Disorders of Hemostasis

Question 1

Hemostasis

Answer 1

stopping blood flow, literally taking blood from a liquid state into a solid state
-Either inappropriate clotting or insufficient clotting

Question 2

Platelets (Thrombocytes)

Answer 2

• Platelets live 8-10 days in circulation
• Many stored in the spleen
• are disc shaped

Question 3

What is the normal value for platelets

Answer 3

150,000 - 400, 000

Question 4

What are mediators hemostasis

Answer 4

Chemicals produced by platelets that are released at an injury to start the clotting process

Question 5

What is the blood vessels role in clotting

Answer 5

The prevent and control the formation of blood clots. Blood vessels are lined with epithelial cells that either promote blood flow by blocking platelet adhesion and lysing blood clots

Question 6

How is the endothelium activated?

Answer 6

by infectious agents
hemodynamic factors
plasma mediators
and cytokines that are liberated during the inflammatory process

Question 7

Epithelium cells elaborate and enzyme called

Answer 7

adenosine diphosphatase

Question 8

Phase 1 of hemostasis

Answer 8

Vessel spasm
vasoconstricton
formation of soft plug
short lived

Question 9

Phase 2 of hemostasis

Answer 9

Release of Von Willebrand Factor by endothelial cells

ADP helps stick together

Release of factor 3 which constricts the vessel so that the platelet doesn’t get kicked off

platelet plug

Question 10

Phase 3 of hemostasis

Answer 10

Coagulation phase

Extrinsic pathways, Intrinsic Pathways start 30 seconds to several min after phase 1 and 2

which both end in x factor (common pathway) prothombin to thrombin (without this it cannot occur)

Fibrinogen to fibrin

Question 11

Extrinsic Pathway (tissue factor)

Answer 11

much faster
begins with trauma to the tissue to release
very rapid, 12-15 seconds (smaller clots)
chemical shortcut
Ends in factor x

Question 12

factor x

Answer 12

prothombin activator

Without this, you cannot clot

Question 13

Intrinsic Pathway (Blood Vessel injury)

Answer 13

slow (5-10 min)
collagen in the blood vessel wall activates
Larger amounts of thrombin= larger clots
ends in factor x

Question 14

Ptt

Answer 14

Intrinsic- heparin, already have a clot

Question 15

aPt

Answer 15

Extrinsic- coumadin- to avoid a clot

Question 16

factor v complex

Answer 16

prothombin to thrombin, without this you cannot clot

Question 17

Prothombin to thrombin ——–>

Answer 17

fibrogenogen to fibrin =clot

Question 18

Clot retraction IV

Answer 18

pulls tight on top of injury site in order to reduce further hemorrhage

Question 19

Fibrinolysis V

Answer 19

and enzyme plasmin digests or degrades the clot

T-PA tissue plasminogen activator converts plasminogen into plasmin and eats the clot

then plasmin digests the clot

Question 20

All but 2 of the hemostasis phases require calcium to clot except for stages

Answer 20

1 and 2

Question 21

Thrombocytopenia

Answer 21

Platelet count less than 150,000

Less than 50,000 means hemorrhage
Less than 15,000 means spontaneous bleeding
less than 10,000 means severe bleeding

Question 22

What causes thrombocytopenia

Answer 22

Hyperspleenism,
autoimmune disease
hypothermia
viral or bacterial infections that cause DIC

Question 23

Too much vitamin K =

Answer 23

clot

Question 24

Too little vitamain K=

Answer 24

bleed

Question 25

Where is vitamin k stored

Answer 25

in the liver

Question 26

Liver disease causes

Answer 26

defects in coagulation fibrinolysis platelet number and function

Question 27

NASH

Answer 27

non alcoholic fatty liver

Question 28

Hypercoaguability states

Answer 28

Inherited genetically and acquired | Increased platelet function

Question 29

Inheritated hypercoagulation

Answer 29

usually associated with venous thrombosis C protein down will create DVT S protein down will create arterial thrombosis

Question 30

C breaks down

Answer 30

clots

Question 31

Factor V leiden AKA activated protein resistance (Inherited hypercoaguability)

Answer 31

resists protein c from breaking down a clot due to genetic mutation

Question 32

Most common acquired increased clotting

Answer 32

``` Smoking Disseminated Cancer Obesity sickle cell Most common female aquired oral contriceptives ```

Question 33

Hemophilia

Answer 33

most common x linked genetic disease (female carrier) Hemophilia A or classic, factor 8 most common and is a lack of factor 8 Hemophilia b is a lack of factor 9 and is called christmas disease

Question 34

DIC

Answer 34

is acquired is where clotting and bleeding at the same time Caused by sepsis, cancer, trauma, blood transfusion causes tissue damage and has 85% mortality rate

Question 35

What would you expect to see if your patient had widespread thrombosis followed by widespread bleeding?

Answer 35

symmetrical blue fingers and toes

Question 36

Anticoagulant drugs

Answer 36

Heparin- Binds to ATP | Coumadin- interfere with vit K (oral)

Question 37

Antiplatelet drugs

Answer 37

Inhibits platelet formation | Asprin plavix

Question 38

Thrombocytic drugs

Answer 38

tissue plasminagin actorvator tPA plasmin to plasmin