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Liz's Hemostasis/Coagulation > Introduction to Hemostasis: Specimen Collection > Flashcards

Introduction to Hemostasis: Specimen Collection Flashcards

1
Q

List the four major systems involved in maintaining hemostasis

A
  • Vascular system (1st)
  • Platelets (2nd)
  • Plasma coagulation factors (3rd)
  • Fibrinolytic system (4th)
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2
Q

Process by which the body (upon vessel injury) spontaneously stops bleeding and maintains blood in the fluid state w/in the vascular system

A

Hemostasis

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3
Q

Prevents blood loss from injuries by the formation of a thrombus, and reestablish blood flow during the healing process

A

Hemostasis (formal definition)

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4
Q

Process of clot formation

A

Coagulation

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5
Q

A blood clot w/in the vascular system; “platelet plug”

A

Thrombus

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6
Q

Refers to formation of blood clot or thrombus, but usually considered to be an abnormal finding

A

Thrombosis

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7
Q

Which system is responsible for primary hemostasis?

A

Platelets (2nd system)

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8
Q

Which system is responsible for secondary hemostasis?

A

Plasma coagulation factors (3rd system)

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9
Q

Define fibrinolysis

A

Breakdown of fibrin

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10
Q

Reduces blood flow to area of injury to minimize blood loss and also draws platelets close to the injured vessel wall

A

Vasoconstriction

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11
Q

Damaged endothelial cells secrete ____

A

von Willebrand factor (vWF)

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12
Q

What is activated by exposure of tissue thromboplastin/tissue factor (TF)?

A

Plasma coagulation system

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13
Q

Platelet adhesion,aggregation, and secretion is necessary to form ____

A

Platelet plug

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14
Q

What three consequences leads to the formation of fibrin?

A

Coagulation, inflammation, and tissue repair

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15
Q

Two stages of hemostasis

A

Primary and secondary hemostasis

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16
Q

Primary hemostasis

- Function

A

Platelets interact w/ injured vessels (and other platelets) to seal the wound and form a primary platelet plug

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17
Q

Primary hemostasis

- Short vs. long-term effect

A

Short-term → temporarily arrests bleeding

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18
Q

Primary hemostasis

- Associated systems

A
  • Vascular intima

- Platelets

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19
Q

Primary hemostasis

- “Type” of tests used to differentiate

A

Platelet tests

  • Platelet count
  • Bleeding time
  • Platelet fxn analyzer (PFA)
  • Platelet aggregation
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20
Q

Secondary hemostasis

- Function

A

Thrombin generated via coagulation cascade, in turn, generate fibrin and froms secondary hemostatic plug

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21
Q

Secondary hemostasis

- Short vs. long-term effect

A

Long-term → strengthens the platelet plug

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22
Q

Secondary hemostasis

- Associated systems

A

Coagulation and fibrinolysis

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23
Q

Secondary hemostasis

- “Type” of tests used to differentiate

A

Coagulation tests

  • PT (prothrombin time)
  • APPT (activated partial thromblastin time)
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24
Q

Briefly describe an overview of hemostasis… beginning with the initial damage to the blood vessel. and ending with fibrinolysis

A
  • Vessel injury
  • Collagen exposed/vWF secreted…platelet adhesion
  • ADP secreted from granules → platelet aggregation = 1° hemostasis
  • Platelet plug reinforced by fibrin = 2° hemostasis
  • Thrombus dissolved by fibrinolytic system
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25
List 7 types of bleeds associated w/ a platelet or vascular defect (problem w/ primary hemostasis)
- Petechiae - Purpura - Epistaxis - Hematemesis - Menorrhagia - Telangiectasia - Mucosal bleeding
26
Pinpoint hemorrhages from arterioles or venules
Petechiae
27
Purple discoloration of skin cuased by many petechiae (small bruises)
Purpura
28
Nosebleeds
Epistaxis
29
Vomiting blood
Hematemesis
30
Abnormal, prolonged menstruation
Menorrhagia
31
Spider-like dilations of small blood vessel
Telangiectasia
32
List 3 types of bleeds associated w/ disorders of coagulation (problem w/ secondary hemostasis)
- Ecchymoses - Hemarthrosis - Delayed bleeding and oozing from wounds
33
Very severe bleed(s) into deep tissues/muscles (large bruises)
Ecchymoses
34
Joint bleed(s) characteristic of hemophilia
Hemarthrosis
35
Hemostasis is a combination of ____ and ____
Cellular; biochemical events
36
List 2 types of mechanisms in enzyme systems
Coagulation and fibrinolysis mechanisms
37
This includes vascular intima, platelets, erythrocytes, neutrophils, and monocytes
Cellular component of hemostasis
38
What occurs when hemostatic systems are out of balance?
Thrombosis or hemorrhage or both may occur
39
What is the preferred venipuncture method?
Evacuated Tube System (ETS)
40
List three venipuncture methods
- Evacuated tube system - Butterfly/syringe - Indwelling catheter
41
What is the correct specimen collection and handling requirement for evacuated tube system?
- MUST HAVE GOOD VEINS | - Assures correct blood: anticoagulant ratio
42
What is the correct specimen collection and handling requirements for butterfly/syringe?
- Used w/ small, fragile veins | - Pose additional needle stick risk when transferring blood into tube
43
This method is discouraged as heparin contaminates sample and prolongs clotting times if not properly flushed
Indwelling catheter
44
What is the correct specimen collection and handling requirement for Indwelling catheter?
- Flush line w/ saline - Withdraw 5-10 mL blood and discard - Collect specimen
45
Most common anticoagulant used
3.2% sodium citrate (PT/APPT)
46
Blood: anticoagulant ratio
9:1 need a full tube draw
47
Chelates (binds) free plasma calcium to prevent clotting
3.2% sodium citrate
48
Specimen collection and handling requirement for 3.2% sodium citrate tube
Must be plastic or siliconized glass and mix tube well by gentle inversion--DO NOT shake
49
What is order of blood draw?
- ALWAYS use a non-additive discard tube with a winged needle (butterfly) collection..."dead space" - Always draw blue top after a non-additive tube
50
Why do we always draw a blue top after a non-additive tube?
To prevent contamination w/ the previous tube's anticoagulant
51
Why don't we use EDTA tube to collect blood for coag?
EDTA chelates calcium to prevent blood from clotting and it also binds reagent calcium in clot testing, so CANNOT USE!
52
How does increased hematocrit (>55%) affect routine coagulation (PT/APTT)?
- Increased hct in plasma vol relative to whole blood decreases plasma: anticoagulant ratio - Excess anticoagulant may then bind to the CaCl (added during the testing procedure) prolonging the clotting time
53
List five unacceptable specimens
- Clotted - Hemolyzed - Lipemia - Short draw sodium citrate tubes - Increased hematocrit (before reporting results)
54
Explain how the clotted specimen will affect routine coagulation testing?
- Many factors, platelets, and RBCs are consumed in clotting. - Be sure to gently invert tube after venipuncture (4-6X) to prevent clots
55
Would clotted specimens be falsely prolonged or falsely shortened clotting times?
Falsely prolonged clotting times
56
Would hemolyzed specimen have falsely prolonged or falsely shortened clotting times?
Falsely shortened clotting times
57
In hemolyzed specimens procoagulant substances released from cells and tissues to ______
Activate clotting pathways
58
Hemolyzed specimens can be in vitro or in vivo. What causes in vitro hemolysis?
- Prolonged tourniquet application - Excessive needle manipulation - Mixing blood too vigorously - Forcing blood through a small bore needle - Pulling too hard on a syringe
59
What results are given when specimens are lipemic?
Additional light scatter from lipid droplets gives erroneous results
60
Would lipemic specimen be falsely prolonged or falsely shortened?
Falsely prolonged clotting times
61
Why are short drawn specimens not acceptable?
- If tube is under filled, excess anticoagulant remains in the plasma layer after spinning - This excess anticoagulant may then bind to the CaCl - 9:1 ratio must be maintained
62
Would short drawn specimens be falsely prolonged or falsely shortened?
Falsely prolonged clotting times
63
What are transportation and storage requirements for specimens?
- Keep tube stoppered and in upright position to maintain proper pH - Samples should not be chilled (chilled WB may activate platelets, Factors VII/VIIa, and contact system) - Transport to the lab at RT
64
Never refrigerate blood/plasma for ____; and test w/in ____ hours
PT; 24 hours
65
May refrigerate blood/plasma for ____; but need to test w/in ____ hours plus must spin and/or remove plasma w/in ____ if patient is on heparin
APTT; 4 hours; 1 hour
66
Platelet rich plasma (PRP) is slow spun and used for _____
Platelet aggregation studies
67
Platelet poor plasma (PPP) is spun faster and used for ____
Used for all routine coagulation assays such as PT and APTT
68
Do PT and APTT measure platelets?
NO
69
Platelet free plasma (PFP) is spun faster, plasma is removed, and re-spun and is used for ____
Heparin or heparin-induced Ab
70
What does APTT stand for?
Activated partial thromboplastin time
71
What does PT stand for?
Prothrombin time

Liz's Hemostasis/Coagulation (10 decks)

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