Week 2 - Hemostasis and Coagulation
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Questions and Answers

What is the primary function of hemostasis?

  • To increase blood flow to tissues
  • To facilitate the movement of blood through the body
  • To lower blood pressure
  • To prevent blood loss after vessel injury (correct)

    • A patient's personal or family history of bleeding disorders is not a relevant factor when assessing hemostasis.

    False (B)

    Name the three main components involved in hemostasis.

    vessel wall, platelets, and plasma coagulation proteins

    Bleeding into the joint spaces is known as ________.

    <p>hemarthrosis</p> Signup and view all the answers

    Match the following physical findings with their descriptions:

    <p>Petechiae = Small, pinpoint red spots on the skin Purpura = Larger, reddish-purple spots on the skin Ecchymosis = A bruise caused by blood leaking from vessels Telangiectasia = Small, widened blood vessels on the skin</p> Signup and view all the answers

    Which of the following is NOT typically a reason for evaluating hemostasis and coagulation?

    <p>To prepare for a routine physical checkup (B)</p> Signup and view all the answers

    Only individuals with a family history of bleeding disorders should be screened for coagulation abnormalities.

    <p>False (B)</p> Signup and view all the answers

    What type of medications could potentially influence hemostasis?

    <p>anticoagulants</p> Signup and view all the answers

    Which laboratory test assesses the extrinsic pathway of coagulation?

    <p>PT/INR (D)</p> Signup and view all the answers

    A primary cause of bleeding is always a problem with the coagulation pathway, not the vascular component.

    <p>False (B)</p> Signup and view all the answers

    What is the diagnostic approach for vascular purpura after ruling out other disorders?

    <p>Diagnosis is one of exclusion</p> Signup and view all the answers

    Ehlers-Danlos syndrome is characterized by deficient ______ and elastin.

    <p>collagen</p> Signup and view all the answers

    Match the following conditions or tests with their descriptions:

    <p>CBC = Identifies anemia Bleeding time = Evaluates vascular status and platelet function aPTT = Assesses the intrinsic pathway Rumpel-Leede test = Specific to vascular purpura</p> Signup and view all the answers

    Hereditary Hemorrhagic Telangiectasia is characterized by which feature?

    <p>Vessel walls composed of a single layer of endothelium (B)</p> Signup and view all the answers

    Vitamin C deficiency can lead to defective collagen synthesis, which may result in vascular purpura.

    <p>True (A)</p> Signup and view all the answers

    What is the primary treatment approach for vascular purpura?

    <p>removing and avoiding the causative agent</p> Signup and view all the answers

    A primary cause of bleeding in platelet disorders is due to an abnormality in which of the following?

    <p>The quantity or quality of platelets (B)</p> Signup and view all the answers

    Thrombocytosis is defined as having a platelet count less than 400,000/mm3.

    <p>False (B)</p> Signup and view all the answers

    Name one inherited qualitative platelet disorder.

    <p>Bernard-Soulier syndrome, von Willebrand disease, or thrombasthenia</p> Signup and view all the answers

    A low platelet count, prolonged bleeding time, and abnormal peripheral smear are characteristics of ________.

    <p>thrombocytopenia</p> Signup and view all the answers

    Match the following platelet disorders with their primary characteristic:

    <p>Thrombocytopenia = Low platelet count Thrombocytosis = High platelet count Qualitative Platelet Disorder = Abnormal platelet function</p> Signup and view all the answers

    Which of the following is NOT a general mechanism for thrombocytopenia?

    <p>Increased platelet survival (B)</p> Signup and view all the answers

    Coagulopathies involve defects in the normal clotting mechanism.

    <p>True (A)</p> Signup and view all the answers

    Name one cause of secondary thrombocytosis.

    <p>response to hemorrhage, disease process, or splenectomy</p> Signup and view all the answers

    Which of the following is the most common inherited coagulation disorder?

    <p>Hemophilia (C)</p> Signup and view all the answers

    Hemophilia B is caused by a deficiency in factor VIII.

    <p>False (B)</p> Signup and view all the answers

    What is the primary treatment for Von Willebrand disease?

    <p>desmopressin</p> Signup and view all the answers

    Vitamin K deficiency can lead to a deficiency of coagulation factors ______, _______, ________ and ________.

    <p>II, VII, IX, X</p> Signup and view all the answers

    Match the following coagulation disorders with their appropriate treatment:

    <p>Hemophilia A = cryoprecipitate or factor VIII concentrate Hemophilia B = fresh frozen plasma or cryoprecipitate Von Willebrand Disease = desmopressin Acquired Vitamin K deficiency = parenteral administration of vitamin K</p> Signup and view all the answers

    Which of the following is NOT a cause of acquired Vitamin K deficiency?

    <p>Type 1 Diabetes (C)</p> Signup and view all the answers

    In disseminated intravascular coagulation (DIC), the fibrinogen level and platelet count are increased.

    <p>False (B)</p> Signup and view all the answers

    What is the primary goal of treatment for Disseminated Intravascular Coagulation(DIC)?

    <p>Treat or remove the underlying cause</p> Signup and view all the answers

    Study Notes

    Chapter 14: Alterations in Hemostasis and Blood Coagulation

    • Hemostasis is the arrest of bleeding or the prevention of blood loss after blood vessel injury
    • It involves the vessel wall, circulating platelets, and plasma coagulation proteins
    • Learning Objectives include describing how platelets and clotting factors work in hemostasis, identifying findings from patient history and exams, laboratory tests, vascular alterations, causes of platelet deficiencies, excesses, and dysfunction, and inherited/acquired coagulation disorders

    Evaluation of Hemostasis and Coagulation

    • Patient history and physical exams are crucial to determine if & why a bleeding problem exists
    • Personal and family history of bleeding disorders is key
    • Active bleeding unresponsive to standard interventions needs evaluated
    • Pre-surgical screening and ongoing anticoagulation therapy evaluation are part of the process
    • Key aspects of clinical assessment include personal/family history of bleeding disorders, systemic diseases, medication history, and physical findings such as petechiae, purpura, ecchymosis, hematoma, hemarthrosis, telangiectasia, and occult or frank bleeding.

    Laboratory Tests

    • Primary and secondary hemostasis are evaluated
    • Complete blood count (CBC) aids in anemia identification
    • Platelet counts help determine platelet number
    • Peripheral blood smears provide a visual assessment of platelet morphology
    • Bleeding time evaluation considers vascular status and platelet function
    • Prothrombin time (PT) and International Normalized Ratio (INR) evaluate the extrinsic pathway of coagulation
    • Activated partial thromboplastin time (aPTT) assesses the intrinsic pathway

    Bleeding Disorders

    • Laboratory tests: specific lab values suggest various bleeding disorders, such as anemia, leukemia, disseminated intravascular coagulation (DIC), thrombocytopenia, platelet-vessel wall interactions, and deficiencies of coagulation factors (I, II, V, VII, VIII, IX, X)
    • Vascular Purpura: Diagnosis is through exclusion, ruling out platelet and coagulation disorders. Tourniquet (Rumpel-Leede) test might be used. Treatment focuses on removing or avoiding the causative agent.
    • Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease): genetic trait, vessel wall composition, repeated bleeding episodes, and family history are significant factors. Supportive treatments, such as topical hemostatic agents, cauterization, iron replacement, and laser therapy, are key.

    Platelet Disorders

    • General Mechanisms of Thrombocytopenia: Involve decreased platelet production, survival, or splenic sequestration. This leads to low platelet count, prolonged bleeding time, and abnormal peripheral smears
    • Treatment: Depends on the cause of thrombocytopenia
    • Thombocytosis: Platelet count greater than 400.000/mm³. Can be transient (stress/physical activity) or primary (polycythemia vera, chronic granulocytic leukemia). Secondary to hemorrhage or disease. Treatment reserved for primary causes
    • Qualitative Platelet Disorders: Platelet function problems; inherited (Bernard-Soulier syndrome, VonWillebrand's disease, thrombasthenia) or acquired (drug-induced, renal failure, hematologic disease). Treatment based on the underlying disorder; platelet transfusion may be needed

    Coagulation Disorders

    • Coagulopathies: Defects within the normal clotting mechanism.
    • Results: Bleeding from problems in clot formation, stabilization or lysis of the fibrin clot, or excessive clot formation.
    • Hemophilia: Hereditary coagulation disorder, most common resulting in excessive bleeding. Hemophilia A (factor VIII deficiency), Hemophilia B (factor IX deficiency). Treatment includes patient/family education; cryoprecipitate or factor VIII concentrate (Hemophilia A), fresh frozen plasma or cryoprecipitate (Hemophilia B).
    • Von Willebrand Disease: Autosomal dominant disorder of factor VIII carrier protein leading to platelet dysfunction and excessive bleeding, Treatment with desmopressin (to release von Willebrand factor and factor VII from endothelial cells); cryoprecipitate and humate-P for severe bleeding.
    • Vitamin K Deficiency Bleeding in Infancy: Lack of vitamin K-dependent coagulation factors (II, VII, IX, X), early bleeding (melena, hematuria, intracranial hemorrhage, hypovolemic shock). Prophylactic vitamin K to the newborn prevents this.
    • Acquired Vitamin K Deficiency: Can occur from malnutrition, malabsorption, chronic hepatic disease, antibiotic therapy, or oral anticoagulation; results in excessive bleeding. Treatment with parenteral vitamin K
    • Disseminated Intravascular Coagulation (DIC): Acquired hemorrhagic syndrome where clotting and bleeding happen simultaneously. Fibrinogen and platelet counts are reduced. Increased bleeding time, elevated PT/INR/aPTT/D-dimer. Treatment focuses on the cause

    Hepatic Disease

    • Coagulopathies emerge from Impaired vitamin K absorption, decreased synthesis of fibrinogen/factors V and XI, trouble removing activated coagulation factors and fibrinolytic proteins, and problems with coagulation inhibitor production.
    • Treatment consists of vitamin K, platelet transfusions, fresh frozen plasma, or whole blood.

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    Chapter 14 Alterations in Hemostasis and Blood Coagulation PDF

    Description

    Explore Chapter 14 on alterations in hemostasis and blood coagulation. This quiz covers the mechanisms of hemostasis, essential laboratory tests, and assessment techniques for bleeding disorders. Identify key factors and their roles in preventing blood loss and understand the implications for patient care.

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