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HEMA 2 LAB > Primary hemostasis (blank) > Flashcards

Primary hemostasis (blank) Flashcards

1
Q

Vascular System:

A

arteries, capillaries and veins

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2
Q

Platelets – productions is influenced by _______

produced in the ________

A

THROMBOPOIETIN

liver or kidneys

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3
Q

Maturation time from the blast stage to platelet formation is
typically ______

A

5 days

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4
Q

Normal marrow contains approximately ________ (equates to ~ 5 to 10 megakaryocytes per
10× power field when bone marrow smears are microscopically examined)

A

15 million

megakaryocyte.

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5
Q

Normal circulation life of a platelet is ______

A

8 to 10 days

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6
Q

Platelets are removed by __________

or by __________

A

macrophage in the liver and spleen;

active use in daily coagulation mechanisms.

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7
Q

Circulating platelets are distributed between the _____ and
______:
a. ____ in spleen
b. platelet count is _____ in patients without a spleen and ____ in patients with splenomegaly enlarged spleen.

A

spleen
blood
a. 1/3
b. higher; lower

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8
Q

Regulation of the platelet count

Under normal conditions the platelet count (or mass) is
______, even with active use. This indicates a feedback
system that adjusts production to consumption.
(1) Rebound ______ occurs after platelet transfusion.
(2) Rebound _____ occurs after platelet depletion.

A

constant

(1) thrombocytopenia
(2) thrombocytosis

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9
Q

Regulation of the platelet count

Feedback stimulus results in an ______, which increases platelet volume and number. It also affects _______, which results in more megakaryoblast.

A

increased megakaryoblast
endomitosis;
committed unipotential stem cells

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10
Q

1st response to injured vessel.

Initiated by _____ and _____ derived from platelets and endothelial cells

A

Vasoconstriction

serotonin and thromboxane A2

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11
Q

Formation of Primary Hemostatic Plug or Platelet Plug:

A

Adhesion
Activation
Secretion
Aggregation

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12
Q

_______ - platelet adherence to exposed subendothelial
surface*

*collagen – in ___ & *glass – in ____

Occurs within ____ after a break in the _____

Occurs in the presence of _____ (receptor for ___:___)

A

Adhesion
vivo & vitro
1 to 2 mins; endothelium
vWF; vWF: Gp1b

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13
Q

______– morphologic and functional changes in platelets

Agonists that lead to platelet \_\_ are varied & include: 1-4
-
-
-
-

______ – a substrate that is converted to TxA2 by
cyclooxygenase

_______: vasoconstrictor & stimulates platelet
secretion

A

Activation

Arachidonic acid
Functions of TxA2

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14
Q

______ – release of platelet granules

Alpha granules: (_______)

Dense granules:

_____ – involved in all steps of coagulation (except the contact
factor of the intrinsic pathway of secondary hemostasis)

_____ – stimulates platelet aggregation

______ – vasoconstrictor

A

Secretion

(platelet factor, platelet-derived GF, platelet
fibrinogen, factor V, vWF, β-thromboglobulin,
thrombospondin, fibronectin & platelet albumin)

Ca
ADP
Serotonin

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15
Q

______ – platelet attachment to each other

Requires ______(receptor for ______: GpIIb-IIIa

A

Aggregation
fibrinogen & Ca
fibrinogen

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16
Q

Glycoprotein Receptors:

A

GpIb – receptor for vWF

GpIIb-IIIa – receptor for fibrinogen

GpVa – receptor for thrombin

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17
Q

events in primary hemostasis include:

A 
VASOCONSTRICTION
PLATELET ADHESION
PLATELET ACTIVATION
PLATELET SECRETION
PLATELET AGGREGATION
PRIMARY HEMOSTATIC PLUG or PLATELET PLUG FORMATION
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18
Q

HEREDITARY CONNECTIVE TISSUE DEFECTS:

A

EHLERS-DANLOS SYNDROME;

PSEUDOXANTHOMA ELASTICUM

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19
Q

ACQUIRED CONNECTIVE TISSUE DEFECTS:

A

SCURVY

SENILE PURPURA

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20
Q

HEREDITARY ALTERATIONS OF VESSEL WALL SYNDROME:

A

HEREDITARY HEMORRHAGIC TELANGIECTASIA
(OSLER-WEBER-RENDU DISEASE);

CONGENITAL HEMANGIOMATA
(KASABACH-MERRITT SYNDROME)

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21
Q

ACQUIRED ALTERATIONS OF VESSEL WALL SYNDROME:

A

DIABETES MELLITUS

AMYLOIDOSIS

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22
Q

ENDOTHELIAL DAMAGE:

A

AUTOIMMUNE VASCULAR PURPURA:

  • Drug-induced purpura
  • Allergic (HENOCH-SCHÖNLEIN PURPURA)

INFECTIOUS PURPURA

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23
Q

Drug-induced purpura:

A

Quinine, procaine, penicillin, aspirin, sulfonamides,

sedatives, coumarins

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24
Q

It is associated with abdominal pain secondary to GI bleeding

A

Henoch purpura

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25
Q

It is associated with joint pain

A

Schönlein purpura

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26
Q

Bacteria, viruses and parasites

A

INFECTIOUS PURPURA

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27
Q

Most common inherited vascular disorder; blood

vessel walls are thin and lack smooth muscle

A

HEREDITARY HEMORRHAGIC TELANGIECTASIA

OSLER-WEBER-RENDU DISEASE

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28
Q

Blood vessel tumor

A

CONGENITAL HEMANGIOMATA

KASABACH-MERRITT SYNDROME

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29
Q

Large vessels may become atherosclerotic and capillary basement membrane may thicken thus blocking normal blood flow

A

DIABETES MELLITUS

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30
Q

Deposition of fibrillar protein causing vessel obstruction

A

AMYLOIDOSIS

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31
Q

Increased vascular fragility; lack of peptidase that converts procollagen to collage

A

EHLERS-DANLOS SYNDROME

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32
Q

Elastic fibers in small arteries are calcified & structurally abnormal

A

PSEUDOXANTHOMA ELASTICUM

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33
Q

Defect in collagen synthesis due to deficiency of Vit C or

ascorbic acid

A

SCURVY

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34
Q

Degradation of collagen and elastin

A

SENILE PURPURA

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35
Q

decrease in the no. of circulating platelet

A

Thrombocytopenia

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36
Q

Decrease Production:

______– decrease RBC, WBC & platelets
(Congenital: Fanconi’s anemia; Acquired: exposure to radiation, drugs (Chloramphenicol) & benzene)

_____ – Chlorothiazide (selective suppression of the
megakaryocyte)

______ – space-occupying lesion in the bone marrow such
as metastatic tumor, fibrosis, or leukemia

A

aplastic anemia/ Pancytopenia
Drug Toxicity
Myelophthisic process

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37
Q

Increased Loss or Destruction:

______ – extensive blood transfusion is often accompanied by
thrombocytopenia, and the degree of which is directly proportional to the
no. of units transfused

_____– mass consumption of platelets

_____– autoantibody directed against platelet

A

Dilution loss
DIC
ITP

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38
Q

most common cause of thrombocytopenia in children; acquired after a viral illness such as measles, chickenpox, rubella or infectious mononucleosis

A

Acute ITP

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39
Q

_______– occurs in adults

A

Chronic ITP – occurs in adults

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40
Q

Increased Platelet Sequestration by Spleen:

A

Splenomegaly – 50 – 90% of platelets may be sequestered

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41
Q

increase in number of circulating platelets

A

Thrombocytosis

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42
Q

Thrombocytosis:

It is uncontrolled proliferation of platelets

A

primary (autonomous)

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43
Q

Characteristics of myeloproliferative disorders:

A

Polycythemia vera PV

Essential thrombocytopenia (ET)

Chronic Myelogenous Leukemia (CML)

Myelofibrosis with myeloid metaplasia (MMM)

44
Q

thrombocytosis is usually transient:

A

Secondary (Reactive)

45
Q

Secondary (Reactive) – thrombocytosis is usually transient:

A

Iron deficiency
Hemolytic anemias & acute blood loss
Splenectomy

46
Q

iron inhibits thrombopoietin

A

Iron deficiency

47
Q

due to rapid blood regeneration

A

Hemolytic anemias & acute blood loss

48
Q

increase platelet count is noted 1 to 10 days after

______and peaks 1 to 3 weeks later

A

Splenectomy

49
Q

Platelet Disorders - Quantitative:

A

Thrombocytopenia

Thrombocytosis

50
Q

Platelet Disorders - Qualitative:

A

Hereditary

Acquired

51
Q

Platelet Adhesion Disorders:

A

Bernard-Soulier Disease

Von Willebrand Disease

52
Q

Platelet Aggregation Disorders:

A

Glanzmann’s Thrombasthenia

53
Q

lacks GpIb; associated w/ giant platelets

A

Bernard-Soulier Disease

54
Q

lacks vWF; treated w/ cryoprecipitate

A

Von Willebrand Disease

55
Q

lacks GpIIb-IIIa complex

A

Glanzmann’s Thrombasthenia

56
Q

RESULTS in PLATELET AGGREGATION TEST:

Bernard-Soulier & vWD: __
Glanzmann’s Thrombasthenia: ____

A

Bernard-Soulier & vWD – Normal: ADP, Collagen & Epinephrine
Abnormal: Ristocetin

Glanzmann’s Thrombasthenia – Normal: Ristocetin
Abnormal: ADP, Collagen & Epinephrine

57
Q

Platelet Secretion Disorders:

A

ALPHA GRANULE DEFICIENCY:
- Gray Platelet Syndrome

DENSE GRANULE DEFICIENCIES:

  • Hermansky-Pudlak
  • Chediak-Higashi
  • Wiskott-Aldrich Syndrome
58
Q

Hereditary disorder in which platelets are large and gray or blue-gray in color

Dense tubular system which is storage site for Ca and cyclooxygenase is abnormal

A

Gray Platelet Syndrome

59
Q

It is the triad of tyrosinase-positive oculocutaneus albinism, accumulation of ceroid-like pigment in macrophages and bleeding tendencies

A

Hermansky-Pudlak

60
Q

characterized by albinism, recurrent infections and giant

lysosomes in all granule-containing cells

A

Chediak-Higashi

61
Q

It is the triad of thrombocytopenia, recurrent infections and eczema; platelets are small and have abnormal cellular membrane

A

Wiskott-Aldrich Syndrome

62
Q

Platelet Disorders - Qualitative

Acquired:

A 
Uremia
Paraproteinemias
AML
Myeloproliferative disorders
Drugs
63
Q

accumulation of toxic metabolites

A

Uremia

64
Q

coating of platelet membrane with abnormal protein

A

Paraproteinemias

65
Q

characterized by abnormal megakaryocyte

A

AML

66
Q

result in a platelet dysfunction by irreversible inactivation of the cyclooxygenase enzyme and the resultant decrease in
TxA2 formation

A

Aspirin (and other NSAIDs)

67
Q

the most potent of the penicillin group of antibiotics capable
of affecting platelet function

A

Carbenicillin

68
Q

purplish red pinpoint hemorrhagic spots (<3mm) in the skin caused by loss of capillary ability to withstand normal blood pressure and trauma

A

petechiae

69
Q

hemorrhage of blood (1 cm) into small areas of skin, mucous membrane

A

Purpura

70
Q

form of purpura (>3 cm) in which blood escapes into large areas of skin and mucous
membranes, but not into deep tissues

A

Ecchymosis

71
Q

nosebleed

A

Epistaxis

72
Q

leakage of blood into joint cavities

A

Hemarthrosis

73
Q

vomiting of blood

A

Hematemesis

74
Q

swelling or tumor in the tissues

A

Hematoma

75
Q

red blood cells in urine

A

hematuria

76
Q

hemoglobin in urine

A

hemoglobinuria

77
Q

stool with dark red or black blood

A

melena

78
Q

excessive menstrual bleeding

A

menorrhagia

79
Q

Laboratory Tests for Primary Hemostasis:

A 
Platelet Count
Bleeding Time
Platelet Adhesiveness
Platelet Aggregation
Clot Retraction Time
Capillary Fragility Test/ Rumpel-Leede Test/ Tourniquet
Test
80
Q

Platelet Count

NV: _____

Methods: _____

Significant bleeding does not occur until platelet count is ______

_______ = minor bruising, menorrhagia & post-operative or post-traumatic bleeding

_______= spontaneous bleeding into skin & mucous membrane (most serious site of bleeding – CNS)

A 
NV: 150 to 450 x 109/L
Methods: Manual & Automated
less than 60 x 109/L
20 to 60 x 109/L
Below 20 x 109/L
81
Q

Bleeding Time

In vivo measure of primary hemostasis

NV: _______

Methods:
____
____

As long as platelet function is normal, template bleeding time is not increased when platelet counts are _______

When count falls below this, the degree to which bleeding time is prolonged is _____ proportional to the decrease in platelet count

A

NV: 2 to 9 mins (Steininger)

Duke Method – fingertip or earlobe
Ivy Method – pressure cuff at 40 mmHg

greater than 100 x 109/L

inversely

82
Q

Platelet Adhesiveness tests:

A

Glass Bead Retention Test

Platelet Adhesiveness in vivo

83
Q

Platelet Aggregation

In vitro test to determine the ability of platelets to aggregate with certain agonist: _____

Platelet-rich plasma (PRP) + agonist 🡪 O.D. monitored

PRP is prepared by ______

Tube used: _____

A

Epinephrine, ADP, collagen, ristocetin

centrifugation at 200 x g for 10 minutes

75 mm plastic tube

84
Q

In vivo measure of primary hemostasis

A

Bleeding Time

85
Q

In vitro test to determine the ability of platelets to aggregate with certain agonist: Epinephrine, ADP, collagen, ristocetin

A

Platelet Aggregation

86
Q

Clot Retraction Time Methods:

A

Castor Oil/ Hirschboeck Method
Stefanini Method
MacFarlane Method

87
Q

Clot Retraction Time

Within _____ after whole blood is allowed to clot in a clean glass tube at ____, the clot will begin to shrink and retract from the walls of the
tube.

Clot retraction depends on __________

A

1 hr; 37oC

normal numbers of contractile platelets, Ca & ATP & a normal concentration of fibrinogen

88
Q

Formation of dimpling/ droplet-like serum on the surface of blood drop

A

Castor Oil/ Hirschboeck Method

89
Q

Castor Oil/ Hirschboeck Method

NV: ______

A

15 to 45 minutes

90
Q

Stefanini Method

Uses ______ blood at _____

Measured at ____ hours

NV: retraction begins _____ & completes _____

A

3 to 5 mL; 37oC
1/2/16/18/24 hrs
within 1 hr; within 18 to 24 hrs

91
Q

MacFarlane Method

Uses _____ blood at ____ for ____

CRT = _____

NV: ______

A

5 L; 37oC; 1 hr
CRT = volume or serum/total volume x 100
NV: 44 to 67%

92
Q

CRT: Usually abnormal when platelet count is_____

A

below 60 x 109/L

93
Q

Correlates with the degree of thrombocytopenia

A

Capillary Fragility Test/ Rumpel-Leede Test/ Tourniquet Test

94
Q

Capillary Fragility Test/ Rumpel-Leede Test/ Tourniquet Test

______ of the systolic and diastolic pressure for ____ and after ______, count petechiae

Decrease platelet –> _______

This test should not be repeated on the same arm for _____!!!

A

100 mmHg or midway; 5 mins; 15 to 30 min
increase petechiae
7 days

95
Q

Grade 1+

Petechiae:
Remarks:

A

0 – 10

Few petechiae on the anterior surface of the arm

96
Q

Grade 2+

Petechiae:
Remarks:

A

10 – 20

Moderate petechiae on the anterior surface of the arm

97
Q

Grade 3+

Petechiae:
Remarks:

A

20 – 50

Many petechiae on the arm & at the back of the hands

98
Q

Grade 4+

Petechiae:
Remarks:

A

> 50

Confluent petechiae on the arm & at the back of the hands

99
Q

Quantitative Disorders:

A

Decreased platelet count

Increased platelet count

100
Q

Decreased Platelet Count:

A

Distribution and dilution
Disorders of production
Disorders of destruction

101
Q

Decreased Platelet Count:

Distribution and dilution
-
-
-

A

Splenomegaly
Hypothermia
Transfusion

102
Q

Decreased Platelet Count:

Disorders of production:
-
-

A

Decrease in megakaryocyte

Ineffective production

103
Q

Decreased Platelet Count:

Disorders of Destruction:
-
-
-

A 
Combined consumption
    - DIC and its causes
Isolated consumption 
    - TTP
Immune destruction
    - ITP & Drug Induced (Quinidine, Heparin)
104
Q

Increased Platelet Count:

A 
IDA
Chronic inflammatory disease
Malignancies 
Splenectomy
Rebound thrombocytosis
105
Q

Qualitative disorders:

A

Surface membrane
Storage granule disorders
Disorders of TxA2 generation
Acquired

106
Q

Qualitative disorders:

Surface membrane:
-
-

A

Glanzmann’s thrombasthenia

Bernard-Soulier syndrome

107
Q

Qualitative disorders:

   Storage granule disorders
     -  
     -
     -
     -
A

Hermanksy-Pudlak syndrome
Wiskott-Aldrich syndrome
Chediak-Higashi syndrome
Storage pool disease

HEMA 2 LAB (7 decks)

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