Primary Hemostasis Flashcards
(182 cards)
1
Q
Stoppage of blood flow
A
Hemostasis
2
Q
Normal volume of blood
A
5-6L
3
Q
Cellular element of hemostasis that surrounds the vessel
A
Extravascular tissue factor (TF)
4
Q
Cellular element of hemostasis where the blood flows
A
Vascular Intima
5
Q
The stage of hemostasis that refers to the role of blood vessels and platelets
A
Primary Hemostasis
6
Q
Two elements involved in Primary Hemostasis
A
Blood Vessels and Platelets
7
Q
The final product of primary hemostasis
A
Platelet plug / Hemostatic plug
8
Q
A general test performed to assess primary hemostasis
A
Bleeding Time
9
Q
In platelet adhesion, platelets adhere to _
A
Collagen
10
Q
Needed for normal platelet adhesion
A
vWF
11
Q
Bridge between platelet and collagen
A
vWF
12
Q
Bernard-Soulier disease is also known
A
Giant Platelet syndrome
13
Q
Bernard-Soulier disease has a deficiency in the _ receptor for vWF
A
GPIB/IX/V
14
Q
Refers to the morphologic and functional changes in platelets
A
Platelet Activation
15
Q
In platelet activation, platelets become spherical with _ formation
A
Pseudopod
16
Q
Elements responsible for the formation of actomyosin
A
Actin, myosin and Ca2+
17
Q
A vasoconstrictor that stimulates platelet secretion
A
Thromboxane A2
18
Q
A drug that inhibits cyclooxygenase
A
Aspirin
19
Q
The eicosanoid pathway is otherwise known as
A
Thromboxane A2 Synthesis pathway / Arachidonic acid metabolism pathway
20
Q
A substage of primary hemostasis which is responsible for the release of granules
A
Platelet secretion
21
Q
Thromboxane A2 precursor
A
Arachidonic acid
22
Q
Only Alpha granule deficiency
A
Gray platelet syndrome
23
Q
Enumerate the dense granule deficiencies
A
- Hermansky-Pudlak
- Chediak-Higashi
- Wiskott-Aldrich Syndrome
24
Q
Primary substance needed in platelet aggregation
A
Fibrinogen
25
Platelet receptor for fibrinogen
GPIIb/IIIa
26
Deficiency in GPIIbIIIa
Glanzmann's thrombasthenia
27
End product of Secondary Hemostasis
Fibrin clot
28
The general test for assessing secondary hemostasis
Clotting time
29
Elements involved in secondary hemostasis
Coagulation Factors
30
it is the production and maturation of platelets
Megakaryopoiesis / Thrombopoiesis
31
The time it takes to complete process of megakaryopoiesis
5 days
32
Primary stimulatory protein for megakaryopoiesis
Thrombopoietin
33
Site for the sequestration (storage) of platelets
Spleen
34
The major organ that produces TPO
Liver
35
Normal Value of platelet count
150,000-400,000 /uL or 150-400 x10^9/L
36
What happens to the platelet count of the patient when there is Splenomegaly
Decreased platelet count
37
What happens to the platelet count of the patient when there is Splenectomy
Increased platelet count
38
Megakaryocyte progenitors resemble _ under light microscopy
Lymphocytes
39
Three megakaryocyte Progenitors
1. BFU-Meg
2. CFU-Meg
3. LD-CFU- Meg
40
The first stage of endomitosis in the platelet maturation series
LD-CFU- Meg
41
A type of cell division wherein there is nuclear division, but no cytoplasmic division
Endomitosis
42
How many stages does the megakaryopoiesis have?
6
43
Last stage of megakaryopoiesis capable of endomitosis
Promegakaryocyte/ MK-II
44
Reason for the increased N: C ratio of platelet maturation series
Endomitosis
45
The largest blood cell in the bone marrow smear
Mature Megakaryocyte / MK-III
46
The largest blood cell in a normal peripheral blood smear
Monocytes
47
The largest blood cell
Megakaryocytes
48
The smallest blood cell fragment
Platelets / Thrombocytes
49
Diameter of mature megakaryocyte
40-120 um
50
Diameter of platelets
2-5 um
51
Not a true cell
Platelets
52
Parts of a platelet
1. Chromomere
| 2. Hyalomere
53
The chromatin of MK II
Moderately condensed
54
Describe the platelet production if the megakaryocytes possess more nuclear lobes
Higher platelet production
55
The first stage where Demarcating Membrane System is first formed
Promegakaryocyte
56
Process wherein there is release of an abundance of platelet fragments
Platelet shedding
57
Mean Platelet volume
8-10 fL
58
Four areas of the platelets
PSOM
1. Peripheral
2. Sol-gel
3. Organelle
4. Membranous
59
The life span of platelets
10 days
60
The mean platelet volume is inversely proportional to _
Platelet count
61
MPV should be based on specimens that are _ hrs. old
1-4 hrs. old
62
The outermost layer of the platelets
Peripheral Zone
63
Another name of actomyosin
Thrombosthenin
64
Important in clot retraction
Actomyosin / Thrombosthenin
65
Area of the platelet containing microfilaments and microtubules
Sol-gel zone
66
Microfilaments in the sol-gel zone
Actin & Myosin
67
Microtubule in the sol-gel zone
Tubulin
68
The protein responsible for the maintenance of the platelet's disc shape/cytoskeleton
Tubulin
69
Area of the platelet where granules are located
Organelle zone
70
Two types of membranous system
1. Open Canalicular System (Surface connecting system)
| 2. Dense Tubular System
71
Part of the membranous system where the eicosanoid pathway occurs
Dense Tubular System
72
Part of the membranous system where the granules are released
Open Canalicular System (Surface connecting
73
Smallest blood vessel
Capillaries
74
Signifies capillary fragility characterized by pinpoint hemorrhagic spots
Petechiae
75
The no. of petechiae is _ proportional to the platelet count
Inversely
76
Difference of purpura and ecchymosis
Size of skin
* Purpura-small areas of skin
* Ecchymosis- large areas of skin
77
The most common complication in venipuncture
Ecchymosis
78
Bloody stool associated with lower GIT bleeding characterized by a red-colored stool
Hematochezia
79
Bloody stool associated with upper GIT bleeding characterized by a black tarry stool
Melena
80
Excessive menstrual bleeding
Menorrhagia
81
Epistaxis which persists for >_min. may be a manifestation of a hemostatic disorder
>15 min.
82
Occurs as a result of skin fragility
Simple purpura (Devil's pinches)
83
Type of primary purpura characterized by the development of cayenne pepper petechiae
Schamberg's purpura (Progressive pigmentary purpura)
84
Purpura that is not associated with any specific disease
Primary purpura
85
Purpura that applies to a rapid onset
Purpura fulminans
86
Purpura that may be seen in endocarditis, and ecthyma gangrenosum
Septic emboli
87
Blood clots containing bacteria
Septic emboli
88
Henoch-Schonlein purpura in an/a _ type of purpura
Allergic
89
Scurvy is associated with what deficiency?
Vitamin C
90
An increased corticosteroid excess that results in purpura
Cushing Syndrome
91
Purpura secondary to dysproteinemia characterized by hemosiderin staining of the skin similar to Schamberg's
Waldestrom's purpura
92
An autosomal dominant disorder characterized by hyperdistensible joints and fragile skin
Ehler's-Danlos Syndrome
93
A defective disorder due to the mutation of fibrillin
Marfan's Syndrome
94
Functional abnormalities of platelets
Qualitative platelet disorder
95
Receptor for vWF
GPIB
96
The most severe type of von Willebrand Disease
Type 3 (Complete deficiency of vWF)
97
Type of von Willebrand disease characterized by increased binding of factor VIII to vWF
Type 2N
98
Classic test to differentiate Bernard-Soulier syndrome and von Willebrand disease against Glanzmann's Thrombasthenia
Platelet aggregation test
99
Deficiencies seen in von Willebrand disease
Factor VIII and vWF
100
Storage pool defect that demonstrates the smallest platelet
Wiskott-Aldrich Syndrome
101
Characterized by a decreased functional platelet factor V, and normal plasma factor V
Quebec platelet disorder
102
Low platelet count
Thrombocytopenia
103
Platelets that are produced as compensation to platelet consumption
Stress / Reticulated platelets
104
Four causes of thrombocytopenia
1. Decreased platelet production
2. Peripheral platelet destruction
3. Abnormal platelet distribution
4. Dilution of platelet count
105
Increased platelet production
Thrombocytosis
106
Classification of thrombocytosis characterized by a moderate increase (401-600x10^9/L)
Reactive thrombocytosis
107
Classification of thrombocytosis characterized by a marked increase (>601x10^9/L)
Autonomous thrombocytosis
108
Best anticoagulant for quantitative platelet evaluation (platelet count)
Citrate
109
Most common anticoagulant for quantitative platelet evaluation (platelet count)
EDTA
110
Most frequently involved leukocyte in platelet satellitosis
Neutrophils
111
Remedy for platelet satellitosis
Recollect in a citrated tube (Sodium citrate)
112
Components of the Reese-Ecker diluting fluid
1. Sodium citrate (prevents coagulation)
2. Formaldehyde (preservative)
3. Brillant Cresyl Blue (dye)
113
Best microscope for the evaluation of platelet morphology
Phase-Contrast Microscope
114
Reference method for platelet count
Brecker-Cronkite
115
Thoma pipette utilized for platelet counting
Red Thoma Pipette (1:100)
116
Indirect platelet count is also known as
Platelet estimate
117
Three methods utilized for platelet estimate
1. Fonio's
2. Dameshek
3. Olef's
118
In the platelet estimate, platelets are counted within how many fields?
10 fields
119
The average of 10 fields in the platelet estimates is multiplied to _
20,000
120
What should be the platelet count for PRP (platelet-rich plasma)
>10,000/uL
121
Best promoter of platelet adhesion in vitro
Glass
122
Best promoter of platelet adhesion in vivo
Collagen
123
This platelet retention test tests the retention of platelets within the glass bead column
Salzmann method
124
The test used to measure the entire platelet function
Clot retraction
125
Rumpel-Leede is otherwise known as _, uses a tourniquet to measure capillaries to resist pressure
Hess test / Positive pressure technique
126
Pressure applied for the Rumpel-Leede test
100 mmHg for 5 min (Count petechiae after 15-30 min.)
127
Qualitative test for platelets which may be assessed by the presence of dumpling/droplet-like serum on the surface of the blood drop within 14-45 min.
Hirshboeck or Castor Oil Method
128
It is an in vivo measure of primary hemostasis
Bleeding time
129
Factor that is not a protein
Factor IV
130
What are the stages involved in primary hemostasis?
AASA
1. Adhesion
2. Activation
3. Secretion
4. Aggregation
131
Diseases related to platelet adhesion
1. vWF deficiency
| 2. Bernard Soulier disease
132
What are the alpha granules in platelet secretion
BFA(2)TP(3)F(5)C
1. Beta-thromboglobulin
2. Fibronectin
3. Albumin
4. Alpha-2-antiplasmin
5. Platelet Factor IV
6. Platelet-derived growth factor
7. Plasminogen
8. FI
9. FV
10. FVIII
11. vWF
12. High Molecular Weight Kininogen
13. C1 esterase inhibitor
133
What are the dense granules in platelet secretion
C2APAS+1
1. Calcium
2. Catecholamine
3. ADP
4. Pyrophosphate
5. ATP
6. Serotonin
7. Magnesium
134
What are the Lysosomal granules in platelet secretion?
BAN
1. Bacteriocidal enzymes
2. Acid Hydrolase
3. Neutral Protease
135
Granules released by platelets
```
ADLGM
Alpha
Dense
Lysosomal
Glycogen
Membrane Phospholipid
```
136
Enumerate the megakaryopoietic stages:
1. MK-I (Megakaryoblast)
2. MK-II ( Promegakaryocyte)
3. Granular Megakaryocyte
4. MK- III (Mature Megakaryocyte)
5. Metamegakaryocyte
6. Platelet/Thrombocyte
137
Average size of platelets?
1-4um
138
Osteogenesis imperfecta is a rare autosomal dominant disorder characterized by mutation of genes that code for peptides of type _ collagen
Type 1
139
Involves the vessels throughout the body, which are dilated, tortuous (twisty/curvy), and disorganized
Hereditary hemorrhagic telangiectasia (Osler-Weber Rendu disease)
140
Tumors composed of blood vessels that swell and bleed at the surface
Congenital hemangiomata (Kasabach-Meritt syndrome)
141
Size of platelets in Bernard Soulier syndrome
>20 um (Bernard is a giant bear = giant platelets)
142
The quantitative subtypes of vWF deficiency
Type 1 and 3
143
The qualitative subtype of vWF deficiency
Type 2
144
The initial treatment of choice for Von Willebrand's disease
DDAVP
| 1-Desamino-8-D-Arginine Vasopressin also known as DESMOPRESSIN
145
The most preferred treatment for Von Willebrand disease
Humate P (contains intact vWF)
146
The treatment used for patients unresponsive to DDAVP
Cryoprecipitate
147
Type of von Willebrand disease with marked increased affinity for glycoprotein Ib
Type 2B
148
Subtypes of vWF disease Type 2
2A
2B
2M
2N
149
Type of von Willebrand disease with marked increased binding of Factor VIII to vWF
Type 2N
150
In platelet aggregation test, Glanzmann thrombasthenia will show a normal reaction in:
a. Epinephrine
b. Collagen
c. ADP
d. Ristocetin
d. Ristocetin
* Glanzmann will only show a normal reaction in ristocetin, and negative for all. On the other hand, Bernard Soulier will show a normal reaction in all EXCEPT ristocetin
151
The best test used to distinguish Hemophilia A from von Willebrand disease
Bleeding time
* Hemophilia = Normal ;VWD: Abnormal (primary hemostasis disorder)
152
Hemophilia A and Von Willebrand disease has this deficiency
Factor VIII deficiency
153
What is the point of distinction from other patients with the alpha-gamma storage pool defect from gray platelet syndrome?
Decreased platelet P-selectin (CD26P)
154
Disease wherein there is an impaired ability of platelets to promote coagulation due to the translocation of PS to the platelet outer membrane leaflet
Scott's Syndrome
155
Causes of Thrombocytopenia
1. Decreased platelet production in the BM
2. Peripheral Platelet destruction
3. Abnormal platelet distribution
4. Dilution of platelet count
156
Components of the Guy-and Leake reagent for platelet count
1. Sodium oxalate
2. Formaldehyde
3. Crystal Violet
157
Anticoagulant for Brecker Conkrite method?
1% Sodium Oxalate
158
Dilution in using unopette for platelet count
1:100 (use RBC Thoma pipette)
159
Platelets are counted in their relationship to red cells on a fixed smear
Indirect platelet count / Platelet estimate
160
Give the automation/s utilized in platelet count and their principle
1. Voltage pulse counting -electrical impedance
| 2. Electro-optical counting - Flow cytometry
161
Significant platelet levels
<100,000/uL Abnormally low
<30,000-50,000/uL Bleeding with trauma
<30,000/uL Spontaneous bleeding
<5,000/uL Severe Spotaneous bleeding
162
Give a probable reason:
| Normal platelet count and Prolonged Bleeding Time
Qualitative Platelet Abnormality (Adhesion, aggregation, storage pool defects)
163
Give a probable reason:
| Low platelet count and Normal Bleeding Time
Autoimmune Thrombocytopenia (antiplatelets)
164
What is the sample for the platelet aggregation test?
Platelet Rich Plasma
165
Agonists in the platelet aggregation test
1. Epinephrine
2. Collagen
3. ADP
4. Ristocetin
166
Test considerations for Platelet Aggregation Test
1. NO hemolysis
2. Fasting for 8 hrs
3. pH of 6.5-8.5
4. No NSAIDS (Non-steroidal anti-inflammatory drugs)
5. Within 3 hrs
167
Another name for the platelet retention test
Platelet adhesiveness test
168
Measures the entire function of platelets
Clot Retraction Test
169
Qualitative test for platelet retraction that uses castor oil to form "dimpling" / droplet like-serum on the surface of blood drop
Hirshboeck or castor oil method
170
The normal value for Hershboeck/castor oil method
15-45 min.
171
Capillary resistance test correlates with the degree of _
Thrombocytopenia
172
Rumpel-Leede Grading System
```
1+ = 0-10 petechiae
2+ = 10-20 petechiae
3+ = 20-50 petechiae
4+ = >50 petechiae
```
173
Suction cup method for capillary resistance utilizes a modified _ instrument
da Silva Melle instrument
174
What are the methods for bleeding time?
1. Duke's method
2. Modified Ivy's method
3. Coply-lalitch method
4. Adelson-Crosby method
5. MacFarlane method
6. Aspirin tolerance test
175
Which is more accurate for bleeding time?
| Duke's or modified Ivy's method
Modified Ivy's method because it uses a standard pressure of 40 mmHg
176
The normal value for the Duke's bleeding time method
6-10 min. (blot every 30 seconds)
177
The best method to assess platelet adhesiveness
Modified Ivy method
178
The normal value for the Modified Ivy bleeding time method
3-6 min.
179
Where should you prick the patient when you are using modified ivy's method?
The volar surface of the arm
180
Site of puncture for Macfarlane's method
Earlobe
181
The pressure needed for modified Ivy's method
40 mmHg
182
Difference of Stefanini method and McFarlane method for clot retraction
Stefanini method uses time intervals that begins in 1 hr, and ends within 18-24 hrs; McFarlane should be measured after 1 hr only.
