an activated coagulation system as in DIC or the presence of plts
NV for APTT
25-35 seconds
Used to differentiate factor deficiency and disorder of circulating anticoagulanta
Differential Tests of Activated Partial Thromboplastin Time (DAPTT)
If prolonged APTT corrected by addition of normal control plasma then the patient has?
Factor Deficiency
If not corrected then the patient’s defect is due to what?
Circulating AC
Identification of factor deficiency:
Patient’s plasma + absorbed plasma
Factors 5 and 8
Identification of factor deficiency:
Patient’s plasma + serum
Factors 11 and 12
Another modification of APTT which is done by mixing the pxn’s plasma with commercially available correcting rgts.
Differential Partial Thromboplastin time (DPTT)
If prolongrd APTT is corrected in DPTT:
Factor 8 patient has
Hemophilia A
If prolongrd APTT is corrected in DPTT:
Factor 9 rgt patient has
Hemophilia B
If prolongrd APTT is corrected in DPTT:
Partially corrected with either rgt patient has
Hemophilia C
Serum prothrombin time/ prothrombin consumption time
Normal value
26-37
Best considered as a test of platelet phospholipids activity
Serum prothrombin time/ prothrombin consumption time
If the PT and PTT are normal, a short PCT indicates a deficiency of ____ due to _______
PF3
thrombocytopenia
Thrombopathia
Principle of this test lies in the knowledge that for normal thromboplastin activity to develop in blood, HF, Platelets, PTC, PTA, factor V and stuart factor are ionized calcium are all necessary
Thromboplastin Generation Time
Reagents for TGT
Al(OH)3 adsorbed plasma
Normal plasma
Normal platelets
Calcium (M/40 CaCl2)
Methods of TGT
Biggs and macfarlane method
Hick’s-pitney kaolin modification TGT
Reagents for biggs and macfarlane method
Al(OH)3 adsorbed plasma
Normal plasma
Normal platelets
Calcium (M/40 CaCl2)
Reagent for hick’s-pitney kaolin modification TGT
Al(OH)3 adsorbed plasma
Normal plasma
Calcium (M/40 CaCl2)
Test for deficiency or inhibition of fibrinogen
Thrombin time
Good screening test for thrombi-fibrinogen/fibrin interaction
Thrombin time
Thrombin time
NV
10-20 seconds
Prolonged TT occur in patients with
Receiving therapeutic heparin
Patients wt increase antithrombin or FSP
Patients with any disorder of hypofibrinogenemia
Alternative to thrombin time except reptilase reagent is added to plasma
Reptilase R test
Not inhibited by heparin
Inhibited minimally by FSP
Reptilase-R test
Rapid slide test based on agglutination of fibrinogen-coated RBC by latex anti-human fibrinogen reagent
Fi-test (immunilogic test)
Serial dilutions of plasma ate clotted with thrombin
Fibrinogen titer method
When added to plasma containing fibrinogen, thrombin produces clotting
Fibrindex test
Thrombin is commercially availabe as
Fibrindex
Fibrindex time
NV normal plasma
5-10 seconds
Fibrindex time
NV firm clot
Within 30-60 seconds
Accurate methods available for the quantitative assay o plasma fibrinogen
Assay of plasma fibrinogen
A clot is dissolved as a result of plasmin activity
Whole blood clot lysis time
Whole blood clot lysis time
NV
Lysis clot after 24 hrs
More sensitive test than the whole blood clot lysis time
Euglobulin test
Screening procedure for
Measurement of fibrinolytic activity
Euglobulin clot lysis time
Euglobulin clot lysis time
NV
Lysis about 300 minutes or longer-N
Euglobulin clot lysis time
Lysis in 60 mins or less
Strong lysis
Euglobulin clot lysis time
Lysis in 120 mins or less
Increased lytic activity
Plasmin inhibitors lose activity on dilution
Diluted blood clot lysis time
Diluted blood clot lysis time
Nv
Blood clot should not lyse in less than 6-10hrs
Serial dilutions of patient’s plasma and normal plasma are prepared
Diluted plasma clot lysis time
Methods for assay of these fragments are based on red cell hemagglutination inhibitors
Quantitative assay of fibrin-fibrinogen degradation products
Protamine sulfate turbidity test
Method
Kidder’s
When a dilute solution of protamine sulfate is added o citrated plasma incubated at 37C, a precipitate in the presence of fibrin monomer or early fibrin degradation products is formed to produce turbidity.
Effects of heparin is antagonized
Protamine sulfate turbidity test
Fibrinogen degradation products present in the serum reacts with latex coated with anti-fibrinogen showing an agglutination reaction
Latex bead agglutination
Rapid semiquantitative method. If the antibody used in this assay recognizes only neoantigens created by the proteolytic action if thrombin on fibrinogen then, patient’s plasma may be substituted for patient’s serum in the assay
Latex bead agglutination
Test is superior in sensitivity and specificity as compared with the conventional FDP assay
D-dimer test
Test positive in early DIC.
Specific for cross-linked d/dimer fragment fibrin
D-dimer test
New assay that is sensitive biologic marker of thrombin generation and Xa activity because generation of F-1.2 precedes thrombus formation
Prothrombin fragment 1.2 test (F-1.2)
