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CVT - Path Exam 2 Alterations in Hemostasis and Blood Coagulation


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means arrest of bleeding or prevention of blood loss
Stages of hemostasis:
1st-vasoconstriction (immediate response)
2nd-formation of platelet plug
3rd-coagulation (fibrin clot)
4th-clot retraction (firm clot bc serum leaves clot)
-norm: 250-400K
-come from megakaryocytes in marrow (platelets)
-70% circulate throughout the body
-30% located in the spleen
-10 day life span
-catalyze conversion of prothrombin to thrombin
What are the blood coagulation factors?
1. plasma proteins from liver
2. vitamin K necessary (from liver and bacteria)
3. calcium
How many multiple factors are involved in the coagulation process?
What are the disorders of hemostasis and coagulation?
1. vascular purpura
2. hereditary hemorrhagic telangiectasia
3. platelet disorders
4. coagulation disorders
vascular purpura:
-petichiae, ecchymoses
-caused by drug allergy, old age, vitamin C deficiency (poor collagen)
large hemorrhages into the skin
What test can be performed to determine purpura?
tourniquet test
-network of fine vessels
-congenital disorder
-a vascular lesion formed by dilation of a group of small vessels
-congenital tendency to uncontrolled bleeding; usually affects males and is transmitted from mother to son
-pinpoint red spots from broken capillaries in the skin
-extreme or unnatural paleness
-yellowish discoloration of the whites of the eyes, skin, and mucous membranes
-caused by deposition of bile salts in these tissues, occurring as a symptom of various diseases, such as hepatitis, that affect the processing of bile.
Prothrombin time (PT) is associated with which pathway?
APTT is associated with which pathway?
Clinical assessment list:
1. family and personal history
2. vascular and platelet defects usually after trauma
3. coagulation defects
4. systemic disease
5. medications as cause
6. petechiae
7. pallor or jaundice
8. ecchymosis (hematoma)
9. bleeding from body systems
-deficiency of platelets
-platelets are <150,000
ITP stands for:
Idiopathic Thrombocytopenia Purpura
Causes of thrombocytopenia:
virus, drugs, folate/B12 deficiency, radiation, chemotherapy, blood dyscrasias, AIDs
4 mechanisms of thrombocytopenia:
1. less platelet production
2. less platelet survival
3. splenic pooling (pooled platelets)
4. intravascular transfusion (massive transfusions)
Symptoms of pts with multiple transfusions:
decreased clotting ability, more subject to bleeding, BP will not go back to normal
Diagnosis of thrombocytopenia:
decreased platelets, increased bleeding time, history of drugs (ASA)
1. What does heparin do?
2. What does coumadin do?
3. What does ASA do?
4. What do all 3 drugs have in common?
1. decrease thrombin
2. decrease Vitamin K
3. decrease platelets
4. all are anticoagulants
causes of thrombocytosis:
polycythemia, hemorrhage, infection, malignancy
Tx for thrombocytosis:
anti-platelet therapy such as ASA
List the 2 platelet disorders:
thrombocytopenia and thrombocytosis
List the 5 coagulation disorders:
1. hemophilia
2. hemorrhagic disease of newborn
3. disseminated intravascular coagulation (DIC)
4. vitamin K deficiency
5. hepatic disease
Causes of hemophilia:
1. hereditary disease, affects mostly young males
2. 85% A disease (factor VIII deficiency)
3. 15% B diseaes (factor IX deficiency)
Diagnosis of hemophilia:
1. deficiency in factors VIII and IX
2. prolonged APTT
Treatment for hemophilia:
1. patient education
2. Factor VIII (type A)
3. Fresh plasma or factor concentrate in type B
Hemorrhagic disease of newborn:
-vitamin K deficiency causing a decrease in coagulation factors
-occurs 48-72 hrs after birth
-breast milk has less vitamin K than formula
=Disseminated intravascular coagulation
-all abnormal coagulation studies
Causes of DIC:
sepsis, malignancy trauma (due to bleeding disorder), transfusions, burns, shock, severe liver disease
Effects of DIC:
1. clotting and bleeding occur simulaneously
2. clotting in small vessels
3. coagulation factors consumed and fibrinolysis occurs
Clinical indications of DIC:
1. bleeding
2. thrombi (causing pulmonary and renal shutdown)
Tx of DIC:
1. fresh frozen plasma
2. give pt more RBCs and platelets
3. Heparin (anti-coagulant may be possible)
List the 4 fat soluble vitamins:
Vitamin A, D, E, K

(means the vitamins need fat in order to be absorbed)
Causes of vitamin K deficiency:
1. malabsorption of fats
2. anticoagulant therapy (coumadin affects K+)
3. hepatic disease
4. PT is increased

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