Primary Hemostasis, Platelet Function. Lab Tests Flashcards
Cellular elements of hemostasis
Vascular intima
Extracellular tissue factor bearing cells
Platelets
Plasma components of hemostasis
Coagulation and fibrinolytic
Structure of blood vessel wall
Vascular initima
Rhomboid and contiguous
Endothelial cells
Anticoagulant properties of Vascular intima
Lamina propia Nitric oxide Heparin sulfate TFPI Thrombomodulin PGI2 or prostacyclin TPA
Activates fibrinolytic serum. Dissolves clot
TPA
Vasodilator, inhibits platelet activation
Prostacyclin
Activates protein C pathway. Digest factor Va and VIIIa
Thrombomodulin
Inactivates coagulation factor VIIa
TFPI
Inactivates extrinsic factor
TFPI
Retards coagulation by activating antithrombin
Heparin sulfate
Counteracts vasoconstriction
Nitric oxide
Relaxing factor
Nitric oxide
Promotes platelet activation and adhesion
Collagen
Origin of collagen
Fibroblast
Activates fibrin bound plasminogen to form plasmin
TPA
Digest thrombus and restore blood flow
Plasmin
Inhibits activation of fibrinolytic system
PAI-1
Adhesion molecules
P-selectin
ICAM
PECAM
Induce vasoconstriction
Smooth muscle cells
Who secretes vWF
Endothelial cells
Promotes leukocyte binding
ICAM
PECAM
Promotes platelets and leukocytes binding
P selectin
Platelets roll and cling to nonplatelet surfaces
Adhesion
Platelet adheres to each other
Aggregation
Platelets discharge the contents of their granules
Secretion
Absence of GP IIb/IIIa
Glanzmann thrombostemia
Absence of Gp Ib/IX
Bernard soulier syndrome
Where is vWF being stored
Weible palade bodies
Bind vWF
GP Ib/IX receptor
For jigsaw puzzle effect
Pseudopod
For crosslink to other platelet
GP IIb/IIIa
Requires fibrinogen
Aggregation
Requires extensive damage
Aggregation
Reversible aggregation
Platelets adhere loosely to each other
Primary aggregation
Irreversible aggregation
Release of substance that acts as antagonist
Secondary aggregation
Substances that promotes coagulation
HMWK
Fibrinogen
Factor V
Factor VIII:vWF
Substances that promotes aggregation
ADP
Calcium
PF4
Thrombospondin
Promotes vasoconstriction
Serotonin
Thromboxane A2
Promotes vascular repair
PDGF
B-thromboglobulin
Plasma precursors
Plasminogen
Plasma inhibitors
Alpha-2-antiplasmin
Complement system inhibitors
C1 esterase inhibitor
Positive result of capillary fragility test
Petechiae
Methods of Capillary fragility test
Tourniquet test
Rumple Leed
Gothlin
Quick
4+ petechiae
> 50
1+ petechiae
0-10
2+ petechiae
11-20
3+ petechiae
21-50
Pinpoint hemorrhagic spots
Petechiae
Correlates with the degree of thrombocytopenia
Capillary fragility test
Original test for platelets
Bleeding time
Normal value of Duke method
2-4mins
Normal value of Ivy method
2-9mins
Factors affecting bleeding time
Vascular integrity
Platelet function
Platelet count
2 cuts in volar surface of hand
Ivy method
Reason why platelet count is difficult
Platelets: .easily adhere to foreign surface .Easily disintegrate .difficult to distinguish from debris .unequal distribution in circulation
Whole blood is diluted with diluting fluid in RBZc pipet and counted in hemocytometer
Direct platelet count
Platelets are counted in relation to 1000 RBC in the PBS
Indirect platelet count
Indirect methods
Damashek
Fonio
Olef
Direct methods
Guy and Leake
Reese Ecker
Brecker cronkite
Unopette
Direct using light microscope
Reese Ecker
Guy and Leake
Diluting fluid of Reese Ecker
Sodium citrate
BCB
Distilled water
Guy and Leake diluting fluid
Sodium citrate or oxalate
Crystal violet
Formalin
Diluent of brecker cronkite and use of diluent
1% ammonium oxalate
Hemolyzes RBC
Damashek diluent
BCB Sodium citrate Distilled water Formalin Sucrose
Best indirect method
Olef
Diluent of Fonio
14% MgSO4
Inhibits cyclopxygenase enzyme
Aspirin
Inhibit GP IIb/IIIa
Tirofibom
Inhibits ADP receptor
Clopidogrel bisulfate
Inhibit circulating thrombin
Heparin
Inhibit thrombin attach to fibrin
Hirudin
Process by which blood is maintained within the vessel walls
Hemostasis