Chapt 15 Hemostasis Disorders (FINAL)

Start Studying!

Terms

undefined, object

copy deck

Plasma constitutes what percentage of the total volume of the blood?: 50-60%
11 substances found in plasma?: 1. water

2. proteins

3. ions

4. glucose

5. lipids

6. amino acids

7. vitamins

8. globulins

9. albumin

10. hormones

11. dissolved gases
3 general cells/cellular components of blood?: 1. RBCs (erythrocytes)

2. WBCs (leukocytes)

3. Thrombocytes (platelets)
RBCs have what for O2 binding?: hemoglobin
What do WBCs do?: fight infection
How many types of WBCs are there? Name them.: 5

1. T an B lymphocytes

2. Monocytes/macrophages

3. Neutrophils

4. Eosinophils

5. Basophils
What are thrombocytes and what are they involved in?: fragments of megakaryocytes...inv. in blood clotting
What percentage of plasma is water?: 90%
What portion of blood is plasma?: the liquid portion
The plasma is a ? medium.: transport
What, in general, does the plasma transport?: inorganic substances (ex, Na+ and Cl-) and organic substances (ex, plasma proteins)
Name the 5 plasma proteins?: 1. Albumins

2. Other proteins that buffer pH change

3. Globulins (alpha, beta, and gamma)

4. Gamma globulins

5. Fibrinogen
Function of albumin?: est. osmotic gradient b/n blood and interstitial fluid
Function of Globulins (alpha, beta, and gamma)?: roles range from blood clotting to transport
Function of Gobulins (alpha, beta, and gamma)?: roles range from blood clotting to transport
Function of gamma globulins?: role in immunity as antibodies
Function of fibrinogen?: key factor in blood clotting
Besides the plasma proteins name 4 other substances you may see in the plasma?: 1. nutrients

2. wastes

3. gases

4. hormones
What are erythrocytes?: RBCs...they transport O2
What are leukocytes?: WBCs...they are mobile units of the body's immune defense system
3 functions of leukocytes?: 1. defend against invasion by pathogens

2. identify and destroy cancer cells

3. function as "clean up crew", by phagocytizing debris of dead or injured cells
What are thrombocytes?: platelets....circulating cell frags of megakaryocytes...involved in hemostasis
There are ? kinds of leukocytes split into ? categories.: 5 kinds split into 2 categories
What are the 2 categories of leukocytes?: 1. polymorphonuclear granulocytes

2. mononuclear agranulocytes
What characterizes polymorphonuclear granulocytes?: nuclei segmented into lobes, with abundant membrane-enclosed granules in cytoplasm
Which leukocytes fall under the category of polymorphonuclear granulocytes?: 1. Neutrophils

2. Eosinophils

3. basophils
Which of the polymorphonuclear granulocytes is phagocytic, seen in acute infl., and attacks bacteria, fungi and cell debris?: neutrophils
Which polymorph. gran. is associated with allergic rxns and parasitic infections?: eosinophils
Which polymorph. gran. is assoc. with allergica and stress responses (although not much else is known about their function)?: basophils
What characterizes mononuclear agranulocytes?: They have a single, large, nonsegmented nucleus and few granules
Which of the leukocytes fall under the category of mononuclear agranulocytes?: 1. monocytes/macrophages

2. lymphocytes (
Which of the mononuc. agran.s are phagocytic, important in inflammation, wound healing, T cell activation, and are seen in chronic inflammation?: monocytes/macrophages
Which of the mononuclear agranulocytes is associated with T and B cells and the immune response?: lymphocytes
What is hemostasis?: arrest of bleeding from damaged blood vessels
5 stages of hemostasis?: 1. vascular spasm

2. platelet plugging

3. blood coagulation

4. clot retraction

5. clot dissolution
Describe the 1st stage of hemostasis?: Vascular spasm: Vascular constriction, reduces blood flow thru damaged vessel (last less than 1 min., short lived)
Describe the 2nd step of hemostasis?: Platelet plugging: platelet aggregation forms plug, sealing vessel
Describe the 3rd step of hemostasis?: blood coagulation: clotting
Describe the 4th stage of hemostasis?: clot retraction: shrinkage, w/ squeezing out of serum and cells, 20-60 minutes after clot formation
Describe th 5th stage of hemostasis?: clot dissolution: clot slowly dissolved by plasmin, but dissolution begins shortly after clotting
What is Von Willebrand Factor (vWF)?: produced by epithelial cells...circulates in blood...a carrier of factor VIII...binds to collagen at injury and then platelets bind to factor VIII
What does the aggregating platelet plugging release?: ADP and thrombaxone
The ADP and thrombaxone produced by the aggregating platelet plug do what?: Gives positive feedback to platelet plug so it produces more ADP and thrombaxone...also stimulates normal (uninjured endothelium) to produce prostacyclin and Nitrous Oxide to prevent clotting
Coagulation does what to the platelet plug?: reinforces it
What does coagulation do to blood?: converts it to a gel in area of vessel damage
In coagulation what stabilizes the clot?: formation of fibrin mesh
What forms the fibrin mesh in coagulation?: conversion of fibrinogen to fibrin (catalyzed by thrombin)
During coagulation what do fibrin threads trap?: RBCs, platelets, and other components (forming a clot)
The 2 possible pathways of coagulation?: 1. extrinsic

2. intrinsic
Speed of intrinsic pathway? What initiates it?: - slower clot formation

-initiated by VESSEL injury (collagen exposure)
Speed of extrinsic pathway? What initiates it?: - more rapid

- initiated by exposure of blood to TISSUE proteins
Where do the extrinsic and intrinsic pathways meet?: at Factor X...at which point the remaining cascade is the same
What converts prothrombin to thrombin: Factor Xa
What converts fibrinogen to fibrin?: Thrombin (IIa)
What is a cofactor required by many steps in the clotting cascade?: Calcium
What do protein c, protein s, and anti-thrombin do?: all prevent clotting (endogenous to body)
What enzyme slowly dissolve the clot during clot dissolution?: plasmin
Where is plasmin made?: in the liver, as the inactive precursor plasminogen
In what fashion is plasminogen activated in?: cascade fashion
Name a factor that is involved in clot formation that is also involved in the cascade that activates plasminogen for clot dissolution?: Factor XII (hageman factor)
When a clot is formed, and activated plasmin is trapped in the clot what does it slowly break down?: the fibrin mesh
What is fibrinolysis?: the process of clot dissolution
What removes the products of a dissolving clot?: Phagocytic WBCs
What does hypercoaguable literally mean?: "too much clotting"
2 general forms of hypercoagulable states?: 1. conditions creating increased platelet function

2. cond.s causing increased clotting activity
Hypercoaguable states predispose to thrombosis, thrombi in what two structures? Due to what?: 1. arteries : due to turbulence (platelets)

2. Veins : due to stasis (platelets and fibrin)
In hypercoaguable states which has the higher pressure, Arteries or Veins?: arteries
What does stasis mean?: blood not flowing
Name 3 scenarios of increased platelet activation?: 1. endothelial damage

2. increased platelet sensitivity to adhesion, aggregation factors

3. disturbances in flow
Name 5 things that may lead to disturbances of flow and result in increased platelet activation?: (damage in chronic disease states)

1. artherosclerosis

2. smoking

3. HTN

4. diabetes mellitus

5. elevated blood lipids/cholesterol
2 general disorders that may affect coagulation components and result in increased clotting activity?: 1. Primary : genetic mutations

2. Secondary : acquired
In primary disorders affecting coagulation components what may there be genetic mutations in?: 1. Factor V and prothrombin are the most common (so clotting cascade can go on indiscriminately)

2. Deficiencies in antithrombin III, protein C, and protein S are less common (anticoagulant factors)
Name 4 different things that you may acquire that could cause 2ndary increased clotting activity?: 1. Stasis (immobilized or postsurgical patient)

2. MI

3. Cancer

4. Hyperestogenic states, oral contraceptives
Can tumor cells produce thrombin?: yes
An increase in estrogen can lead to what?: increased synthesis of clotting factors in liver and decreased synthesis of anticlotting factors (such as antithrombin III)

-leads to secondary disorder of coagulation component
Name 4 types of bleeding disorders?: 1. Platelet defects

2. coagulation defects

3. disseminated intravascular coagulation

4. vascular disorders
What are platelets integral to the formation of?: clots
What does the suffix -penia indicate?: a decreased number of
Name two types of platelet defects?: 1. thrombocytopenia

2. thrombocytopathia
What is thrombocytopenia?: a platelet defect where there is a decreased number of circulating platelets
What is thrombocytopathia?: decreased platelet FUNCTION
Normally there are how many platelets per mL of blood? How many are there in thrombocytopenia?: normally 150-400 million/mL....in thrombocytopenia there is less than 100,000 platelets/mL (so more than 1000X decrease)
In thrombocytopenia there is an increased ? risk.: bleeding
Two types of increased bleeding risks seen in thrombocytopenia?: 1. Petechiae

2. Purpura
What is petechiae?: small, purple spots seen on skin surface in thrombocytopenia
What is purpura?: larger than petechiae...bruising...associated with thrombocytopenia
Where is there decreased platelet production in people with thrombocytopenia?: in the bone marrow
Name 4 things that may cause decreased platelet production in the bone marrow associated with thrombocytopenia?: 1. aplastic anemia

2. leukemia

3. radiation

4. HIV
In thrombocytopenia where may you see increased platelet pooling?: in the spleen
What is splenomegaly? What is it associated with? What is it caused by?: an increase in spleen size...associated with thrombocytopenia...may be caused by,
1. cirrhosis
2. portal HTN
3. lymphomas
In thrombocytopenia you may see decreased ? survival due to immune or nonimmune mechanisms.: platelet
What makes the platelets appear as if they are foreign to the body, causing the body to make antiplatelet Abs to remove them?: haptins
3 general things associated with thrombocytopenia?: 1. decreased platelet production in bone marrow

2. increased platelet pooling in spleen

3. decreased platelet survival due to immune or nonimmune mechanisms
2 ways that you may become inflicted with thrombocytopathia?: 1. inherited disorders

2. drug induced
An inherited disorder causing thrombocytopathia?: von willebrand disease
3 drugs associated with drug induced thrombocytopathia?: 1. aspirin and other nsaids (ex. ibuprofen) : inhibit thromboxane production

2. Clopidogrel/ticlopidine : inhibit ADP

3. GPIIb/GPIIIa inhibitors : block receptor
What are GPIIb/GPIIIa inhibitors? What do they do?: glycoprotein inhibitors (may cause thrombocytopathia)...glycoprotein causes von willebrand factor to stick, so when using these if they block the receptor platelets won't stick
What are coagulation defects?: defects in the coagulation cascade
2 general types of coagaltion defects?: 1. impaired synthesis

2. hereditary disorders
2 types of impaired synthesis associated with coagulation defects?: 1. liver disease : because liver produces the most coagulationn factors

2. Vitamin K deficiency : factors VII, IX, X, prothrombin are vitamin K dependent
2 types of hereditary disorders associated with coagulation defects?: 1. hemophilia A : factor VIII (common, 1:5000 males)

2. von Willebrand disease : factor VIII-vWF (common, effects boys and girls)(often not diagnosed until adulthood because bleeding is so mild)
What is DIC aka?: Disseminated Intravascular Coagulation (a coag. defect)
Is DIC a primary disease?: no it is a complication of other disorders
Is DIC localized?: no, it is throughout the body
DIC is a paradoxical rxn of what?: coagulation and hemorrhage
DIC is the activation of what?: the clotting cascade via thrombin generation resulting in systemic fibrin formation
In DIC what system is overwhelmed?: anticoagulant
What is microvascular thrombosis?: (associated with coagulation defects, DIC)...a vessel occlusion (closing off) and tissue ischemia
In DIC what does massive clot formation use?: all coagulation proteins and platelets
In DIC what is activated and leads to more bleeding?: fibrinolytic system
Besides thrombocytopenia where else do you see petechiae and purpura?: vascular disorders
Name 4 vascular disorders?: 1. hemorrhagic telangiectasia

2. scurvy : vitamin C deficiency

3. cushing's syndrome

4. senile purpura
What is hemorrhagic telangiectasia?: a vascular disorder
-uncommon autosomal dominant disorder

-thin-walled, dilated capillaries and arterioles
What is scurvy?: a vascular disorder

-vitamin C deficiency

-poor collagen synthesis in endothelial wall, results in fragile vessel walls
What is Cushing's disease?: a vascular disorder

-protein wasting and loss of tissue support due to excess cortisol
What is senile purpura?: a vascular disorder

-bruising in the elderly caused by aging

Start Studying!

Deck Info

Number of cards 116