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43 Cards in this Set

  • Front
  • Back
Large bruises called?
Why does cirrhosis cause bleeding?
b/c coagulation factors are made in the liver (low fibrinogen w/ cirrhosis)
Bleeding into soft tissue called?

...classically cause by hemophilia
Pinpoint hemorrhages called?

A little larger version of them called?


...both associated with platelets

Hematochezia: lower GI bleed; bright red blood in stool (often due to hemorrhoids)

Melena: upper GI bleed; dark, tarry stool
T/F Most patients with bleeding disorders do not have problems in the blood

-usually do NOT requre blood tests
Clinical Presentation's of what?:




Hematemesis - portal hypertension & cirrhosis

Menorrhagia - aspirin/NSAID overuse

Melena - Colon cancer

Hematuria - renal calculus
Primary hemostasis problme will result in what kind of bleeding?
Mucocutaneous bleeding:

Petechiae, purpura, menorrhagia, mucosal bleeds
Controling components of primary hemostasis are?
Vessel wall
vW factor
Two signs of scurvy?
1) Vascular abnormalities - bleeding deficiency (ie gums & legs)

2) corkscrew hairs
Congenital causes of vascular abnormalities?
1) Hereditary hemorrhagic telangiectasia

2) CTD (ie Marfan's)

...all vascular abnormalities manifest as petechial/purpuric hemorrhages
1st thing that happens in primary hemostasis? Describe
Platelets adhere to hte subendothelium

vWF bridges the platelets with the subendothelium

Platelets then become more active and spill granular contents that recruit more platelets (secondary hemostasis)
Not having enough platelets called?

-the MC cause of bleeding!
Dysfunctional platelets may be caused by?
substrate that bridges platelets to other platelets
Fibrinogen (substrate for Fibrin - secondary hemostasis)
Three main causes of platelet disorders?
1)Thrombocytopenia (not enough platelets)

2)problem with collagen or vWF

3)Cirrhosis (low fibrinogen)
CBC tells you what information?
Complete Blood Count

Platelet count and morphology
MPV means what?
Mean platelet volume - SIZE of platelets
Causes of over-destruction of platelets desprite normal produection by bone marrow (4)
1) Antibodies against platelets (immune thrombocytopenic purpura, ITP



4))hypersplenism (as in cirrhosis)
When platelets are low b/c of increased platelet destruction, the bone marrow is making ____ platelets to compensate for the loss
LARGER platelets (ie in ITP or DIC)
When platelets are low b/c of decreased platelet production, the bone marrow is making ____ platelets to compensate for the loss
normal-sized in
Causes of inhibition of Bone marrow platelet production
1) Drugs

2) Toxins

3) Tumors

4) Acute leukimic process (no room for megakaryocytes to grow)
T/F The reference range for platelet counts are quite large?

150000-440000 per microliter of blood
Bone marrow may increase platelet production by up to ___ from baseline?
Average platelet life span?
Percentage of platelet pool in the spleen?
33% (1/3!)

those with cirrhosis, portal hypertension and large spleens have thrombocytopenia
Name and describe problem of the 2 congenital platelet disorders
Bernard Soulier Syndrome (BSS) - deficiency of Gp1b receptor, which binds the vWF for platelet adhesion to endothelium

2)Glanzman's thrombasthenia - defect of the GpIIb-IIIa complex, which is the fibrinogen receptor

"Think that B comes before G and GpIb comes before GpIIb-IIIa"
BSS has similar manifestation to what other disease?
vWF disease, much more common than BSS
If you see thrombocytopenia AND giant platelets think
Mild QUANTITATIVE abnormlaity of vWF leading to mucotaneous bleeding
Type 1 vWF disease
Mild QUALITATIVE abnormlaity of vWF

Very severe deficiency of vWF?
Type 2 vWF disease

Type 3 vWF disease
T/F vWF disease affects male and females equally?


F, hemophilia is mostly X-linked
One problem with making the diagnosis of vWF disease (which requires blood testing) is what?
vWF FLUCTUATES b/c it is one of the acute phase reactants (like fibrinogen and Factor VIII)
Disorders of secondary hemostasis (coaagulation cascade) usually result in?

Problem in Adults? Children?
Hemarthrosis (soft tissue or joint bleeds)

Adults = acqurired (drugs, diseases or diet)

Children = congenital, even in absence of family history
If fibrinogen is below ___ mg/dL, the patient will likely bleed
50 mg/dL
"Match that starts the fire" of clotting cascade?

Activates what?
Factor vii and Tissue Factor (TF)

-fairly short lived

-activates Factors IX and X
"Fuel fo rthe flame" of the clotting cascade?
Factors X and IX
What transforms fibrinogen into fibrin
Most common/important acquired causes of secondary hemostasis disorders (2)
1) Liver disease (Cirrhosis - Hep C most commmon cause of in USA)

2) Oral anticoagulation (ie warfain
Risk of bleeding with warfarin increases with what concomitant problems (3)?
1) A ^ INR (international normalized ratio)

2) A history of stroke or GI bleed

3) Age > 65
clotting so much that you use up the platelets and coagulation factors called?


treat by addressing underlying cause
Most important genetic disorder of the coagulation cascade?

Hemophilia A & B

A 5 times more comon than B, but CLINICALLY INDISTINGUISHABLE
Factor deficiency of Hemophilia A? B?
Hemophilia A = Factor VIII deficiency

Hemophilia B = Factor IX deficiency