Blood and lymph

Question 1

How is blood transported

Answer 1

Via vessels and pressure

Question 2

What is a blood clot

Answer 2

Simply a combination of platelets and fibrin meshed together

Question 3

What is haemostasis

Answer 3

Process to prevent and stop bleeding

Question 4

What are the 5 steps to haemostasis?

Answer 4

1. Vascular spasm
2. Platelet plug formation
3. Coagulation
4. Clot retraction and repair
5. Fibrinolysis

Question 5

What is vascular spasm?

Answer 5

Injury to endothelium

Release of endothelium

Vasoconstriction, smooth muscle contraction

Stimulation of pain receptors

Question 6

Explain the coagulation cascade

Answer 6

This results in the accumulation of platelets at the wound site and form a fibrin clot which stems blood flow in order to limit the amount of blood loss

Question 7

Explain the platelet plug formation

Answer 7

1. Von Willebrand factor - initial platelet binding
2. Secretion of ADP, TXA2 and serotonin - stimulates and attracts platelets
3. Platelets bind together with fibrinogen
4. TXA2 and serotonin enhance vascular spasm

Question 8

Explain clot retraction and repair

Answer 8

1. Once body starts healing up, clotting starts to occur
2. Platelet contraction - Actin and myosin contract pulling damaged cells together
3. Platelet derived growth factor - proliferation of mitosis - repair of muscle/tissue

Vascular endothelial growth factor - renew endothelium - builds tissue backup from damaged vascular tissue repair

Question 9

Explain fibrinolysis

Answer 9

1. Plasminogen - eats fibrin mesh and breaks down clot
2. Tissue plasminogen activator - releases plasmon
3. Breaks down fibrin - breaks down the clot
4. D-Dimer release - diagnostic significance (test)

Question 10

What are a group of drugs that keep blood flowing

Answer 10

Anti- coagulants

Anti- platelets

Question 11

Name and explain anti-coagulant drugs

Answer 11

Warfarin inhibits vitamin K and this is needed for clotting factor activation - stops clotting

Rivaroxaban inhibits clotting factor Xa and blocks fibrin

Heparin increase antithrombin III and insist thrombin and factor X

Question 12

Name and explain anti-platelet drugs

Answer 12

Clopidogrel, ticagrelor inhibits ADP pathway - stops platelets coming together rather than stopping the formation of the clot

Aspirin inhibits the TXA2 pathway

Question 13

What is TXA

Answer 13

Medication used to treat or prevent excessive blood loss form major trauma - either taken orally or by injection

Question 14

How does TXA work?

Answer 14

Inhibits fibrinolysis by stopping plasminogen binding to fibrin - this allows clot formation to carry on inhibited - stops clot breaking down stopping the plasminogen binding to fibrin - to maintain the clot for as long as possible

Question 15

What is blood dyscrasia

Answer 15

This is a non-specific term that refers to a disease or disorder of the blood

Question 16

State examples of blood dyscrasias

Answer 16

Anaemia

Clotting disorders

Disseminated intravascular coagulation (DIC)

Neoplastic blood disorders

Question 17

What is anaemia?

Answer 17

Group of diseases which result in decreased haemoglobin content therefore reduced o2 transport

Cellular metabolism is reduced

Question 18

List the 3 types of anaemia

Answer 18

1. Iron deficiency
2. Pernicious anaemia
3. Sickle cell anaemia

Question 19

List some general signs and symptoms of anaemia

Answer 19

Fatigue
Pallor
Tachycardia
Dyspnoea

Question 20

What is iron deficiency anaemia

Answer 20

Reduced iron impairs haemoglobin synthesis

Reduced haemoglobin = reduced o2 transport

Common condition

Question 21

List signs and symptoms of iron deficiency anaemia

Answer 21

Pallor
Lethargy, fatigue
Delayed healing

Degenerative changes to hair and nails
Menstrual irregularities

Tachycardia, syncope, palpitations

Question 22

What is pernicious anaemia

Answer 22

Immature nucleated erythrocytes (megaloblastic)

Deficiency B9 folic acid and or B12

Malabsorption of B12 in gastric mucosa

B12 deficiency leads to erythrocytes and impaired maturation

Question 23

Signs and symptoms of pernicious anaemia

Answer 23

Tongue may be red, sore and shiny
Diarrhoea and nausea
Tingling and burning sensations
Loss of muscle control

Question 24

What is sickle cell anaemia

Answer 24

Abnormal haemoglobin production

When deoxygenated the haemoglobin crystallised and alters the shape of the erythrocyte - from a disc to a sickle

Short cell lifespan (20 days) - haemolysis - (destruction of red blood cells prior to the end of their normal 120 day lifespan)

Sickle cell causes obstruction in small blood vessels - thrombus formation, infarction, necrosis

Question 25

What happens when a sickle cell crisis occurs?

Answer 25

Blood vessels become impeded by sickled RBC’s - there is tissue damage, infarctions, severe pain and loss of function

Question 26

Signs and symptoms of sickle cell anaemia

Answer 26

Signs do not usually present until after 12 months

Hyperbilirubinemia - jaundice, gallstones

Splenomegaly - spleen enlargement

Heart failure
Frequent infections - reduced healing

Question 27

State treatments for sickle cell

Answer 27

Oxygen
Pain relief - entonox, morphine
Transport patients treating hospital

Question 28

What are some signs of clotting disorders

Answer 28

Persistent bleeding from gums, repeated nosebleeds

Petechiae - pinpoint rash from bleeding capillaries

Bruises

Haemoptysis - coughing blood
Haematemesis - vomiting blood
Blood in faeces

Question 29

Name 3 clotting disorders

Answer 29

Haemophilia A (Deficiency of clotting factor VIII) - break in clotting factor chain

Haemophilia B (Christmas disease)

Haemophilia C (Rosenthal’s)