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Hematology 2 > Primary Hemostasis > Flashcards

Primary Hemostasis Flashcards

1
Q

Stoppage of blood flow

A

Hemostasis

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2
Q

Normal volume of blood

A

5-6L

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3
Q

Cellular element of hemostasis that surrounds the vessel

A

Extravascular tissue factor (TF)

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4
Q

Cellular element of hemostasis where the blood flows

A

Vascular Intima

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5
Q

The stage of hemostasis that refers to the role of blood vessels and platelets

A

Primary Hemostasis

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6
Q

Two elements involved in Primary Hemostasis

A

Blood Vessels and Platelets

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7
Q

The final product of primary hemostasis

A

Platelet plug / Hemostatic plug

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8
Q

A general test performed to assess primary hemostasis

A

Bleeding Time

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9
Q

In platelet adhesion, platelets adhere to _

A

Collagen

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10
Q

Needed for normal platelet adhesion

A

vWF

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11
Q

Bridge between platelet and collagen

A

vWF

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12
Q

Bernard-Soulier disease is also known

A

Giant Platelet syndrome

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13
Q

Bernard-Soulier disease has a deficiency in the _ receptor for vWF

A

GPIB/IX/V

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14
Q

Refers to the morphologic and functional changes in platelets

A

Platelet Activation

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15
Q

In platelet activation, platelets become spherical with _ formation

A

Pseudopod

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16
Q

Elements responsible for the formation of actomyosin

A

Actin, myosin and Ca2+

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17
Q

A vasoconstrictor that stimulates platelet secretion

A

Thromboxane A2

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18
Q

A drug that inhibits cyclooxygenase

A

Aspirin

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19
Q

The eicosanoid pathway is otherwise known as

A

Thromboxane A2 Synthesis pathway / Arachidonic acid metabolism pathway

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20
Q

A substage of primary hemostasis which is responsible for the release of granules

A

Platelet secretion

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21
Q

Thromboxane A2 precursor

A

Arachidonic acid

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22
Q

Only Alpha granule deficiency

A

Gray platelet syndrome

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23
Q

Enumerate the dense granule deficiencies

A
  1. Hermansky-Pudlak
  2. Chediak-Higashi
  3. Wiskott-Aldrich Syndrome
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24
Q

Primary substance needed in platelet aggregation

A

Fibrinogen

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25
Q

Platelet receptor for fibrinogen

A

GPIIb/IIIa

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26
Q

Deficiency in GPIIbIIIa

A

Glanzmann’s thrombasthenia

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27
Q

End product of Secondary Hemostasis

A

Fibrin clot

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28
Q

The general test for assessing secondary hemostasis

A

Clotting time

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29
Q

Elements involved in secondary hemostasis

A

Coagulation Factors

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30
Q

it is the production and maturation of platelets

A

Megakaryopoiesis / Thrombopoiesis

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31
Q

The time it takes to complete process of megakaryopoiesis

A

5 days

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32
Q

Primary stimulatory protein for megakaryopoiesis

A

Thrombopoietin

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33
Q

Site for the sequestration (storage) of platelets

A

Spleen

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34
Q

The major organ that produces TPO

A

Liver

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35
Q

Normal Value of platelet count

A

150,000-400,000 /uL or 150-400 x10^9/L

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36
Q

What happens to the platelet count of the patient when there is Splenomegaly

A

Decreased platelet count

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37
Q

What happens to the platelet count of the patient when there is Splenectomy

A

Increased platelet count

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38
Q

Megakaryocyte progenitors resemble _ under light microscopy

A

Lymphocytes

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39
Q

Three megakaryocyte Progenitors

A
  1. BFU-Meg
  2. CFU-Meg
  3. LD-CFU- Meg
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40
Q

The first stage of endomitosis in the platelet maturation series

A

LD-CFU- Meg

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41
Q

A type of cell division wherein there is nuclear division, but no cytoplasmic division

A

Endomitosis

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42
Q

How many stages does the megakaryopoiesis have?

A

6

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43
Q

Last stage of megakaryopoiesis capable of endomitosis

A

Promegakaryocyte/ MK-II

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44
Q

Reason for the increased N: C ratio of platelet maturation series

A

Endomitosis

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45
Q

The largest blood cell in the bone marrow smear

A

Mature Megakaryocyte / MK-III

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46
Q

The largest blood cell in a normal peripheral blood smear

A

Monocytes

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47
Q

The largest blood cell

A

Megakaryocytes

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48
Q

The smallest blood cell fragment

A

Platelets / Thrombocytes

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49
Q

Diameter of mature megakaryocyte

A

40-120 um

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50
Q

Diameter of platelets

A

2-5 um

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51
Q

Not a true cell

A

Platelets

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52
Q

Parts of a platelet

A
  1. Chromomere

2. Hyalomere

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53
Q

The chromatin of MK II

A

Moderately condensed

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54
Q

Describe the platelet production if the megakaryocytes possess more nuclear lobes

A

Higher platelet production

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55
Q

The first stage where Demarcating Membrane System is first formed

A

Promegakaryocyte

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56
Q

Process wherein there is release of an abundance of platelet fragments

A

Platelet shedding

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57
Q

Mean Platelet volume

A

8-10 fL

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58
Q

Four areas of the platelets

A

PSOM

  1. Peripheral
  2. Sol-gel
  3. Organelle
  4. Membranous
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59
Q

The life span of platelets

A

10 days

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60
Q

The mean platelet volume is inversely proportional to _

A

Platelet count

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61
Q

MPV should be based on specimens that are _ hrs. old

A

1-4 hrs. old

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62
Q

The outermost layer of the platelets

A

Peripheral Zone

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63
Q

Another name of actomyosin

A

Thrombosthenin

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64
Q

Important in clot retraction

A

Actomyosin / Thrombosthenin

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65
Q

Area of the platelet containing microfilaments and microtubules

A

Sol-gel zone

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66
Q

Microfilaments in the sol-gel zone

A

Actin & Myosin

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67
Q

Microtubule in the sol-gel zone

A

Tubulin

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68
Q

The protein responsible for the maintenance of the platelet’s disc shape/cytoskeleton

A

Tubulin

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69
Q

Area of the platelet where granules are located

A

Organelle zone

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70
Q

Two types of membranous system

A
  1. Open Canalicular System (Surface connecting system)

2. Dense Tubular System

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71
Q

Part of the membranous system where the eicosanoid pathway occurs

A

Dense Tubular System

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72
Q

Part of the membranous system where the granules are released

A

Open Canalicular System (Surface connecting

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73
Q

Smallest blood vessel

A

Capillaries

74
Q

Signifies capillary fragility characterized by pinpoint hemorrhagic spots

A

Petechiae

75
Q

The no. of petechiae is _ proportional to the platelet count

A

Inversely

76
Q

Difference of purpura and ecchymosis

A

Size of skin

  • Purpura-small areas of skin
  • Ecchymosis- large areas of skin
77
Q

The most common complication in venipuncture

A

Ecchymosis

78
Q

Bloody stool associated with lower GIT bleeding characterized by a red-colored stool

A

Hematochezia

79
Q

Bloody stool associated with upper GIT bleeding characterized by a black tarry stool

A

Melena

80
Q

Excessive menstrual bleeding

A

Menorrhagia

81
Q

Epistaxis which persists for >_min. may be a manifestation of a hemostatic disorder

A

> 15 min.

82
Q

Occurs as a result of skin fragility

A

Simple purpura (Devil’s pinches)

83
Q

Type of primary purpura characterized by the development of cayenne pepper petechiae

A

Schamberg’s purpura (Progressive pigmentary purpura)

84
Q

Purpura that is not associated with any specific disease

A

Primary purpura

85
Q

Purpura that applies to a rapid onset

A

Purpura fulminans

86
Q

Purpura that may be seen in endocarditis, and ecthyma gangrenosum

A

Septic emboli

87
Q

Blood clots containing bacteria

A

Septic emboli

88
Q

Henoch-Schonlein purpura in an/a _ type of purpura

A

Allergic

89
Q

Scurvy is associated with what deficiency?

A

Vitamin C

90
Q

An increased corticosteroid excess that results in purpura

A

Cushing Syndrome

91
Q

Purpura secondary to dysproteinemia characterized by hemosiderin staining of the skin similar to Schamberg’s

A

Waldestrom’s purpura

92
Q

An autosomal dominant disorder characterized by hyperdistensible joints and fragile skin

A

Ehler’s-Danlos Syndrome

93
Q

A defective disorder due to the mutation of fibrillin

A

Marfan’s Syndrome

94
Q

Functional abnormalities of platelets

A

Qualitative platelet disorder

95
Q

Receptor for vWF

A

GPIB

96
Q

The most severe type of von Willebrand Disease

A

Type 3 (Complete deficiency of vWF)

97
Q

Type of von Willebrand disease characterized by increased binding of factor VIII to vWF

A

Type 2N

98
Q

Classic test to differentiate Bernard-Soulier syndrome and von Willebrand disease against Glanzmann’s Thrombasthenia

A

Platelet aggregation test

99
Q

Deficiencies seen in von Willebrand disease

A

Factor VIII and vWF

100
Q

Storage pool defect that demonstrates the smallest platelet

A

Wiskott-Aldrich Syndrome

101
Q

Characterized by a decreased functional platelet factor V, and normal plasma factor V

A

Quebec platelet disorder

102
Q

Low platelet count

A

Thrombocytopenia

103
Q

Platelets that are produced as compensation to platelet consumption

A

Stress / Reticulated platelets

104
Q

Four causes of thrombocytopenia

A
  1. Decreased platelet production
  2. Peripheral platelet destruction
  3. Abnormal platelet distribution
  4. Dilution of platelet count
105
Q

Increased platelet production

A

Thrombocytosis

106
Q

Classification of thrombocytosis characterized by a moderate increase (401-600x10^9/L)

A

Reactive thrombocytosis

107
Q

Classification of thrombocytosis characterized by a marked increase (>601x10^9/L)

A

Autonomous thrombocytosis

108
Q

Best anticoagulant for quantitative platelet evaluation (platelet count)

A

Citrate

109
Q

Most common anticoagulant for quantitative platelet evaluation (platelet count)

A

EDTA

110
Q

Most frequently involved leukocyte in platelet satellitosis

A

Neutrophils

111
Q

Remedy for platelet satellitosis

A

Recollect in a citrated tube (Sodium citrate)

112
Q

Components of the Reese-Ecker diluting fluid

A
  1. Sodium citrate (prevents coagulation)
  2. Formaldehyde (preservative)
  3. Brillant Cresyl Blue (dye)
113
Q

Best microscope for the evaluation of platelet morphology

A

Phase-Contrast Microscope

114
Q

Reference method for platelet count

A

Brecker-Cronkite

115
Q

Thoma pipette utilized for platelet counting

A

Red Thoma Pipette (1:100)

116
Q

Indirect platelet count is also known as

A

Platelet estimate

117
Q

Three methods utilized for platelet estimate

A
  1. Fonio’s
  2. Dameshek
  3. Olef’s
118
Q

In the platelet estimate, platelets are counted within how many fields?

A

10 fields

119
Q

The average of 10 fields in the platelet estimates is multiplied to _

A

20,000

120
Q

What should be the platelet count for PRP (platelet-rich plasma)

A

> 10,000/uL

121
Q

Best promoter of platelet adhesion in vitro

A

Glass

122
Q

Best promoter of platelet adhesion in vivo

A

Collagen

123
Q

This platelet retention test tests the retention of platelets within the glass bead column

A

Salzmann method

124
Q

The test used to measure the entire platelet function

A

Clot retraction

125
Q

Rumpel-Leede is otherwise known as _, uses a tourniquet to measure capillaries to resist pressure

A

Hess test / Positive pressure technique

126
Q

Pressure applied for the Rumpel-Leede test

A

100 mmHg for 5 min (Count petechiae after 15-30 min.)

127
Q

Qualitative test for platelets which may be assessed by the presence of dumpling/droplet-like serum on the surface of the blood drop within 14-45 min.

A

Hirshboeck or Castor Oil Method

128
Q

It is an in vivo measure of primary hemostasis

A

Bleeding time

129
Q

Factor that is not a protein

A

Factor IV

130
Q

What are the stages involved in primary hemostasis?

A

AASA

  1. Adhesion
  2. Activation
  3. Secretion
  4. Aggregation
131
Q

Diseases related to platelet adhesion

A
  1. vWF deficiency

2. Bernard Soulier disease

132
Q

What are the alpha granules in platelet secretion

A

BFA(2)TP(3)F(5)C

  1. Beta-thromboglobulin
  2. Fibronectin
  3. Albumin
  4. Alpha-2-antiplasmin
  5. Platelet Factor IV
  6. Platelet-derived growth factor
  7. Plasminogen
  8. FI
  9. FV
  10. FVIII
  11. vWF
  12. High Molecular Weight Kininogen
  13. C1 esterase inhibitor
133
Q

What are the dense granules in platelet secretion

A

C2APAS+1

  1. Calcium
  2. Catecholamine
  3. ADP
  4. Pyrophosphate
  5. ATP
  6. Serotonin
  7. Magnesium
134
Q

What are the Lysosomal granules in platelet secretion?

A

BAN

  1. Bacteriocidal enzymes
  2. Acid Hydrolase
  3. Neutral Protease
135
Q

Granules released by platelets

A 
ADLGM 
Alpha 
Dense 
Lysosomal 
Glycogen 
Membrane Phospholipid
136
Q

Enumerate the megakaryopoietic stages:

A
  1. MK-I (Megakaryoblast)
  2. MK-II ( Promegakaryocyte)
  3. Granular Megakaryocyte
  4. MK- III (Mature Megakaryocyte)
  5. Metamegakaryocyte
  6. Platelet/Thrombocyte
137
Q

Average size of platelets?

A

1-4um

138
Q

Osteogenesis imperfecta is a rare autosomal dominant disorder characterized by mutation of genes that code for peptides of type _ collagen

A

Type 1

139
Q

Involves the vessels throughout the body, which are dilated, tortuous (twisty/curvy), and disorganized

A

Hereditary hemorrhagic telangiectasia (Osler-Weber Rendu disease)

140
Q

Tumors composed of blood vessels that swell and bleed at the surface

A

Congenital hemangiomata (Kasabach-Meritt syndrome)

141
Q

Size of platelets in Bernard Soulier syndrome

A

> 20 um (Bernard is a giant bear = giant platelets)

142
Q

The quantitative subtypes of vWF deficiency

A

Type 1 and 3

143
Q

The qualitative subtype of vWF deficiency

A

Type 2

144
Q

The initial treatment of choice for Von Willebrand’s disease

A

DDAVP

1-Desamino-8-D-Arginine Vasopressin also known as DESMOPRESSIN

145
Q

The most preferred treatment for Von Willebrand disease

A

Humate P (contains intact vWF)

146
Q

The treatment used for patients unresponsive to DDAVP

A

Cryoprecipitate

147
Q

Type of von Willebrand disease with marked increased affinity for glycoprotein Ib

A

Type 2B

148
Q

Subtypes of vWF disease Type 2

A

2A
2B
2M
2N

149
Q

Type of von Willebrand disease with marked increased binding of Factor VIII to vWF

A

Type 2N

150
Q

In platelet aggregation test, Glanzmann thrombasthenia will show a normal reaction in:

a. Epinephrine
b. Collagen
c. ADP
d. Ristocetin

A

d. Ristocetin
* Glanzmann will only show a normal reaction in ristocetin, and negative for all. On the other hand, Bernard Soulier will show a normal reaction in all EXCEPT ristocetin

151
Q

The best test used to distinguish Hemophilia A from von Willebrand disease

A

Bleeding time

  • Hemophilia = Normal ;VWD: Abnormal (primary hemostasis disorder)
152
Q

Hemophilia A and Von Willebrand disease has this deficiency

A

Factor VIII deficiency

153
Q

What is the point of distinction from other patients with the alpha-gamma storage pool defect from gray platelet syndrome?

A

Decreased platelet P-selectin (CD26P)

154
Q

Disease wherein there is an impaired ability of platelets to promote coagulation due to the translocation of PS to the platelet outer membrane leaflet

A

Scott’s Syndrome

155
Q

Causes of Thrombocytopenia

A
  1. Decreased platelet production in the BM
  2. Peripheral Platelet destruction
  3. Abnormal platelet distribution
  4. Dilution of platelet count
156
Q

Components of the Guy-and Leake reagent for platelet count

A
  1. Sodium oxalate
  2. Formaldehyde
  3. Crystal Violet
157
Q

Anticoagulant for Brecker Conkrite method?

A

1% Sodium Oxalate

158
Q

Dilution in using unopette for platelet count

A

1:100 (use RBC Thoma pipette)

159
Q

Platelets are counted in their relationship to red cells on a fixed smear

A

Indirect platelet count / Platelet estimate

160
Q

Give the automation/s utilized in platelet count and their principle

A
  1. Voltage pulse counting -electrical impedance

2. Electro-optical counting - Flow cytometry

161
Q

Significant platelet levels

A

<100,000/uL Abnormally low
<30,000-50,000/uL Bleeding with trauma
<30,000/uL Spontaneous bleeding
<5,000/uL Severe Spotaneous bleeding

162
Q

Give a probable reason:

Normal platelet count and Prolonged Bleeding Time

A

Qualitative Platelet Abnormality (Adhesion, aggregation, storage pool defects)

163
Q

Give a probable reason:

Low platelet count and Normal Bleeding Time

A

Autoimmune Thrombocytopenia (antiplatelets)

164
Q

What is the sample for the platelet aggregation test?

A

Platelet Rich Plasma

165
Q

Agonists in the platelet aggregation test

A
  1. Epinephrine
  2. Collagen
  3. ADP
  4. Ristocetin
166
Q

Test considerations for Platelet Aggregation Test

A
  1. NO hemolysis
  2. Fasting for 8 hrs
  3. pH of 6.5-8.5
  4. No NSAIDS (Non-steroidal anti-inflammatory drugs)
  5. Within 3 hrs
167
Q

Another name for the platelet retention test

A

Platelet adhesiveness test

168
Q

Measures the entire function of platelets

A

Clot Retraction Test

169
Q

Qualitative test for platelet retraction that uses castor oil to form “dimpling” / droplet like-serum on the surface of blood drop

A

Hirshboeck or castor oil method

170
Q

The normal value for Hershboeck/castor oil method

A

15-45 min.

171
Q

Capillary resistance test correlates with the degree of _

A

Thrombocytopenia

172
Q

Rumpel-Leede Grading System

A 
1+ = 0-10 petechiae 
2+ = 10-20 petechiae
3+ = 20-50 petechiae 
4+ = >50 petechiae
173
Q

Suction cup method for capillary resistance utilizes a modified _ instrument

A

da Silva Melle instrument

174
Q

What are the methods for bleeding time?

A
  1. Duke’s method
  2. Modified Ivy’s method
  3. Coply-lalitch method
  4. Adelson-Crosby method
  5. MacFarlane method
  6. Aspirin tolerance test
175
Q

Which is more accurate for bleeding time?

Duke’s or modified Ivy’s method

A

Modified Ivy’s method because it uses a standard pressure of 40 mmHg

176
Q

The normal value for the Duke’s bleeding time method

A

6-10 min. (blot every 30 seconds)

177
Q

The best method to assess platelet adhesiveness

A

Modified Ivy method

178
Q

The normal value for the Modified Ivy bleeding time method

A

3-6 min.

179
Q

Where should you prick the patient when you are using modified ivy’s method?

A

The volar surface of the arm

180
Q

Site of puncture for Macfarlane’s method

A

Earlobe

181
Q

The pressure needed for modified Ivy’s method

A

40 mmHg

182
Q

Difference of Stefanini method and McFarlane method for clot retraction

A

Stefanini method uses time intervals that begins in 1 hr, and ends within 18-24 hrs; McFarlane should be measured after 1 hr only.

Hematology 2 (3 decks)

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