Test 2 Flashcards
The right lymphatic duct drains into?
The right subclavian vein.
The thoracic duct carries lymph into?
The left subclavian vein
Lymph nodes are most extensive in
Crossing joints, the breast, neck, axilla, abdomen, thorax, pelvis & groin
In arterials Pc is?
Capillary hydrostatic pressure
In arterials ∏c is?
Capillary oncotic pressure
Which arterial pressure is dominant?
Capillary hydrostatic pressure going out (Pc)
Which venule pressure is dominant?
Capillary oncotic pressure going in (∏c)
Lesser Pi, and ∏i direction of pressure.
Pi always into the capillary, ∏i always out of the capillary.
Edema can be caused by:
- excess filtration (typically reflected by ↑P)
- decreased absorption (typically reflected by ↓π)
- increased capillary permeability
- blocked lymphatics
Without normal lymph drainage, fluid can build up in the affected arm or leg, and________ can develop.
lymphedema
caused by obstruction of the lymphatic system. Sometimes a parasite.
elephantiasis
The there types of tonsils are?
- Pharyngeal (adenoids)
- Palatine
- Lingual
is the diffusion system of small concentrations of lymphoid tissue in the GI tract.
Mucosa associated lymphoid tissue (MALT)
Stem cell development path to platelet.
Hemocytoblast>> Megakaryoblast>> Promegakaryocyte>> Megakaryocyte>> Thrombocytes (platelets)
Of our total megakaryocytic where are most “stored”
Pooled in spleen 20-30%
Characteristics of a megakaryocytic
no nuc, or organelles
many granolas
Average life span 5-20 days
Continually produced by bone marrow.
3 general phases of hemostasis
Vasoconstrictive Phase or Vascular Spasm Platelet Plug Formation ----Adhesion ----Aggregation Coagulation Phase (Blood Clotting)
Platelets stick to the exposed COLLAGEN of damaged endothelium or an artificial surface via…
GPIa receptors
via GPIb receptors, it specifically causes platelets to attach firmly to and spread across the damaged endothelial surface…
is a protein found in plasma, platelets and the walls of blood vessels…
von Willebrand’s Factor (vWF)
During adhesion, platelets will undergo major structural changes and deformations. Adhesion also triggers the secretion of multiple factors from the platelets.
What are these factors?
ADP (adenosine diphosphate)
Thromboxane A2 (TA2; TXA2; a prostaglandin)
Serotonin (5-HT)
What will ADP, TXA2 & to some extent 5-HT do when initial platelets release these factors after the adhesion process.
will bind to specific receptors on other platelets. Stimulation of these receptors will activate these platelets by making them more sticky and thus adhere to one another to form.
“Natural” Anticoagulants
- Thrombomodulin
- Antithrombin III (or just Antithrombin)
- Heparin cofactor II
What does the thrombomodulin-thrombin complex activate?
PROTEIN C
What is protein C’s cofactor?
Protein S
Antithrombin III is…
a glycoprotein produced by the liver that binds to and subsequently inhibits factor X and thrombin
Heparin cofactor II…
is a plasma protein synthesized by the liver and inhibits thrombin
What is the Fibrinolytic System?
restore normal blood flow in a vessel.
This is initiated by the enzyme PLASMIN which is synthesized from an inactive plasma protein synthesized by the liver called PLASMINOGEN.
converts plasminogen to the active plasmin, thus allowing fibrinolysis to occur
TISSUE PLASMINOGEN ACTIVATOR (t-PA)
Fibrinolysis inhibitors are required in vivo to prevent prolonged or unwanted degradation of fibrinogen. Several natural inhibitors have now been described, including:
- Plasminogen activator inhibitor 1
- Plasminogen activator inhibitor 2
- α2-antiplasmin
- α2-macroglobulin
Condition, low platelet count → increased risk for bleeding
Thrombocytopenia
Often, low platelet levels do not lead to a small red or purple spot caused by bleeding into the skin called…
petechia
Citrate binds…
Calcium
the ratio of a patient prothrombin time to a normal (control) sample, raised to the power of the ISI.
The INR
Clinically, the INR is most often used to…
monitor the effectiveness of drugs such as warfarin (Coumadin)
Most laboratories report PT results that have been adjusted to the INR for patients on anti-coagulant drugs. These patients should have an INR of ___ to ____for basic “blood-thinning” needs. For some patients who have a high risk of clot formation, the INR needs to be higher - about ___ to ___.
2.0-3.0
Higher INR
2.5-3.5
In an APTT test, clotting normally takes ______ seconds
25-36
Coagulation Tests Used to assess the intrinsic pathway
ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)
Coagulation Tests Used to assess the extrinsic pathway
PROTHROMBIN TIME (PT); PRO-TIME
Clinically, the APTT is most often used to monitor..
HEPARIN therapy
Coagulation Tests Used to assess the common pathway
THROMBIN CLOTTING TIME (TT)
Used to determine actual deficiencies of specific clotting factors
COAGULATION FACTOR ASSAYS
Clinically, TT is used when…
a PT and/or APTT test is prolonged, particularly if abnormal fibrinogen level or function is considered
X-linked disorder; mutations in factor VIII gene
Hemophilia A (Factor VIII Deficiency)
X-linked disorder; mutations in factor IX gene
Hemophilia B (Christmas Disease)
are one of the most serious symptoms of hemophilia
joint bleeds
In cases of hemophilia Joint damage is not a result of blood in the capsule but rather…
the healing process
Patients with very low factor levels, who experience repeated and painful bleeds into their joints and skeletal muscles, are given
IV factor replacement
Most common inherited bleeding disorder → affects 125 per million & leads to a mild bleeding disorder affecting males and females equally
Von Willebrand’s Disease (vWD)
vWF has 2 major roles:
- Mediating platelet adhesion
2. Stabilizing factor VIII
Unlike hemophilia A, patients vWD patients have prolonged PT because of…
A failure in platelet-vessel wall interaction.
Because of its links to factor VIII, low levels of vWF, like hemophilia A, also result in…
a prolonged APTT & reduced factor VIII clotting activity
Thrombocytopenia can be caused by:
Impaired production of platelets
• Drug induced
• Bone marrow failure
autoimmune response to platelets, which are
removed prematurely by the reticuloendothelial
system
Idiopathic thrombocytopenic purpura (ITP)
Thrombophilias are
conditions associated with excessive clotting
Examples of inherited thrombophilias include
Protein C Deficiency
Protein S Deficiency
Examples of inherited thrombophilias include:
Activated Protein C Resistance, a poor response by Factor V to protein C occurs.
A mutation in the Factor V gene (Factor V Leiden) was identified as the major cause
