Chapter 1 Flashcards
1
Q
- purplish red, pinpoint hemorrhagic spots in the skin caused by loss of capillary ability to withstand normal blood pressure and trauma.
A
Petechiae
2
Q
- produced by hemorrhage of blood into small areas of skin, mucous membranes, and other tissues.
A
Purpura
3
Q
First appears red-purple the turns brownish yellow
A
Purpura
4
Q
- a form of purpura in which blood escapes into large areas of skin or mucous membranes, but not into deep tissue.
A
Ecchymosis
5
Q
Appears Black/blue then turns greenish brown to yellow
A
Ecchymosis
6
Q
- nosebleed
A
Epistaxis
7
Q
- leakage of blood into a joint cavity
A
Hemarthrosis
8
Q
- vomiting of blood
A
Hematemesis
9
Q
- expectoration of blood secondary to hemorrhage in the larynx, trachea, bronchi or lungs
A
Hemoptysis
10
Q
- a swelling or tumor in the tissues or a body cavity that contains clotted blood
A
Hematoma
11
Q
- in vivo blood clot causing vascular occlusion and tissue ischemia
A
Thrombus
12
Q
- formation, presence of a clot in a blood vessel
A
Thrombosis
13
Q
- presence of intact red cells in the urine
A
Hematuria
14
Q
- presence of hemoglobin in the urine
A
Hemoglobinuria
15
Q
- passage of dark tarry stool containing decomposing blood.
A
Melena
16
Q
- excessive menstrual bleeding
A
Menorrhagia
17
Q
- passage of blood in feces
A
Hematochezia
18
Q
Hemostasis- a complex mechanism that
1. retains the blood within the[?] during periods of injury
2. localizes the reaction involved to the [?] of injury
3. repairs and re-establishes [?] through the injured vessels
A
vascular system
site
blood flow
19
Q
Three Hemostatic Components:
A
Extravascular components
Vascular components
Intravascular components
20
Q
Play a part in hemostasis by providing back pressure on the injured vessel through swelling and entrapment of escaped blood
A
Extravascular components
21
Q
Extravascular components Depends on the
• [?] of surrounding tissue
• [?] of tissue
• [?] of the surrounding tissue
A
bulk or amount
type
tone
22
Q
Vascular components Depends on:
Size of the [?]
Amount of [?] within their wall
Integrity of the [?]
A
blood vessels
smooth muscle
endothelial cell lining
23
Q
Platelets and biochemicals in the plasma
A
Intravascular components
24
Q
STAGES OF HEMOSTASIS
A
Primary Hemostasis
Secondary Hemostasis
25
(compare the walls of the arteries from that of the veins and capillaries)
26
Primary Hemostasis Involves
- Vasoconstriction
- Platelet adhesion, release reaction & aggregation
27
• Activated by desquamation and small injuries to blood vessels
Primary Hemostasis
28
Procoagulant substances are exposed or released by damaged or activated endothelial cells
Primary Hemostasis
29
• Involves vascular intima and platelets
Primary Hemostasis
30
- Rapid, short-lived response
Primary Hemostasis
31
- Ends with platelet plug formation
Primary Hemostasis
32
Do platelets have role in secondary hemostasis?
33
Involves activation of a series of plasma proteins in the coagulation system until fibrin clot formation
Secondary Hemostasis
34
Activated by large injuries to blood vessels and surrounding tissues
Secondary Hemostasis
35
→ Tissue factor exposed on cell membranes
Secondary Hemostasis
36
Involves platelets and coagulation system
Secondary Hemostasis
37
Delayed, long-term response
Secondary Hemostasis
38
Naturally occurring inhibitors in blood will block activated coagulation factors so that widespread coagulation does not occur
Secondary Hemostasis
39
Fibrinolysis
Secondary Hemostasis
40
Slow breakdown & removal of fibrin clot as healing of the injured vessel occurs
Fibrinolysis
41
Inhibits platelet activation
Prostacyclin (PGI2)
42
Stimulates vasodilation
Prostacyclin (PGI2)
43
Anticoagulant
Prostacyclin (PGI2)
Heparan sulfate
Thrombomodulin (Endothelial protein C receptor)
Tissue factor pathway inhibitor (TFPI)
44
Fibronolytic
Thrombomodulin (Endothelial protein C receptor)
Tissue plasminogen activator (tPA)
45
Reduces blood flow rate’
Adenosine
46
Procoagulant
von Willebrand factor (VWF) (Weibel-Palade bodies)
Adhesion molecules
47
• Coats the endothelial cell surface and weakly enhances activity of antithrombin-Ill
Heparan sulfate
48
• Endothelial surface receptor for thrombin (binds and inactivates thrombin)
Thrombomodulin (Endothelial protein C receptor)
49
• Enhances anticoagulant and fibrinolytic action of protein C
Thrombomodulin (Endothelial protein C receptor)
50
• Controls activation of the extrinsic pathway
Tissue factor pathway inhibitor (TFPI)
51
• Converts plasminogen to plasmin
Tissue plasminogen activator (tPA)
52
• Stimulates vasodilation
Adenosine
53
• Required for platelet adhesion to site of vessel injury
von Willebrand factor (VWF)
(Weibel-Palade bodies)
54
• P-selectin; Intercellular adhesion molecules (ICAMs)
Adhesion molecules
55
• Platelet endothelial cell adhesion molecules (PECAMs)
Adhesion molecules
56
* help cells stick to each other and to their surroundings
• Platelet endothelial cell adhesion molecules (PECAMs)
57
BLEEDING DISORDERS CAUSED BY VASCULAR DEFECTS
58
Hereditary Connective Tissue Defects
59
• Sex-linked
1. Ehlers-Danlos Syndrome
60
Caused by a defect in peptidase enzyme that converts procollagen to collagen
1. Ehlers-Danlos Syndrome
61
• Characterized by hyperextensive joints and hyperplastic skin
1. Ehlers-Danlos Syndrome
62
Laboratory findings: Normal Coagulation test and platelet function studies
1. Ehlers-Danlos Syndrome
63
• Autosomal recessive
2. Pseudoxanthoma elasticum
64
Characterized by calcified and structurally abnormal elastic fibers
2. Pseudoxanthoma elasticum
65
Acquired Connective Tissue Defects
66
Importance of vitamin C: for the formation of the intact structure of the vascular basement membrane
1. Vitamin C Deficiency (Scurvy)
67
Characterized by gingival bleeding
1. Vitamin C Deficiency (Scurvy)
68
hemorrhage into subcutaneous tissues and muscles
1. Vitamin C Deficiency (Scurvy)
69
Large hemorrhagic areas may develop just below the eyes
1. Vitamin C Deficiency (Scurvy)
70
splinter-like hemorrhage may also appear in the fingernail beds
1. Vitamin C Deficiency (Scurvy)
71
• Laboratory findings: CFT= usually positive
1. Vitamin C Deficiency (Scurvy)
72
• Related with normal aging process
2. Senile Purpura
73
• Laboratory findings: CFT= positive
2. Senile Purpura
74
Bleeding time= normal or only slightly prolonged
2. Senile Purpura
75
Hereditary Alteration of Vessel Wall Structure
76
Autosomal dominant trait characterized by thin-walled, focally disorganized and dilated blood vessels with a discontinuous endothelium appearing as red pinpoint lesions most commonly on the face, lips, tongue, mucous membranes of the mouth and nose, the ears, conjunctiva, palms and soles
1. Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber Syndrome)
77
Laboratory findings: Bleeding time, platelet function tests, Capillary Fragility test and coagulation tests are all normal
1. Hereditary Hemorrhagic Telangiectasia (Rendu-Osler-Weber Syndrome)
78
What are telangiectasias?
79
Disorders associated with tumors composed of many vessels.
2. Congenital Hemangiomata (Kasabach-Merritt Syndrome)
80
Formation of fibrin clots, platelet consumption and red cell destruction secondary to vascular obstruction occur at the site of tumor
2. Congenital Hemangiomata (Kasabach-Merritt Syndrome)
81
Acquired Alterations of Vessel Wall Structure
82
Deposition of glycosylated proteins leading to thickening of capillary basement membrane affecting often the capillaries of the renal glomeruli and retina
1. Diabetes Mellitus
83
Excessive amyloid deposit in small vessels
2. Amyloidosis
84
Endothelial Damage
85
1. Autoimmune Vascular Purpura
86
* Common drugs that induce purpura:
sulfonamides & iodides quinine, procaine, penicillin, aspirin, sedatives, coumarin
87
* May be due to development of antibodies to vessel wall components, development of immune complexes, and changes in vessel wall permeability.
a. Drug Induced Purpura
88
b. Allergic purpura/Anaphylactoid purpura
89
* associated with certain foods and drugs, cold temperature, insect bites and vaccinations.
b. Allergic purpura/Anaphylactoid purpura
90
Associated with bacterial; viral, Rickettsial and protozoal infections.
2. Infectious Purpura
91
= associated with abdominal pain secondary to GIT hemorrhaging
Henoch's Purpura
92
= associated with joint, especially in the knees, ankles and wrists
Schonlein's Purpura
93
• Diameter:
2 - 4 um
94
• MPV (Mean Platelet Volume):
8 - 10 fL
95
• Reference platelet count:
150,000 - 450,000/pL
96
• Daily turnover:
35 X 10%/L (+/- 4.3)
97
• Lifespan:
8 - 11 days
98
• Function: maintenance of vascular integrity and blood coagulation
99
Platelet Factors
100
Plasma coagulation factor V
PF1
101
A globulin that inhibits antithrombin III; increases platelet aggregation and accelerates interaction of thrombin and fibrinogen (fibrinoplastic platelet factor)
PF2
102
A lipoprotein (phospholipid) found in platelet granules & membrane and required in 2 steps of the coagulation process
PF3
103
A glycoprotein stored in the alpha granules and is extruded during the platelet release reaction
PF4
104
Platelet fibrinogen
PF 5
105
A plasma inhibitor associated with platelets
PF 6
106
Cothromboplastin
PF7
107
Antithromboplastin factor
PF 8
108
Accelerator globulin stabilizing factor
PF9
109
Serotonin found in the dense granules
PF 10
110
aids in ADP-induced platelet aggregation and inhibits effect of heparin
P F 4
111
HMWK
Promote coagulation
Fibrinogen
Alpha granules
Factor V
Von Willebrand factor
ADP
Dense bodies
Promote aggregation
Calcium
Platelet factor 4
Alpha granules
Thrombospondin
Promote
Serotonin
Dense bodies
vasoconstriction
Promote vascular
Thromboaxane Az
precursors
Membrane phospholipids
Alpha granules
Platelet-derived growth factor
repair
Beta- thromboglobulin
Plasminogen
Alpha granules
Other systems
affected
02 - antip/asmin
C1 esterase inhibitor
