Hema Hemostasis Ajfb

Front 1

Process that:

1. Retains the blood w/in the vascular system during periods of injury

2. Localizes the reactions involved to the site of injury

3. Repairs and re-establishes blood flow thru the injured vessel

Back 1

Hemostasis

Front 2

Steps in Hemostatic Response:

Back 2

1. Injury to Endothelium (vessel)

2. Primary Hemostasis

3. Secondary Hemostasis

4. Fibrinolysia

Hint 2

2. Formation of primary hemostatic plug (plts have main role)

3. Formation of fibrin clot (coag proteins, major contributor

4. Removal of Clot

Front 3

Primary Hemostasis

Back 3

1. Vasoconstriction

2. Platelet Adhesion

3. Platelet Aggregation (primary hemostatic plug at site lf injury)

Hint 3

Blood Vessels & Plts

are involved

Front 4

Interaction of coagulation factors to produce fibrin (secondary hemostatic plug)

Fibrin Stabilization by Factor XIII

Back 4

Secondary Hemostasis

Hint 4

End Product: Fibrin Clot

Front 5

Fibrinolysis:

Back 5

1. Release of Tissue Plasminogen Activator

2. Converaion Plasminogen to Plasmin

3. Conversion of Fibrin to Fibrin Degradation products

Front 6

Vascular System

Back 6

1. Arteries

2. Veins

3. Capillaries

Hint 6

Platelets: Formation of Primary Hemostatic Plug

Front 7

When vascular injury occurs, platelets come in contact w/ subendothelium (collagen, fibronectin) and adhere to portion of it

Back 7

Platelet Adhesion

Hint 7

Occurs in the presence of vWF (von Willebrand Factor)

Front 8

Morphologic and functional change in platelets

Back 8

Platelet Activation

Hint 8

Cyclooxygenase (frm plt) metabolize arachidonic acid to form prostaglandin endoperoxides converted to TXA2

Front 9

Inactivates enzyme cyclooxygenase

Back 9

Aspirin

Front 10

A potent vasoconstrictor and a platelet stimulator, causing platelet secretion and aggregation

Back 10

Thromboxane A2 (TXA2)

Front 11

Platelet granules move to the center of the plts and fuse with open canalicular system connected to the outside of the platelet; in this way the content of granules are extruded outside

Back 11

Platelet Secretion

Front 12

Following activation the platelet undergoes a shape change caused by contraction of

Back 12

Microtubules

Hint 12

Change from Disk to Spherical Shape w/ extrusion of numerous pseudopods

Front 13

Alpha Granules:

Back 13

1. Platelet Factor 4

2. B-thromboglobulin

3. Platelet Derived Growth Factor (PDGF)

4. Thrombospondin

5. vWD

6. Fibrinogen

7. Fibronectin

8. Factor V

Front 14

Dense Granules:

Back 14

1. ADP

2. ATP

3. Serotonin (5-HIAA)

4. Pyrophosphate

5. Magnesium

6. Iron

Front 15

Substances that promote Coagulation:

Back 15

1. HMWK

2. Fibrinogen

3. Factor V

4. Factor VIII:vWF

Hint 15

All are found in

Alpha Granules

Factor V - Cofactor in Fibrin clot formation

Fibrinogen - Converted to FIBRIN for clot formation

Front 16

Contact activation of intrinsic coagulation pathway

Back 16

HMWK

Front 17

Assists platelet adhesion to subendothelium to provide coagulation surface

Back 17

Factor VIII:vWF

Front 18

Promotes Aggregation:

Back 18

1. ADP

2. Calcium

3. PF4

4. Thrombospondin

Front 19

Promotes Vasoconstriction:

Back 19

1. Serotonin

2. TXA2

Front 20

Promotes Vascular Repair:

Back 20

1. PDGF

2. B-thromboglobulin

Hint 20

PDGF - promotes smooth muscle growth for vessel repair

B-thromboglobulin - Chemotactic for fibroblasts to help in vessel repair

Front 21

Precursor to plasmin, which induces clot lysis

Back 21

Plasminogen

Front 22

Plasmin Inhibitor, inhibits clot lysis

Back 22

A2-Antiplasmin

Front 23

Complement System Inhibitor

Back 23

C1 Esterase Inhibitor

Front 24

Platelet Stimulating Agents

Back 24

1. Epinephrine

2. Collagen

3. Thrombin

4. ADP

Front 25

Platelets adhernce to one another caused by platelet stimulating agents

Back 25

Platelet Aggregation

Hint 25

Fibrinogen - necessary as cofactor for platelet aggregation

Front 26

Most common inherited vascular disorder

Localized dilation of the walls of the small blood vessels (thin & lack smooth muscles) of the skin and mucous membranes

Back 26

Hereditary Hemorrhagic Telangiectasia/ Osler-Weber-Rendu Syndrome

Front 27

Disorder Associated w/ tumors composed of blood vessels that commonly swell and bleed at the surface

Back 27

Congenital Hemangiomata/Kasabach-Merritt Syndrome

Front 28

Ehlers-Danlos Syndrome

Back 28

1

Front 29

Marfan's Syndrome

Back 29

1

Front 30

Connective tissue elastic fibers in small arteries are calcified and structurally abnormal

Back 30

Pseudoxanthoma Elasticum

Front 31

Loss of elsticity of the skin

Bruised areas commonly found on the forearms of elderly persons

Back 31

Senile Purpura

Hint 31

Dec Collagen, Elastin

Front 32

Acquired defect in synthesis of collagen & hyaluronic acid

Ascorbic Acid Deficiency

Back 32

Scurvy

Front 33

Immunologic damage to endothelial cells

Gastrointestinal hemorrhage and joint swelling occur w/ purpuric rash

Back 33

Henoch-Schonlein Purpura

Hint 33

Most common in children

Often follows Respiratory Infection

Front 34

Quantitative Platelet Disorders

Back 34

1. Thrombocytopenia - Dec

2. Thrombocytosis - Inc

Front 35

Causes of Thrombocytopenia:

Back 35

1. Dec Plt Pxn

2. Dec Survival Time

3. Inc Plt Sequestration by Spleen (Splenomegally)

4. Dilution of Plt count

(Massive Transfusion)

Hint 35

Degree of thrombocytopenia is directly proportional to the number of unita mms transfused

Front 36

Dec Plt Pxn seen in:

Back 36

1. Aplastic Anemia

2. Congenital: Fanconi's Anemia

3. Acquired: Radiation, Chemical, Drugs, Benzene

Hint 36

Chloramphenicol

- Antibiotic of last resort

- Causes Aplastic Anemia

Aplastic Anemia

-Pancytopenia, Dec RBC, WBC, PLTS

Front 37

Dec Survival time due to Inc Destruction

Back 37

1. DIC

2. ITP

Hint 37

DIC

- Mass consumption

ITP

- D/t auto-antibodies to plts

Front 38

Moderate Inc in Plts, Asymptomatic

Seen After: Hemorrhage, Splenectomy, Blood Loss

Back 38

Reactive

Thrombocytosis

Hint 38

Inc RBC Inclusion

Front 39

Marked Inc in Plts

Assoc w/ Thrombotic/Hemorrhagic Complications

Back 39

Autonomous Thrombocytosis

Front 40

Plt Count of >1000 x 10^9/L

Plt Function is Abnormal

Back 40

Essential Thromobocythemia

Front 41

Autosomal Recessive Trait

Platelets Lack GpIb

Giant Platelets, upto 20 um in diameter

Back 41

Bernard-Soulier Syndrome

Hint 41

Normal Aggregation w/: Epinephrine, ADP, Collagen

Dec Aggregation w/: Ristocetin

Front 42

Autosomal Recessive Trait

Dec or Absence of GPIIB-IIIa complex

Back 42

Glanzmann's Thrombasthenia

Hint 42

Normal Response w/: Ristocetin

Defective Primary response in presence of: ADP, Collagen, & Epinephrine

Front 43

Von Willebrand's Disease

Back 43

Normal w/: Epinephrine, Collagen, & ADP

Dec aggregation w/: Ristocetin

Front 44

Qualitative Plt Disorders:

Back 44

1. Platelet Adhesion

-vWD

-Bernard-Soulier Syndrome

2. Platelet Aggregation

-Glanzmann's Thrombasthenia

3. Platelet Secretion

Release Disorders (Storage Pool Defects)

Alpha Granule Def: Gray Plt Syndrome, Quebec

Dense Granule Def: Hermansky-Pudlak, Chediak Higashi, WAS

Front 45

Alpha Granule deficiency which there is deficiency of Factor V Binding Protein or

Back 45

Quebec Dse

Front 46

Acquired Plt Disorders:

Back 46

1. Uremia

2. Paraproteinemia

3. Acute Myeloblastic Leukemia

4. Myeloproliferative Disorders

5. Drugs

Hint 46

Acute Myeloblastic Leukemia

- Megakaryocytes in the BM may be small & abnormal

Front 47

Metabolites that are toxic to the platelets accumulate in Plasma

Back 47

Uremia

Front 48

Coating of platelet membrane w/ abnormal proteins

Back 48

Paraproteinemia

Hint 48

1. MM

2. Waldenstrom's Macroglobulinemia

Front 49

Primary Assay to Determine alterations in Plt Function

In vitro test to determine ability of plts to aggregate w/ certain aggonists

Back 49

Platelet Aggregation

Hint 49

Platelet Aggregometer

PRP = Centri= 50g for 30 Mins

Platelet Agonists:

1. Epinephrine

2. Collagen

3. ADP

4. Ristocetin

PRP + Agonist = O.D. Monitored

Front 50

Measure ability of platelets to adhere in glass surfaces

Back 50

Platelet Adhesiveness (Salzmann)

Front 51

Requires normal number of functioning platelets, calcium, ATP, & Normal Fibrinogen Level

Test for Function of Plts

Back 51

Clot Retraction Time

Hint 51

Methods:

1. Castor Oil/Hirschboeck

2. Stefanini

3. MacFarlane

Front 52

Clot Retraction Time method observed for the formation of dimpling/droplet like serum on the surface of blood drop

Back 52

Castor Oil/Hirschboeck Method

Front 53

Initial Work up for vWD

Back 53

1. CBC

2. PT

3. PTT

Front 54

Blood Film taken from Capillary Puncture

Back 54

Poor Man's Aggregation Test

Front 55

Primary Hemostasis screening test

for platelet & vascular function

Original Test of Platelet Function

Back 55

Bleeding Time

Hint 55

*Maybe prolonged in severe fibrinogen def/afibrinogenemia

Methods:

1. Duke

2. Ivy

Front 56

Bleeding Time Method in which a

1. Blood pressure cuff is inflated to 40 mmHg

2. Calibrated spring-loaded lancet was triggered on the volar surface of forearm a few inches distal to the antecubital crease

2. Resulting wound was blotted every 30 Secs w/ filter paper until bleeding stops

Back 56

Ivy Method