J Sarge Hemostasis
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| Factor I | Fibrinogen
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| Factor II | Prothrombin
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| Factor III | Tissue factor
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| Factor IV | Ca++
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| Factor V | Labile factor
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| Factor VII | Stable factor
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| Factor VIII | Antihemophilic factor
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| Factor IX | Christmas factor
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| Factor X | Stuart-Prower factor
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| Factor XI | PTA (plasma thromboplastin antecedent
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| Factor XII | Hageman factor
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| Factor XIII | FSF (fibrin-stabilizing factor)
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| HMWK | High-molecular-weight kininogen, Fitzgerald factor
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| PF3 | Platelet factor 3
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| VWF | von Willebrand factor (carries VIII)
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| Prekallikrein | Fletcher factor, PK
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| What are platelets? | Fragmentation of megakaryocyte cytoplasm originating in the bone marrow
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| What divides in a megakaryocyte, the nucei or the cytoplasm? | Nuclei
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| How many nuclei will a Promegakaryocyte have? | 2-4
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| How many nuclei should there be before we call the cell a megakaryocyte? | 8-32
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| How many platelets may a maegakaryocyte produce? | 2,000 to 7,000
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| Are some megakaryocytes stored in the lungs? | yes
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| Where are about 1/3 of all platelets stored? | In the Spleen
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| Splenomegaly will do what to the platelets? | Will induce large number of plateleats to be stored
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| Hypersplenism invariably results in what? | Thrombocytopenia
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| What can be done to correct thrombocytopenia? | Remove the spleen
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| How long do platelets survive? | 7-10 days
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| What is normal platelet number in the peripheral blood? | 150K-350k/uL
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| Do platelets have nuclei? | No
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| What are the four main components of hemostasis? | Vascular system, Primary Hemostasis, Secondary Hemostasis, Fibrinolytic system
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| What is the role of the vascular system? | Regulation of the rate of blood flow
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| What is the role of primary hemostasis? | Platelets interact with vascular endothelium, formation of primary hemostatic plug which may initiate clotting cascade, maintain vascular integrity
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| What is the role of secondary hemostasis? | Coagulation system, fibrin is the end product, blood clot. Composed of a series of plasma proteins and cofactors interacting. Extrinsic and Intrinsic Cascades
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| What is the function of the fibrinolytic system? | Clot dissolution. Includes specific set of plasma proteins tasked with prevention of hypercoagulability
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| Describe the different layers of the vessel wall. | Intima (inner), media (middle), adventitia (outer)
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| How does the vascular system prevent bleeding? | Vascontriction, Diversion of blood flow, Initiation of contact activation of platelets, Contact activation of the coagulation system
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| What is fibrinolysis? | The action of removing unwanted fibrin deposits and gradually breaking down fibrin into soluble fragments
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| What mediates fibrinolysis? | Plasmin which is generated by t-PA
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| What does plasmin do? | Splits fibrin into smaller pieces until it gets 2 D fragments and an E fragment. (Fibrin Split or Degradation products- FDPs
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| What can we test for to determine if fibrinolysis has occured? | D dimers or FDPs which include the larger pieces (X and Y)
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| Coagulation is usually measure by what tests? | Prothrombin Time (PT) and Partial Tissue Thromboplastin Time (PTT)
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| What test measures the extrinsic pathway? | Prothrombin Time (PT)
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| What test measures the intrinsic pathway? | Partial Tissue Thromboplastin Time (PTT)
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| The PT test is more sensitive to loss of Factor? than to Factor II? | Factor VII
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| The PT test is inhibited by what drug which inhibits Vitamin K uptake by liver cells? | Coumadin
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| The normal range for the PT test is? | 10-13 seconds
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| What is INR when discussing PT time? | International normalized ratio. This is reported in the PT result and allows standardized comparisons of values.
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| The PTT test is inhibited by? | Heparin
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| The PTT test is most sensitive to intrinsic deficiencies occurring in the cascade prior to Factor? | Factor II
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| When the PT test is prolonged by coumadin, will the PTT test be affected? | Yes, it is also prolonged
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| When an unexplained prolonged PT and/or PTT is encountered clinically, what might be suspected? | A Factor deficiency or circulating inhibitor
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| What might be done to detect a factor deficiency? | Different combinations of serum or plasma containing known Factors are added back to the specimen to correct the deficiency
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| What are the role of platelets? | Provide a negatively charged phospholipid surface for fX and pthrombin activation. Release substances that mediate vasocontriction, platelet aggregation, coagulation, and vascular repair. Provide surface membrane glycoproteins which attach to other p-lets
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| What activates a platelet? | Disruption of vascular endothelium. Exposure of collagen in basement membrane attracts and stimulates circulating platelets
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| Is adhesion reversible? | Yes
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| What does a platelet need to initially adhere to exposed collagen? | von Willenbrand Factor, Collagen and GPIb
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| What happens after the initial adherence to exposed collagen? | Release of ADP from dense bodies.Other platelets are activated through interaction of collagen or other mediators (thrombin, ADP , or TXA2) Immediate shape change and pseudopodia. Formation of primary hemostaic plug
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| Is aggregation reversible? | No
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| Steps in aggregation 1... | Release of more ADP form dense bodies; attraction of adjacent platelets initiating aggregation. Need ATP for energy and Ca++, GPIIb, IIIa and fibrinogen. Fibrinogen activates the GPIIb/IIIa complex. Release of PF3 which further simulates coag process
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| Steps in aggregation 2... | Release of PF4 and other factors promoting clot formation. Initiation of coag cascades and formation of fibrin. Formation of secondary hemostatic plug-irreversible process
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| What platelet granules secrete factors throughout the whole process? | Alpha granules
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| Here are other secretions that are essential for clot formation. | Beta-throboglobulin, PF4, thrombospondin, and PDGF are some of the factors secreted and are used as activation markers.
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| What is Brecker-Cronkite Method? | A manual platelet counting method. 1:100, phase-microscopy and 1% ammonium oxalate. est 11-15% error
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| What is Rees-Ecker Method? | A manual platelet counting method. 1:200, light microscopy and sodium citrate, est 16-25% error
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| What are some reasons for false high platelet counts from automated instrumentation? | Presents of abnormal proteins; macroglobulinemia, uremia, multiple myeloma. Patient undergoing chemotherapy or irradiation may be high due to leukocyte or platelet fragmentation. Contamination from bacteria or other particulate matter.
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| What are some reasons for false low platelet counts from automated indtrumentation? | Sample containing platelet aggultinins and/or cold agglutinins. Satellite phenomenon. Platelet aggregates may be counted as platelets,or not counted at all. Giant platelets counted as RBCs
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| What is a Bleeding Time Test? | The amount if time required for a standard sized wound to stop bleeding
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| Describe the Simplate-Template method for a bleeding time test. | Normaltime is 2.5-9.5 minutes; uses a BP cuff to 40mm/Hg; cut on forearm and bleeding is timed; uses a spring-loaded blade (most commonly used)
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| What factors are in the fibrinogen group? | 1, 5, 8 13
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| What factors are in the contact group? | 11 and 12
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| What factors are in the prothrombin group? | 2, 7, 9, 10
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