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Lab Medicine I > Test 2 > Flashcards

Test 2 Flashcards

1
Q

hemostasis definition

A

the process of coagulation and lysis of clots in the body

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2
Q

four processes of hemostasis

A
  • narrowing of blood vessels
  • platelet activity
  • activation of coagulation factors via intrinsic and extrinsic pathways
  • fibrinolysis
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3
Q

excessive hemorrhage caused by

A
  • delays in clot formation

- premature clot lysis

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4
Q

excessive thrombosis caused by

A
  • inappropriate clot activation

- localization of the blood coagulation process

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5
Q

hyperreactivity of platelets leads to

A

arterial thrombosis

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6
Q

accelerated activity of the clotting system leads to

A

venous thrombosis

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7
Q

impaired coagulation caused by

A
  • thrombocytopenia
  • acquired coagulation disorders
  • inherited factor deficiencies
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8
Q

activation of platelets steps

A
  • adhesion
  • aggregation
  • fibrin formation
  • clot retraction
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9
Q

platelet count panic values

A

<20

>1000

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10
Q

causes of thrombocytopenia

A
  • decreased platelet production
  • increased platelet destruction or consumption
  • increased splenic sequestration
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11
Q

heparin induced thrombocytopenia (HIT)

A
  • life threatening complication of exposure to heparin
  • causes platelet activation that causes platelet consumption
  • thrombosis risk is higher than bleeding risk
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12
Q

EDTA sensitivity (pseudothrombocytopenia)

A
  • erroneous low platelet counts due to micro clumping of platelets in spite of anticoagulant in tube
  • low platelet count without history of thrombocytopenia or bleeding episode*
  • redraw specimen in tube with different anticoagulant
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13
Q

causes of thrombocytosis (high platelets)

A
  • essential thrombocythemia (bone marrow over produces)

- reactive thrombocytosis

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14
Q

bleeding time

A
  • measures the primary stage of hemostasis

- interaction of the platelet with the blood vessel wall and formation of hemostatic plug

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15
Q

platelet function analysis

A

-measures the time to form a platelet/RBC thrombus

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16
Q

platelet aggregation study

A
  • gold standard for testing platelet response*

- measures if platelets aggregate, adhere, or release their granules

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17
Q

von Willebrands Type 1

A
  • most common
  • missing some VWF
  • mild symptoms
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18
Q

von Willebrands Type 2

A
  • defective VWF

- mild symptoms

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19
Q

von willebrands type 3

A
  • limited or no VWF

- severe symptoms

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20
Q

von willebrand factor role

A
  • VWF helps adhere platelets to exposed collagen in vessel walls
  • VWF protects factor 8 from degradation by proteins C and S
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21
Q

von willebrands labs

A
  • platelets = normal
  • PTT = normal or increased
  • VWF antigen = decreased
  • factor 8 antigen = decreased
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22
Q

idiopathic thrombocytopenia purpura (ITP)

A
  • unknown cause but usually follows viral illness in children
  • platelets become bound to antibodies
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23
Q

ITP labs

A
  • platelets = decreased
  • bleeding time = increased
  • PT/PTT = normal
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24
Q

ITP treatment

A
  • splenectomy

- platelet transfusion for super low counts

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25
Q

thrombolytic thrombocytopenia purpura (TTP)

A

-small blood clots form throughout the body consuming large numbers of platelets

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26
Q

TTP pentad

A
  • consumptive thrombocytopenia
  • microangiopathic hemolytic anemia
  • neurological
  • fever
  • renal dysfunction
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27
Q

TTP Labs

A
  • platelets = decreased
  • Hb = <10
  • PT/PTT = normal
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28
Q

hemolytic uremic syndrome (HUS)

A
  • rare disorder

- can occur with E. coli infection

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29
Q

HUS triad

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • acute renal failure
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30
Q

HUS labs

A
  • platelets = decreased
  • PT, PTT = normal
  • BUN/creatinine = elevated
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31
Q

HELLP

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelet
  • seen during pregnancy or within 48 hours post partum
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32
Q

HELLP labs

A
  • platelets = lows
  • microangiopathic blood smear
  • PT, PTT = normal
  • bilirubin/AST = elevated
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33
Q

extrinsic pathway factor

A

3, 7

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34
Q

intrinsic pathway factor

A

12, 11, 9, 8

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35
Q

thrombin time (TT)

A
  • measures time needed for plasma to clot when thrombin is added
  • can detect DIC
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36
Q

TT clinical implications

A
  • increased = clots faster

- decreased = clots slower

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37
Q

activated partial thromboplastin time (PTT)

A
  • screens for clotting disorders with deficiencies in the intrinsic pathway
  • used to monitor unfractionated heparin therapy
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38
Q

heparin

A
  • produces immediate anticoagulant effect by enhancing antithrombin
  • neutralized by protamine in case of overdose
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39
Q

prothrombin time (PT)

A
  • measure potential defect in extrinsic pathway
  • dependent on vitamin K intake and absorption
  • PV INR>3.6
  • used to manage coumadin therapy
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40
Q

vitamin K dependent factors

A
  • 2 (prothrombin)
  • 7
  • 4
  • 10
  • protein C & S
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41
Q

vitamin K deficiency causes

A
  • drug therapy (coumadin, antibiotics)

- disease (malabsorption, biliary obstruction, malnutrition)

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42
Q

coumadin

A
  • delays vitamin K formation interfering with dependent factors
  • takes 48-72 hours to cause measurable change in PT/INR
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43
Q

protein C

A
  • prevents thrombosis and enhances fibrinolysis
  • inactivates factor 5 and 8
  • protein C should be checked in conjunction with protein S
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44
Q

protein S

A

-enhances activities of protein C

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45
Q

antithrombin

A

-inhibits factor 10

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46
Q

factor V Leiden

A
  • most common cause of hereditary hypercoagulopathy

- resistant to inactivation by protein C

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47
Q

DIC

A

-continuous generation of thrombin causes depletion of coagulation factors and platelets resulting in uncontrolled bleeding

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48
Q

DIC treatment

A

heparin

-blocks thrombin which blocks coagulation factor consumption

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49
Q

DIC labs

A
  • increased PT, PTT, PFA, D-dimer

- decreased platelets, factors 2,5,8, 10

50
Q

hemophilia A

A

-factor 8 deficiency

51
Q

hemophilia B

A
  • factor 9 deficiency

- treated with fresh frozen plasma

52
Q

hemophilia C

A
  • factor 11 deficiency

- Ashkenazi jews

53
Q

low molecular weight heparin

A
  • does not require PTT testing
  • neutralized by protamine in case of OD
  • decreased risk of HIT
54
Q

urine color

A

caused by the pigment urochrome

55
Q

specific gravity

A
  • normal: 1.005-1.030
  • dilute: 1.000-1.010
  • concentrated: >1.025

measures the ability of the kidneys to concentrate urine and is confirmed with refractometer

56
Q

pH

A

useful for the ID of crystals

57
Q

hemoglobinuria

A
  • no microscopic RBC but color change to “strong”

- pinkish red color

58
Q

hematuria

A
  • speckled dipstick and microscopic RBC

- ascorbic acid = false negative

59
Q

myoglobinuria

A
  • cherry red urine
  • no microscopic RBC
  • increased muscle enzymes
60
Q

protein

A

indicator of renal disease

61
Q

glucose

A
  • critical value = 4+ in pediatrics

- SGLT2 inhibitors can interfere

62
Q

ketones/acetones

A
  • critical value = ketones in child under 2
  • result of fat metabolism
  • significant in DKA
63
Q

nitrite

A

-produced by gram negative bacteria such as E. coli

64
Q

WBC

A

-detect UTI and inflammation

65
Q

bilirubin

A
  • appears in urine before signs of jaundice

- positive in biliary obstruction

66
Q

urobilinogen

A

-most sensitive test for early detection of liver disease

67
Q

microscopic RBC

A

can be confused with yeast, oil, or air bubbles

68
Q

microscopic WBC

A

-clumps suggest renal origin

69
Q

microscopic squamous epithelial cells

A
  • normal finding

- large amounts in females can indicate poor collection

70
Q

transitional epithelial cells

A
  • normal in small numbers

- large numbers due to catherization or trauma

71
Q

renal tubular cells

A

-high numbers can indicate necrosis of renal tubules

72
Q

fatty & waxy/broad casts

A

-indicative of nephrotic syndrome

73
Q

cholesterol crystals

A
  • associated with nephrotic syndrome

- broken windowpane

74
Q

leucine, tyrosine, and bilirubin crystals

A

associated with liver disease

75
Q

urine osmolality

A

-more exact measurement of urine concentration than specific gravity

76
Q

urine microalbumin

A
  • occurs before clinical proteinuria is evident
  • detect early DM and HTN damage
  • preeclampsia
77
Q

sodium

A
  • critical values: <120 >160

- primary determinant of extracellular osmolality

78
Q

hypernatremia

A
  • all cases will have increased serum osmolality
  • low urine osmolality = diabetes insipidis
  • high urine osmolality = non renal cause
  • thirst, restlessness, seizures
79
Q

hyponatremia

A
  • lethargy, confusion, seizures

- tachycardia

80
Q

corrected sodium

A
  • correct sodium to estimate dehydration severity in severe hyperglycemia and DKA
  • normal/high Na and high glucose = severe dehydration
  • low sodium after correction could be over hydration
81
Q

osmolality

A
  • measure of number of dissolved particles in solution

- in general increasing sodium increases osmolality

82
Q

serum osmolality symptom severity

A
  • stupor in hyperglycemia
  • grand mal seizure
  • increased fatality
83
Q

urine osmolality

A
  • Increased = kidneys working properly and loss in non renal

- Decreased = kidneys producing dilute urine and not responding to ADH

84
Q

stool osmolality

A
  • evaluate electrolyte dysfunction in patients with diarrhea

- must be tested in conjunction with serum and urine

85
Q

potassium

A
  • critical value <2.5 >6.5
  • kidneys do not preserve potassium so inadequate intake can cause deficiency
  • difficult to fix hypokalemia is usually due to uncorrected hypomagnesemia
86
Q

hyperkalemia

A
  • acute or chronic renal failure
  • peaked T waves and wide QRS
  • malaise, muscle weakness, nausea
87
Q

hypokalemia

A
  • GI loss
  • muscle cramps, weakness, ileus, rhabdo
  • look for diuretic
  • flattened T waves and U waves
88
Q

hypokalemia and hypomagnesemia

A
  • caused by diarrhea and diuretic therapy

- hypokalemia is refractory to potassium supplementation

89
Q

hypokalemia treatment

A
  • potassium supplement and rich diet

- potassium sparing diuretic (spironolactone)

90
Q

hyperkalemia treatment

A
  • bicarb, glucose, insulin

- kayexalate

91
Q

chloride

A
  • important for acid base balance, water balance, and osmotic pressure
  • follows sodium to maintain neutrality
92
Q

carbon dioxide

A

-majority is from bicarb, rest is dissolved CO2 and carbonic acid

93
Q

BUN, urea nitrogen

A
  • formed in the liver
  • elevated correlates with impaired kidney function and rapid protein catabolism
  • in CKD correlates better with symptoms of uremia and creatinine
94
Q

creatinine

A
  • critical value >10 (nondialysis)
  • freely filtered across glomerulus = better renal function test
  • helps estimate GFR
95
Q

cystatin C

A
  • indicator of GRF

- may be more reliable than creatinine in not affected by muscle mass and nutrition

96
Q

creatinine clearance

A

-measurement of kidney function by measuring the rate by which it is cleared from the blood

97
Q

calcium

A
  • 50% ionized and 50% protein bound
  • hypercalcemia = hyperparathyroidism
  • hypocalcemia = hypoalbuminemia
98
Q

phosphorus

A
  • has an inverse relationship with calcium

- levels controlled by PTH

99
Q

respiratory acidosis labs

A
  • decreased pH
  • increased PCO2
  • compensation = increased bicarb
100
Q

respiratory acidosis conditions

A

asthma, chronic bronchitis, emphysema

101
Q

respiratory alkalosis labs

A

increased pH
decreased PCO2
compensated = decreased bicarb

102
Q

respiratory alkalosis conditions

A

hyperventilation

103
Q

metabolic acidosis labs

A

decreased pH
decreased bicarb
compensated = decreased PCO2

104
Q

metabolic acidosis conditions

A

DKA
renal failure
diarrhea

105
Q

metabolic alkalosis labs

A

increased pH
increased bicarb
compensated = increased PCO2

106
Q

metabolic alkalosis conditions

A

vomiting

hypokalemia

107
Q

anion gap

A

Na - (Cl + HCO3)

108
Q

increased anion gap conditions

A 
methanol
uremia
dka
propylene glycol
ioniazid
lactic acidosis
ethylene glycol 
salicylates
109
Q

decreased anion gap conditions

A

drugs/toxins
cirrhosis
nephrotic syndrome

110
Q

platelet function analysis with normal epinephrine

A

normal PFA

111
Q

platelet function analysis with abnormal epinephrine and normal ADP

A

aspirin therapy

112
Q

platelet function analysis with both abnormal epinephrine and ADP

A

platelet dysfunction disorder

113
Q

D-dimers

A
  • produced with plasmin breaks apart cross linked fibrin

- diagnose DIC or venous thrombosis

114
Q

regulation of sodium

A
  • aldosterone = increase Na
  • natriuretic hormone = decrease Na
  • ADH = increase H2O reabsorption
115
Q

potassium and acid/base balance

A
  • alkalosis = decreased potassium to get H+ from cell

- acidosis = increased potassium to put H+ into cell

116
Q

normal calcium with abnormal phosphorus

A

impaired calcium absorption due to PTH problem

117
Q

normal calcium and elevated BUN

A

primary or secondary hyperparathyroidism due to renal disease

118
Q

normal calcium with decreased albumin

A

hypercalcemia

119
Q

magnesium

A
  • involved with calcium absorption from intestines
  • hypokalemia and hypocalcemia is always hypomagnesemia
  • hypermagnesemia = renal insufficiency
120
Q

prealbumin

A

better than albumin at assessing nutritional status

121
Q

albumin

A

elevated levels associated with nephrotic syndrome

Lab Medicine I (2 decks)

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