Podcast
Questions and Answers
What is the main purpose of haemostasis?
What is the main purpose of haemostasis?
- To prevent and control bleeding while maintaining blood fluidity (correct)
- To increase blood viscosity after injury
- To enhance blood flow to injured areas
- To promote excessive bleeding during injury
Which elements form the clotting trilogy?
Which elements form the clotting trilogy?
- Blood vessels, platelets, and coagulation factors (correct)
- Red blood cells, white blood cells, and plasma
- Endothelial cells, fibroblasts, and growth factors
- Vasoconstrictors, platelets, and fibrinolytic factors
What is primary haemostasis?
What is primary haemostasis?
- The maintenance of normal blood flow during injury
- The initial response to vessel injury involving a platelet plug (correct)
- The interaction of fibrin strands to strengthen a clot
- The process that removes clots after vessel healing
What role does fibrin play in secondary haemostasis?
What role does fibrin play in secondary haemostasis?
What is fibrinolysis?
What is fibrinolysis?
Which layer of the blood vessel wall is responsible for regulating vascular tone?
Which layer of the blood vessel wall is responsible for regulating vascular tone?
What is the primary function of the adventitia layer in blood vessels?
What is the primary function of the adventitia layer in blood vessels?
What is the role of the intima in blood vessels?
What is the role of the intima in blood vessels?
What initiates the extrinsic pathway of the coagulation cascade?
What initiates the extrinsic pathway of the coagulation cascade?
What is the primary role of the TF-FVIIa complex in coagulation?
What is the primary role of the TF-FVIIa complex in coagulation?
What does factor Xa do in the context of the extrinsic pathway?
What does factor Xa do in the context of the extrinsic pathway?
Which component is NOT part of the extrinsic prothrombinase complex?
Which component is NOT part of the extrinsic prothrombinase complex?
What is the function of calcium ions (Ca²⁺) in the coagulation cascade?
What is the function of calcium ions (Ca²⁺) in the coagulation cascade?
What role does factor Va (FVa) serve in the coagulation process?
What role does factor Va (FVa) serve in the coagulation process?
Which of the following is a natural inhibitor of the coagulation process?
Which of the following is a natural inhibitor of the coagulation process?
How does protein C act as an inhibitor in coagulation?
How does protein C act as an inhibitor in coagulation?
What is the main storage location of vitamin B12 in the body?
What is the main storage location of vitamin B12 in the body?
What characterizes megaloblastic anemia?
What characterizes megaloblastic anemia?
What is a major cause of megaloblastic anemia?
What is a major cause of megaloblastic anemia?
What occurs during the amplification stage of coagulation?
What occurs during the amplification stage of coagulation?
What is the main role of thrombin in the coagulation process?
What is the main role of thrombin in the coagulation process?
What is the primary source of vitamin B12 for animals?
What is the primary source of vitamin B12 for animals?
How is a factor assay result interpreted?
How is a factor assay result interpreted?
Which type of inhibitors are known to lose activity over time?
Which type of inhibitors are known to lose activity over time?
What is a Bethesda Unit (BU) used to measure?
What is a Bethesda Unit (BU) used to measure?
What is the purpose of the Ristocetin Cofactor assay?
What is the purpose of the Ristocetin Cofactor assay?
What symptoms are commonly associated with bleeding disorders?
What symptoms are commonly associated with bleeding disorders?
In which scenario does a deficiency of a specific factor manifest during a factor assay?
In which scenario does a deficiency of a specific factor manifest during a factor assay?
Which of the following factors are vitamin K-dependent?
Which of the following factors are vitamin K-dependent?
What is the role of gamma-carboxylation in the vitamin K cycle?
What is the role of gamma-carboxylation in the vitamin K cycle?
What is a common cause of vitamin K deficiency?
What is a common cause of vitamin K deficiency?
Which conditions are classified as acquired bleeding disorders?
Which conditions are classified as acquired bleeding disorders?
How does vitamin K deficiency affect clotting times?
How does vitamin K deficiency affect clotting times?
What type of assay is used to detect Factor VIII inhibitors?
What type of assay is used to detect Factor VIII inhibitors?
What happens to vitamin K-dependent factors in the body during vitamin K deficiency?
What happens to vitamin K-dependent factors in the body during vitamin K deficiency?
What are the three main components of haemostatic mechanisms?
What are the three main components of haemostatic mechanisms?
What is the primary role of von Willebrand factor (vWF) in haemostasis?
What is the primary role of von Willebrand factor (vWF) in haemostasis?
How is the platelet plug primarily formed?
How is the platelet plug primarily formed?
What initiates the process of secondary haemostasis?
What initiates the process of secondary haemostasis?
Which statement best describes thromboxane A2's role in procoagulation?
Which statement best describes thromboxane A2's role in procoagulation?
Where is von Willebrand factor (vWF) primarily produced?
Where is von Willebrand factor (vWF) primarily produced?
What benign role does protein C serve in anticoagulation?
What benign role does protein C serve in anticoagulation?
How is fibrinolysis inhibited during the procoagulation process?
How is fibrinolysis inhibited during the procoagulation process?
What is the role of tissue factor in the coagulation process?
What is the role of tissue factor in the coagulation process?
Which factor is crucial for the localized activation of coagulation factors?
Which factor is crucial for the localized activation of coagulation factors?
What is the structure of von Willebrand factor (vWF)?
What is the structure of von Willebrand factor (vWF)?
How does protein S function in the anticoagulation pathway?
How does protein S function in the anticoagulation pathway?
Why is it important for the coagulation factor activation to occur at membrane surfaces?
Why is it important for the coagulation factor activation to occur at membrane surfaces?
What is indicated by increased levels of serum methylmalonic acid (MMA)?
What is indicated by increased levels of serum methylmalonic acid (MMA)?
What do normal levels of both methylmalonic acid and homocysteine suggest?
What do normal levels of both methylmalonic acid and homocysteine suggest?
What is the gold standard test for determining the cause of B12 deficiency?
What is the gold standard test for determining the cause of B12 deficiency?
What is the first step in the Schilling test?
What is the first step in the Schilling test?
Which of these is a main cause of B12 deficiency?
Which of these is a main cause of B12 deficiency?
Why is folic acid often administered with B12 treatment?
Why is folic acid often administered with B12 treatment?
What is a possible consequence of pancreatic enzyme insufficiency?
What is a possible consequence of pancreatic enzyme insufficiency?
Which condition is NOT associated with folate deficiency?
Which condition is NOT associated with folate deficiency?
What does a blood test showing macrocytic cells typically indicate?
What does a blood test showing macrocytic cells typically indicate?
What is the primary role of reticuloendothelial macrophages in relation to iron?
What is the primary role of reticuloendothelial macrophages in relation to iron?
Which of the following is NOT a mechanism by which anemia can occur?
Which of the following is NOT a mechanism by which anemia can occur?
What is a common factor in cases of folate deficiency?
What is a common factor in cases of folate deficiency?
What is the primary function of transferrin in the body?
What is the primary function of transferrin in the body?
Which vitamin is primarily associated with the absorption issues identified in the Schilling test?
Which vitamin is primarily associated with the absorption issues identified in the Schilling test?
What dietary inclusions are recommended for increasing B12 intake?
What dietary inclusions are recommended for increasing B12 intake?
Where is the majority of stored iron primarily found in the body?
Where is the majority of stored iron primarily found in the body?
What is the primary mechanism by which dietary iron is absorbed in mammals?
What is the primary mechanism by which dietary iron is absorbed in mammals?
How is ferric iron (Fe³⁺) converted to ferrous iron (Fe²⁺) for absorption?
How is ferric iron (Fe³⁺) converted to ferrous iron (Fe²⁺) for absorption?
Which of the following statements regarding hepcidin is accurate?
Which of the following statements regarding hepcidin is accurate?
What effect does a transferrin saturation of less than 20% indicate?
What effect does a transferrin saturation of less than 20% indicate?
What factors are assessed in an extrinsic pathway factor assay?
What factors are assessed in an extrinsic pathway factor assay?
Which factor does NOT influence hepcidin synthesis?
Which factor does NOT influence hepcidin synthesis?
What does it suggest if both PT and APTT are prolonged?
What does it suggest if both PT and APTT are prolonged?
What are the characteristic features observed in a blood film of an individual with iron deficiency anemia?
What are the characteristic features observed in a blood film of an individual with iron deficiency anemia?
How is the total iron-binding capacity (TIBC) measured?
How is the total iron-binding capacity (TIBC) measured?
What is the primary diagnostic application of a D-dimer test?
What is the primary diagnostic application of a D-dimer test?
What condition can lead to a prolonged APTT?
What condition can lead to a prolonged APTT?
What is the standard oral treatment regimen for iron deficiency anemia (IDA)?
What is the standard oral treatment regimen for iron deficiency anemia (IDA)?
What does the Perls stain test specifically assess?
What does the Perls stain test specifically assess?
How is thrombin time (TT) prolonged?
How is thrombin time (TT) prolonged?
What happens to zinc protoporphyrin levels in iron deficiency anemia?
What happens to zinc protoporphyrin levels in iron deficiency anemia?
What does a normal PT with an abnormal APTT suggest?
What does a normal PT with an abnormal APTT suggest?
What is a limitation of the bleeding time test?
What is a limitation of the bleeding time test?
Which of the following is NOT a form of stored iron in the body?
Which of the following is NOT a form of stored iron in the body?
Which mechanism primarily leads to iron overload in the body?
Which mechanism primarily leads to iron overload in the body?
What does a mixing study indicate if the APTT corrects?
What does a mixing study indicate if the APTT corrects?
What is required for the Clauss fibrinogen test?
What is required for the Clauss fibrinogen test?
In which condition are D-dimers raised?
In which condition are D-dimers raised?
What condition is indicated by a prolonged APTT and normal PT?
What condition is indicated by a prolonged APTT and normal PT?
What treatment options are available for patients who cannot tolerate or are unresponsive to oral iron?
What treatment options are available for patients who cannot tolerate or are unresponsive to oral iron?
What indicates the presence of lupus anticoagulant when performing a mixing study?
What indicates the presence of lupus anticoagulant when performing a mixing study?
What is the function of a Clauss fibrinogen test?
What is the function of a Clauss fibrinogen test?
What is a significant risk associated with parenteral iron treatment?
What is a significant risk associated with parenteral iron treatment?
When is a blood transfusion warranted for patients with iron deficiency anemia (IDA)?
When is a blood transfusion warranted for patients with iron deficiency anemia (IDA)?
What factor deficiencies cannot be detected by APTT?
What factor deficiencies cannot be detected by APTT?
What indicates a positive response to IDA treatment?
What indicates a positive response to IDA treatment?
What does a dimorphic blood film signify during treatment for IDA?
What does a dimorphic blood film signify during treatment for IDA?
What does primary haemostatic testing primarily assess?
What does primary haemostatic testing primarily assess?
What substance do chief cells in the stomach secrete that is crucial for protein digestion?
What substance do chief cells in the stomach secrete that is crucial for protein digestion?
Which test is commonly used in secondary haemostatic testing?
Which test is commonly used in secondary haemostatic testing?
What is critical in sample collection for coagulation tests?
What is critical in sample collection for coagulation tests?
What happens to vitamin B12 after it binds to R-protein in the stomach?
What happens to vitamin B12 after it binds to R-protein in the stomach?
What happens if poor venepuncture technique is used during sample collection?
What happens if poor venepuncture technique is used during sample collection?
Why is intrinsic factor (IF) essential for vitamin B12 absorption?
Why is intrinsic factor (IF) essential for vitamin B12 absorption?
What occurs to vitamin B12 after being absorbed in the terminal ileum?
What occurs to vitamin B12 after being absorbed in the terminal ileum?
What do platelet function assays evaluate?
What do platelet function assays evaluate?
What is the typical sample volume needed for platelet function assays?
What is the typical sample volume needed for platelet function assays?
What percentage of vitamin B12 can be absorbed in the absence of intrinsic factor?
What percentage of vitamin B12 can be absorbed in the absence of intrinsic factor?
Which condition is NOT evaluated by the prothrombin time (PT) test?
Which condition is NOT evaluated by the prothrombin time (PT) test?
How does folate deficiency develop compared to vitamin B12 deficiency?
How does folate deficiency develop compared to vitamin B12 deficiency?
What is a hallmark feature of megaloblastic anaemia observed in neutrophils?
What is a hallmark feature of megaloblastic anaemia observed in neutrophils?
How is the INR (International Normalized Ratio) calculated?
How is the INR (International Normalized Ratio) calculated?
What does an INR greater than 5.0 indicate?
What does an INR greater than 5.0 indicate?
What complication can arise due to a deficiency in transcobalamin despite adequate vitamin B12 intake?
What complication can arise due to a deficiency in transcobalamin despite adequate vitamin B12 intake?
What happens to folate once it enters the cell?
What happens to folate once it enters the cell?
What causes hypersegmented neutrophils in megaloblastic anaemia?
What causes hypersegmented neutrophils in megaloblastic anaemia?
How are serum iron and ferritin levels typically affected in megaloblastic anaemia?
How are serum iron and ferritin levels typically affected in megaloblastic anaemia?
What is macrocytosis and how is it related to B12 deficiency?
What is macrocytosis and how is it related to B12 deficiency?
Why is there an increase in serum unconjugated bilirubin in megaloblastic anaemia?
Why is there an increase in serum unconjugated bilirubin in megaloblastic anaemia?
What happens to serum homocysteine levels in individuals with both B12 and folate deficiency?
What happens to serum homocysteine levels in individuals with both B12 and folate deficiency?
What is the first clotting factor to be reduced in liver disease?
What is the first clotting factor to be reduced in liver disease?
What condition is characterized by the depletion of clotting factors and platelets due to ongoing clot formation?
What condition is characterized by the depletion of clotting factors and platelets due to ongoing clot formation?
What is considered massive hemorrhage in terms of blood loss within three hours?
What is considered massive hemorrhage in terms of blood loss within three hours?
What is the main consequence of untreated Disseminated Intravascular Coagulation (DIC)?
What is the main consequence of untreated Disseminated Intravascular Coagulation (DIC)?
Which factor is contained in cryoprecipitate?
Which factor is contained in cryoprecipitate?
What triggers the production of thrombopoietin affecting platelet count?
What triggers the production of thrombopoietin affecting platelet count?
How is Octaplas primarily different in terms of coagulation protein content?
How is Octaplas primarily different in terms of coagulation protein content?
Which condition can result from a deficiency of Factor VIII?
Which condition can result from a deficiency of Factor VIII?
What is the typical dosage of Fresh Frozen Plasma (FFP) administered?
What is the typical dosage of Fresh Frozen Plasma (FFP) administered?
What is a potential risk of transfusion during massive hemorrhage?
What is a potential risk of transfusion during massive hemorrhage?
What percentage of Haemophilia A patients develop inhibitors?
What percentage of Haemophilia A patients develop inhibitors?
In which condition do autoantibodies commonly develop against clotting proteins?
In which condition do autoantibodies commonly develop against clotting proteins?
Which factor is deficient in Hemophilia C?
Which factor is deficient in Hemophilia C?
What storage condition is required for thawed Fresh Frozen Plasma (FFP)?
What storage condition is required for thawed Fresh Frozen Plasma (FFP)?
What is the primary site of haemopoiesis in adults?
What is the primary site of haemopoiesis in adults?
Which of the following is NOT a stage of erythropoiesis?
Which of the following is NOT a stage of erythropoiesis?
What regulates the process of erythropoiesis?
What regulates the process of erythropoiesis?
How long does it take for a red blood cell to develop from a stem cell?
How long does it take for a red blood cell to develop from a stem cell?
Which treatment is used to increase levels of von Willebrand factor?
Which treatment is used to increase levels of von Willebrand factor?
Which of the following is a symptom of platelet disorders?
Which of the following is a symptom of platelet disorders?
What are the stages of thrombopoiesis?
What are the stages of thrombopoiesis?
What characterizes von Willebrand Disease?
What characterizes von Willebrand Disease?
What might increase the risk of infection and thrombosis in haemophilia treatment?
What might increase the risk of infection and thrombosis in haemophilia treatment?
Which type of vWD involves total vWF deficiency?
Which type of vWD involves total vWF deficiency?
What is the role of von Willebrand factor (vWF) in blood coagulation?
What is the role of von Willebrand factor (vWF) in blood coagulation?
What is a common cause of quantitative platelet disorders?
What is a common cause of quantitative platelet disorders?
Which growth factor is responsible for stimulating granulopoiesis?
Which growth factor is responsible for stimulating granulopoiesis?
What is the primary outcome of myelofibrosis?
What is the primary outcome of myelofibrosis?
What triggers the production of erythropoietin (EPO)?
What triggers the production of erythropoietin (EPO)?
Which factor is primarily responsible for stimulating platelet production?
Which factor is primarily responsible for stimulating platelet production?
What defines aplastic anemia?
What defines aplastic anemia?
Where is thrombopoietin (TPO) primarily produced?
Where is thrombopoietin (TPO) primarily produced?
What is the primary function of stromal cells in the bone marrow?
What is the primary function of stromal cells in the bone marrow?
What type of cells are derived from the lymphoid lineage?
What type of cells are derived from the lymphoid lineage?
Which condition is characterized by an overproduction of red blood cells?
Which condition is characterized by an overproduction of red blood cells?
What condition results in the bone marrow producing dysfunctional blood cells?
What condition results in the bone marrow producing dysfunctional blood cells?
What is the role of adhesion molecules in haemopoiesis?
What is the role of adhesion molecules in haemopoiesis?
What role does the transcription factor Hypoxia-Inducible Factor (HIF) play in EPO production?
What role does the transcription factor Hypoxia-Inducible Factor (HIF) play in EPO production?
Which condition can lead to extramedullary haemopoiesis?
Which condition can lead to extramedullary haemopoiesis?
What is the primary characteristic of leukemia?
What is the primary characteristic of leukemia?
What are proplatelets?
What are proplatelets?
What factor is crucial for neutrophil production?
What factor is crucial for neutrophil production?
What is the role of the media layer in the blood vessel wall?
What is the role of the media layer in the blood vessel wall?
What is the main purpose of fibrinolysis?
What is the main purpose of fibrinolysis?
Which statement best describes primary haemostasis?
Which statement best describes primary haemostasis?
What prevents bleeding from occurring as a normal bodily response?
What prevents bleeding from occurring as a normal bodily response?
What are the three layers of the blood vessel wall?
What are the three layers of the blood vessel wall?
How does the adventitia layer contribute to blood vessels?
How does the adventitia layer contribute to blood vessels?
What is the significance of von Willebrand factor (vWF) in primary haemostasis?
What is the significance of von Willebrand factor (vWF) in primary haemostasis?
What event marks the transition from primary to secondary haemostasis?
What event marks the transition from primary to secondary haemostasis?
What initiates the common pathway in the coagulation cascade?
What initiates the common pathway in the coagulation cascade?
What happens when the extrinsic prothrombinase complex is formed?
What happens when the extrinsic prothrombinase complex is formed?
Which factor assists the thrombin-mediated activation of protein C?
Which factor assists the thrombin-mediated activation of protein C?
What is the result of factor XIIIa's action on fibrin?
What is the result of factor XIIIa's action on fibrin?
What best describes the role of the tenase complex in coagulation?
What best describes the role of the tenase complex in coagulation?
Which of these substances is NOT a naturally occurring inhibitor of coagulation?
Which of these substances is NOT a naturally occurring inhibitor of coagulation?
What is a major cause of macrocytic anaemia?
What is a major cause of macrocytic anaemia?
Where is intrinsic factor (IF) secreted during the absorption of vitamin B12?
Where is intrinsic factor (IF) secreted during the absorption of vitamin B12?
Which is NOT a component of the intrinsic tenase complex?
Which is NOT a component of the intrinsic tenase complex?
How does vitamin B12 contribute to DNA synthesis?
How does vitamin B12 contribute to DNA synthesis?
What is a characteristic feature of megaloblastic anaemia observed in the bone marrow?
What is a characteristic feature of megaloblastic anaemia observed in the bone marrow?
Why is a short-term deficiency of vitamin B12 typically not problematic for the body?
Why is a short-term deficiency of vitamin B12 typically not problematic for the body?
What does an increase in serum methylmalonic acid (MMA) indicate?
What does an increase in serum methylmalonic acid (MMA) indicate?
Which step follows confirming low serum B12 levels in the investigation of macrocytic anemia?
Which step follows confirming low serum B12 levels in the investigation of macrocytic anemia?
What role does FXIIIa play in preventing the degradation of clots?
What role does FXIIIa play in preventing the degradation of clots?
What is the percentage of young adult vegans reported to have subnormal vitamin B12 levels?
What is the percentage of young adult vegans reported to have subnormal vitamin B12 levels?
What is a likely cause of B12 deficiency associated with intrinsic factor?
What is a likely cause of B12 deficiency associated with intrinsic factor?
Which test is considered the gold standard for assessing B12 absorption?
Which test is considered the gold standard for assessing B12 absorption?
What indicates a deficiency in intrinsic factor during the Schilling test?
What indicates a deficiency in intrinsic factor during the Schilling test?
What does the presence of radiolabelled B12 in urine after administering antibiotics indicate?
What does the presence of radiolabelled B12 in urine after administering antibiotics indicate?
What is a primary dietary recommendation to treat B12 deficiency?
What is a primary dietary recommendation to treat B12 deficiency?
Which is a common cause of folate deficiency?
Which is a common cause of folate deficiency?
What is the primary mechanism leading to the reduction in RBC formation in anemia?
What is the primary mechanism leading to the reduction in RBC formation in anemia?
Why is folic acid often prescribed along with B12 treatment?
Why is folic acid often prescribed along with B12 treatment?
How is iron primarily supplied for new red blood cell synthesis?
How is iron primarily supplied for new red blood cell synthesis?
What is an indication of significant B12 deficiency in terms of MMA and homocysteine levels?
What is an indication of significant B12 deficiency in terms of MMA and homocysteine levels?
What is the primary role of transferrin in the body?
What is the primary role of transferrin in the body?
How is dietary non-haem iron typically found before absorption?
How is dietary non-haem iron typically found before absorption?
What happens to ferric iron (Fe³⁺) in the enterocytes after absorption?
What happens to ferric iron (Fe³⁺) in the enterocytes after absorption?
What is haemosiderin primarily composed of?
What is haemosiderin primarily composed of?
What role does hepcidin play in iron metabolism?
What role does hepcidin play in iron metabolism?
What characterizes red blood cells in iron deficiency anaemia?
What characterizes red blood cells in iron deficiency anaemia?
Which factor influences hepcidin synthesis?
Which factor influences hepcidin synthesis?
What does total iron-binding capacity (TIBC) measure?
What does total iron-binding capacity (TIBC) measure?
What would a transferrin saturation of less than 20% indicate?
What would a transferrin saturation of less than 20% indicate?
Which method is used to measure serum ferritin?
Which method is used to measure serum ferritin?
What is zinc protoporphyrin (ZPP)?
What is zinc protoporphyrin (ZPP)?
What is the recommended oral iron treatment for iron deficiency anaemia (IDA)?
What is the recommended oral iron treatment for iron deficiency anaemia (IDA)?
What is the primary function of the Perls stain in medical diagnostics?
What is the primary function of the Perls stain in medical diagnostics?
How is serum iron typically measured?
How is serum iron typically measured?
What is the primary role of tissue factor in the coagulation cascade?
What is the primary role of tissue factor in the coagulation cascade?
How does thromboxane A2 contribute to the process of haemostasis?
How does thromboxane A2 contribute to the process of haemostasis?
What is the main function of protein S in the anticoagulation pathway?
What is the main function of protein S in the anticoagulation pathway?
Why is secondary haemostasis important?
Why is secondary haemostasis important?
Which component is primarily responsible for the transitional step from primary to secondary haemostasis?
Which component is primarily responsible for the transitional step from primary to secondary haemostasis?
What activates platelets during the process of adhesion following vessel injury?
What activates platelets during the process of adhesion following vessel injury?
What is the primary mechanism by which vWF protects factor VIII (FVIII)?
What is the primary mechanism by which vWF protects factor VIII (FVIII)?
What role does ADAMTS13 play in the regulation of von Willebrand factor (vWF)?
What role does ADAMTS13 play in the regulation of von Willebrand factor (vWF)?
What triggers the process of fibrinolysis?
What triggers the process of fibrinolysis?
Which of the following factors is critical for localized activation during the coagulation process?
Which of the following factors is critical for localized activation during the coagulation process?
During which phase of the coagulation cascade does the intrinsic pathway operate?
During which phase of the coagulation cascade does the intrinsic pathway operate?
How is nitric oxide involved in the regulation of haemostasis?
How is nitric oxide involved in the regulation of haemostasis?
What do chief cells in the stomach primarily secrete?
What do chief cells in the stomach primarily secrete?
What binds vitamin B12 after it is freed from dietary proteins?
What binds vitamin B12 after it is freed from dietary proteins?
Where are vitamin B12-IF complexes absorbed in the digestive tract?
Where are vitamin B12-IF complexes absorbed in the digestive tract?
What role does intrinsic factor (IF) play in the absorption of vitamin B12?
What role does intrinsic factor (IF) play in the absorption of vitamin B12?
What is the consequence of a lack of intrinsic factor in vitamin B12 absorption?
What is the consequence of a lack of intrinsic factor in vitamin B12 absorption?
How does folate deficiency develop more rapidly than vitamin B12 deficiency?
How does folate deficiency develop more rapidly than vitamin B12 deficiency?
What is a hallmark feature of megaloblastic anaemia in neutrophils?
What is a hallmark feature of megaloblastic anaemia in neutrophils?
What role does transcobalamin play in the body after vitamin B12 absorption?
What role does transcobalamin play in the body after vitamin B12 absorption?
What happens to homocysteine levels in the presence of both vitamin B12 and folate deficiency?
What happens to homocysteine levels in the presence of both vitamin B12 and folate deficiency?
What happens to vitamin B12 after it is absorbed in the terminal ileum?
What happens to vitamin B12 after it is absorbed in the terminal ileum?
Why does megaloblastic anaemia occur despite normal intake of vitamin B12?
Why does megaloblastic anaemia occur despite normal intake of vitamin B12?
What is the primary role of methionine synthetase in folate metabolism?
What is the primary role of methionine synthetase in folate metabolism?
How does low red cell folate reflect folate status in the body?
How does low red cell folate reflect folate status in the body?
What is a potential risk associated with parenteral iron treatment?
What is a potential risk associated with parenteral iron treatment?
What does a dimorphic blood film during IDA treatment indicate?
What does a dimorphic blood film during IDA treatment indicate?
When are blood transfusions considered for IDA patients?
When are blood transfusions considered for IDA patients?
Which of the following tests is NOT used for secondary haemostatic testing?
Which of the following tests is NOT used for secondary haemostatic testing?
What is a primary indicator that APTT is prolonged?
What is a primary indicator that APTT is prolonged?
What can occur if poor venepuncture technique is used during sample collection for coagulation tests?
What can occur if poor venepuncture technique is used during sample collection for coagulation tests?
What is the purpose of the Clauss fibrinogen test?
What is the purpose of the Clauss fibrinogen test?
How does sodium citrate act as an anticoagulant during sample collection?
How does sodium citrate act as an anticoagulant during sample collection?
When is thrombin time (TT) typically prolonged?
When is thrombin time (TT) typically prolonged?
What is the main purpose of using platelet function assays?
What is the main purpose of using platelet function assays?
What does it indicate if a mixing study does not correct APTT?
What does it indicate if a mixing study does not correct APTT?
What is measured during a D-dimer test?
What is measured during a D-dimer test?
What does an INR greater than 5.0 typically indicate?
What does an INR greater than 5.0 typically indicate?
Which of the following factors is NOT evaluated by prothrombin time (PT)?
Which of the following factors is NOT evaluated by prothrombin time (PT)?
What does a prolonged APTT and PT suggest?
What does a prolonged APTT and PT suggest?
What is the key limitation of bleeding time tests?
What is the key limitation of bleeding time tests?
What is the correct order of draw for coagulation samples?
What is the correct order of draw for coagulation samples?
What is a characteristic finding in Bernard-Soulier Syndrome regarding platelet count?
What is a characteristic finding in Bernard-Soulier Syndrome regarding platelet count?
What does a 1:10 dilution represent in the Clauss fibrinogen test?
What does a 1:10 dilution represent in the Clauss fibrinogen test?
What does the prothrombin time (PT) test NOT assess?
What does the prothrombin time (PT) test NOT assess?
What conditions can lead to elevated D-dimer levels?
What conditions can lead to elevated D-dimer levels?
What happens to iron stores in patients undergoing effective treatment for iron deficiency anemia?
What happens to iron stores in patients undergoing effective treatment for iron deficiency anemia?
What does a normal thrombin time indicate?
What does a normal thrombin time indicate?
In factor assays, which factors are assessed in the intrinsic pathway?
In factor assays, which factors are assessed in the intrinsic pathway?
What is a common use of mixing studies?
What is a common use of mixing studies?
What may a prolonged bleeding time suggest?
What may a prolonged bleeding time suggest?
How do inhibitors in coagulation affect clotting times?
How do inhibitors in coagulation affect clotting times?
Which of the following statements accurately describes the Bethesda Unit (BU)?
Which of the following statements accurately describes the Bethesda Unit (BU)?
What is the main reason for post-translational modification of vitamin K-dependent proteins?
What is the main reason for post-translational modification of vitamin K-dependent proteins?
Which method is commonly used to measure the level of von Willebrand factor antigen?
Which method is commonly used to measure the level of von Willebrand factor antigen?
What is the primary function of Ristocetin in the vWF:RCo assay?
What is the primary function of Ristocetin in the vWF:RCo assay?
Which condition is NOT associated with vitamin K deficiency?
Which condition is NOT associated with vitamin K deficiency?
What characterizes secondary haemostatic defects compared to primary defects?
What characterizes secondary haemostatic defects compared to primary defects?
What commonly causes a vitamin K deficiency in newborns?
What commonly causes a vitamin K deficiency in newborns?
What happens to vitamin K-dependent factors in the case of vitamin K deficiency?
What happens to vitamin K-dependent factors in the case of vitamin K deficiency?
Which of the following is a common symptom of bleeding disorders?
Which of the following is a common symptom of bleeding disorders?
In which scenario is a factor assay result not interpretable?
In which scenario is a factor assay result not interpretable?
Which of the following describes how latex immunoassays for vWF antigen work?
Which of the following describes how latex immunoassays for vWF antigen work?
What are known as time-dependent inhibitors?
What are known as time-dependent inhibitors?
What causes a decreased platelet count in liver disease?
What causes a decreased platelet count in liver disease?
What does consumptive coagulation lead to?
What does consumptive coagulation lead to?
What is the definition of massive hemorrhage?
What is the definition of massive hemorrhage?
Which blood components are lost during a massive hemorrhage?
Which blood components are lost during a massive hemorrhage?
When are platelet transfusions typically indicated?
When are platelet transfusions typically indicated?
What is the typical dosage for Fresh Frozen Plasma (FFP)?
What is the typical dosage for Fresh Frozen Plasma (FFP)?
What is the function of thrombin in DIC?
What is the function of thrombin in DIC?
What are the possible causes of Disseminated Intravascular Coagulation (DIC)?
What are the possible causes of Disseminated Intravascular Coagulation (DIC)?
What is the role of the F8 gene?
What is the role of the F8 gene?
Which of the following does not typically characterize the consequences of DIC?
Which of the following does not typically characterize the consequences of DIC?
What is a major risk of untreated DIC?
What is a major risk of untreated DIC?
What typically characterizes von Willebrand Disease (vWD)?
What typically characterizes von Willebrand Disease (vWD)?
Which factor primarily regulates erythropoiesis?
Which factor primarily regulates erythropoiesis?
What is the role of von Willebrand factor (vWF) in relation to Factor VIII?
What is the role of von Willebrand factor (vWF) in relation to Factor VIII?
What is a symptom commonly associated with platelet disorders?
What is a symptom commonly associated with platelet disorders?
How is a major component of thrombopoiesis regulated?
How is a major component of thrombopoiesis regulated?
What is a main cause of symptoms in individuals with Turner syndrome that can lead to hemophilia?
What is a main cause of symptoms in individuals with Turner syndrome that can lead to hemophilia?
Which factor affects the severity of bleeding in thrombocytopenia?
Which factor affects the severity of bleeding in thrombocytopenia?
What are the three distinct types of von Willebrand Disease?
What are the three distinct types of von Willebrand Disease?
What is one of the benefits of prophylaxis over on-demand treatment for hemophilia?
What is one of the benefits of prophylaxis over on-demand treatment for hemophilia?
What is the first stage of erythropoiesis?
What is the first stage of erythropoiesis?
What treatment is used to increase levels of vWF and FVIII in patients with vWD?
What treatment is used to increase levels of vWF and FVIII in patients with vWD?
What is one of the risks associated with prophylaxis in hemophilia treatment?
What is one of the risks associated with prophylaxis in hemophilia treatment?
What triggers extramedullary haemopoiesis to occur?
What triggers extramedullary haemopoiesis to occur?
What does M-CSF primarily regulate?
What does M-CSF primarily regulate?
Which of the following cytokines stimulates the production of neutrophils?
Which of the following cytokines stimulates the production of neutrophils?
Which condition is characterized by a failure of the bone marrow to produce sufficient blood cells?
Which condition is characterized by a failure of the bone marrow to produce sufficient blood cells?
During erythropoiesis, what is the primary role of reticulocytes?
During erythropoiesis, what is the primary role of reticulocytes?
What is the function of proplatelets in thrombopoiesis?
What is the function of proplatelets in thrombopoiesis?
What is polycythaemia vera primarily characterized by?
What is polycythaemia vera primarily characterized by?
What role do adhesion molecules play in haemopoiesis?
What role do adhesion molecules play in haemopoiesis?
What cytokine is primarily responsible for promoting B-cell development?
What cytokine is primarily responsible for promoting B-cell development?
What is an autologous bone marrow transplant?
What is an autologous bone marrow transplant?
What do monocytes differentiate into during monocytopoiesis?
What do monocytes differentiate into during monocytopoiesis?
What is a common treatment used to manage neutropenia?
What is a common treatment used to manage neutropenia?
What is the primary source of thrombopoietin (TPO) production?
What is the primary source of thrombopoietin (TPO) production?
What is the role of platelets during primary haemostasis?
What is the role of platelets during primary haemostasis?
Which function is primarily associated with the media layer of the blood vessel wall?
Which function is primarily associated with the media layer of the blood vessel wall?
How does fibrinolysis contribute to maintaining blood vessel health?
How does fibrinolysis contribute to maintaining blood vessel health?
What is the significance of von Willebrand factor (vWF) in the haemostatic process?
What is the significance of von Willebrand factor (vWF) in the haemostatic process?
What occurs during secondary haemostasis?
What occurs during secondary haemostasis?
Which layer of the blood vessel wall provides protection and structural support?
Which layer of the blood vessel wall provides protection and structural support?
Why is fluidity maintenance of blood essential in normal bodily functions?
Why is fluidity maintenance of blood essential in normal bodily functions?
What is the main function of the intima layer in blood vessels?
What is the main function of the intima layer in blood vessels?
What do chief cells in the stomach secrete?
What do chief cells in the stomach secrete?
What is the consequence of a deficiency in intrinsic factor (IF) related to vitamin B12?
What is the consequence of a deficiency in intrinsic factor (IF) related to vitamin B12?
How is free vitamin B12 transported in the body after absorption?
How is free vitamin B12 transported in the body after absorption?
What is the primary role of R-protein in vitamin B12 absorption?
What is the primary role of R-protein in vitamin B12 absorption?
Where does the B12-intrinsic factor (IF) complex get absorbed?
Where does the B12-intrinsic factor (IF) complex get absorbed?
Why do patients with megaloblastic anemia often have increased serum unconjugated bilirubin?
Why do patients with megaloblastic anemia often have increased serum unconjugated bilirubin?
What is the primary function of thrombomodulin in the anticoagulation process?
What is the primary function of thrombomodulin in the anticoagulation process?
What is the primary form in which non-haem dietary iron is found?
What is the primary form in which non-haem dietary iron is found?
What is the main effect of endothelial cells during procoagulation?
What is the main effect of endothelial cells during procoagulation?
What is the effect of vitamin B12 deficiency on red blood cell production?
What is the effect of vitamin B12 deficiency on red blood cell production?
What type of cells in the bone marrow are affected by deficiencies in vitamin B12 and folate?
What type of cells in the bone marrow are affected by deficiencies in vitamin B12 and folate?
What initiates the process of secondary haemostasis in the coagulation cascade?
What initiates the process of secondary haemostasis in the coagulation cascade?
What is the role of hepcidin in iron metabolism?
What is the role of hepcidin in iron metabolism?
What is the typical serum ferritin level in iron deficiency anaemia (IDA)?
What is the typical serum ferritin level in iron deficiency anaemia (IDA)?
Which of the following statements about folate absorption is accurate?
Which of the following statements about folate absorption is accurate?
How does protein S enhance the function of protein C in anticoagulation?
How does protein S enhance the function of protein C in anticoagulation?
What is the main outcome of primary haemostasis?
What is the main outcome of primary haemostasis?
What factor would NOT lead to iron overload?
What factor would NOT lead to iron overload?
What occurs to serum homocysteine levels in the case of both vitamin B12 and folate deficiencies?
What occurs to serum homocysteine levels in the case of both vitamin B12 and folate deficiencies?
What occurs to zinc protoporphyrin levels in iron deficiency?
What occurs to zinc protoporphyrin levels in iron deficiency?
What role does tissue plasminogen play in the regulation of coagulation?
What role does tissue plasminogen play in the regulation of coagulation?
How do thromboxane A2 and platelet-activating factor (PAF) enhance the coagulation process?
How do thromboxane A2 and platelet-activating factor (PAF) enhance the coagulation process?
What is a hallmark finding in the blood associated with megaloblastic anemia?
What is a hallmark finding in the blood associated with megaloblastic anemia?
How is TIBC (total iron-binding capacity) typically affected in iron deficiency anaemia?
How is TIBC (total iron-binding capacity) typically affected in iron deficiency anaemia?
What is the main role of transcobalamin in relation to vitamin B12?
What is the main role of transcobalamin in relation to vitamin B12?
What is a significant characteristic of von Willebrand factor (vWF) in relation to factor VIII?
What is a significant characteristic of von Willebrand factor (vWF) in relation to factor VIII?
What is the primary function of the Perls stain?
What is the primary function of the Perls stain?
What happens to vitamin B12 once it binds to intrinsic factor?
What happens to vitamin B12 once it binds to intrinsic factor?
What is the main physiological function of prostacyclin in the context of haemostasis?
What is the main physiological function of prostacyclin in the context of haemostasis?
What is not a characteristic feature of iron deficiency anaemia (IDA)?
What is not a characteristic feature of iron deficiency anaemia (IDA)?
What mechanism inhibits fibrinolysis during procoagulation?
What mechanism inhibits fibrinolysis during procoagulation?
In what form is haem iron transported into the enterocyte?
In what form is haem iron transported into the enterocyte?
What happens to iron stored in haemosiderin?
What happens to iron stored in haemosiderin?
What is the primary indication of normal levels of both methylmalonic acid and homocysteine?
What is the primary indication of normal levels of both methylmalonic acid and homocysteine?
What is the key role of fibrin in the coagulation process?
What is the key role of fibrin in the coagulation process?
What does the intrinsic pathway of coagulation primarily rely on?
What does the intrinsic pathway of coagulation primarily rely on?
Which of the following is NOT a characteristic step in investigating macrocytic anaemia?
Which of the following is NOT a characteristic step in investigating macrocytic anaemia?
What is a common cause of iron deficiency?
What is a common cause of iron deficiency?
What is the gold standard test for assessing B12 absorption versus dietary intake?
What is the gold standard test for assessing B12 absorption versus dietary intake?
Which of the following statements is true regarding ferritin?
Which of the following statements is true regarding ferritin?
What is the primary means through which the body loses iron?
What is the primary means through which the body loses iron?
How does increased blood flow affect platelet rolling during vessel injury?
How does increased blood flow affect platelet rolling during vessel injury?
What does the administration of intrinsic factor (IF) in Step 2 of the Schilling test help determine?
What does the administration of intrinsic factor (IF) in Step 2 of the Schilling test help determine?
What happens to transferrin saturation levels in iron deficiency?
What happens to transferrin saturation levels in iron deficiency?
What would the presence of radiolabelled B12 in the urine after Step 3 of the Schilling test indicate?
What would the presence of radiolabelled B12 in the urine after Step 3 of the Schilling test indicate?
In which condition is pancreatic enzyme insufficiency likely to affect B12 absorption?
In which condition is pancreatic enzyme insufficiency likely to affect B12 absorption?
What could be a cause of folate deficiency?
What could be a cause of folate deficiency?
Why is folic acid often administered alongside B12 treatment?
Why is folic acid often administered alongside B12 treatment?
What mechanism primarily supplies iron for new red blood cell synthesis?
What mechanism primarily supplies iron for new red blood cell synthesis?
What is the main outcome of the activation of factor X (FX) in the coagulation cascade?
What is the main outcome of the activation of factor X (FX) in the coagulation cascade?
What factor is associated with both B12 and folate absorption issues?
What factor is associated with both B12 and folate absorption issues?
What defines anaemia according to WHO standards in non-pregnant women over 15 years?
What defines anaemia according to WHO standards in non-pregnant women over 15 years?
What initiates the amplification phase of coagulation?
What initiates the amplification phase of coagulation?
Which complex is primarily responsible for converting prothrombin to thrombin?
Which complex is primarily responsible for converting prothrombin to thrombin?
What are the two primary mechanisms that result in anaemia?
What are the two primary mechanisms that result in anaemia?
What role does tissue factor pathway inhibitor (TFPI) play in coagulation?
What role does tissue factor pathway inhibitor (TFPI) play in coagulation?
What is the primary consequence of FXIIIa's action on fibrin?
What is the primary consequence of FXIIIa's action on fibrin?
What treatment options are available for patients who are intolerant or unresponsive to oral iron?
What treatment options are available for patients who are intolerant or unresponsive to oral iron?
How does factor IXa (FIXa) function within the coagulation cascade?
How does factor IXa (FIXa) function within the coagulation cascade?
What is the role of vitamin K in the coagulation process?
What is the role of vitamin K in the coagulation process?
What potential risks are associated with parenteral iron treatment?
What potential risks are associated with parenteral iron treatment?
When is a blood transfusion considered for patients with iron deficiency anemia (IDA)?
When is a blood transfusion considered for patients with iron deficiency anemia (IDA)?
Which of the following is NOT a key role of thrombin in the coagulation cascade?
Which of the following is NOT a key role of thrombin in the coagulation cascade?
What signifies that a patient is responding to IDA treatment?
What signifies that a patient is responding to IDA treatment?
What is the significance of the intrinsic tenase complex?
What is the significance of the intrinsic tenase complex?
Where is antithrombin primarily produced?
Where is antithrombin primarily produced?
What happens during the propagation phase of coagulation?
What happens during the propagation phase of coagulation?
What are the common tests used in secondary haemostatic testing?
What are the common tests used in secondary haemostatic testing?
Which anticoagulant is used in the collection of coagulation samples?
Which anticoagulant is used in the collection of coagulation samples?
What is the mechanism by which protein C acts to reduce coagulation?
What is the mechanism by which protein C acts to reduce coagulation?
How does sodium citrate act as an anticoagulant?
How does sodium citrate act as an anticoagulant?
How long can the body store vitamin B12 without dietary intake?
How long can the body store vitamin B12 without dietary intake?
What is the purpose of performing mixing studies in prolonged clotting time investigations?
What is the purpose of performing mixing studies in prolonged clotting time investigations?
What type of anaemia is primarily characterized by larger than normal red blood cells?
What type of anaemia is primarily characterized by larger than normal red blood cells?
What does the prothrombin time (PT) evaluate in the coagulation cascade?
What does the prothrombin time (PT) evaluate in the coagulation cascade?
Which of the following conditions can lead to megaloblastic anaemia?
Which of the following conditions can lead to megaloblastic anaemia?
Which of the following conditions can affect prothrombin time (PT)?
Which of the following conditions can affect prothrombin time (PT)?
What does an INR greater than 5.0 indicate regarding patient safety?
What does an INR greater than 5.0 indicate regarding patient safety?
How should platelet function assay samples be stored prior to testing?
How should platelet function assay samples be stored prior to testing?
What aspect of coagulation do optical coagulation analysers primarily measure?
What aspect of coagulation do optical coagulation analysers primarily measure?
What does a prolonged APTT indicate?
What does a prolonged APTT indicate?
In which scenario might PT and APTT both be prolonged?
In which scenario might PT and APTT both be prolonged?
What parameter does the Clauss fibrinogen test primarily measure?
What parameter does the Clauss fibrinogen test primarily measure?
Which of the following conditions can lead to a prolonged APTT?
Which of the following conditions can lead to a prolonged APTT?
When is a D-dimer test most commonly utilized?
When is a D-dimer test most commonly utilized?
What would a normal thrombin time (TT) suggest?
What would a normal thrombin time (TT) suggest?
What does a mixing study that does not correct APTT indicate?
What does a mixing study that does not correct APTT indicate?
Which factors are particularly sensitive to APTT testing?
Which factors are particularly sensitive to APTT testing?
Why is the thrombin time rarely performed in modern labs?
Why is the thrombin time rarely performed in modern labs?
What does a normal bleeding time indicate?
What does a normal bleeding time indicate?
What is the purpose of a factor assay?
What is the purpose of a factor assay?
What can elevated D-dimer levels indicate?
What can elevated D-dimer levels indicate?
At what factor level can PT and APTT detect deficiencies?
At what factor level can PT and APTT detect deficiencies?
Which therapy is most likely to cause prolonged thrombin time?
Which therapy is most likely to cause prolonged thrombin time?
How does the presence of inhibitors affect the function of specific clotting factors?
How does the presence of inhibitors affect the function of specific clotting factors?
What is the primary purpose of the Bethesda Assay?
What is the primary purpose of the Bethesda Assay?
What do latex immunoassays (LIA) rely on for the detection of vWF antigen?
What do latex immunoassays (LIA) rely on for the detection of vWF antigen?
What is a common symptom of primary haemostatic defects?
What is a common symptom of primary haemostatic defects?
Which of the following conditions is an example of an inherited bleeding disorder?
Which of the following conditions is an example of an inherited bleeding disorder?
What condition can lead to the development of inhibitors in patients?
What condition can lead to the development of inhibitors in patients?
Which vitamin K-dependent factor is involved in inhibiting coagulation?
Which vitamin K-dependent factor is involved in inhibiting coagulation?
What does the Ristocetin Cofactor assay specifically measure?
What does the Ristocetin Cofactor assay specifically measure?
What happens to vitamin K-dependent factors during vitamin K deficiency?
What happens to vitamin K-dependent factors during vitamin K deficiency?
What is often observed in patients with secondary haemostatic defects?
What is often observed in patients with secondary haemostatic defects?
What effect does gamma-carboxylation have on vitamin K-dependent proteins?
What effect does gamma-carboxylation have on vitamin K-dependent proteins?
What treatment is given to newborns for vitamin K deficiency?
What treatment is given to newborns for vitamin K deficiency?
What is a potential cause of vitamin K deficiency?
What is a potential cause of vitamin K deficiency?
What is the primary cause of decreased platelet count in liver disease?
What is the primary cause of decreased platelet count in liver disease?
During massive hemorrhage, what component is NOT typically lost?
During massive hemorrhage, what component is NOT typically lost?
What defines consumptive coagulation?
What defines consumptive coagulation?
What is the storage duration for thawed Fresh Frozen Plasma (FFP)?
What is the storage duration for thawed Fresh Frozen Plasma (FFP)?
Which of the following is a consequence of Disseminated Intravascular Coagulation (DIC)?
Which of the following is a consequence of Disseminated Intravascular Coagulation (DIC)?
What is a common trigger for the development of inhibitors in coagulation disorders?
What is a common trigger for the development of inhibitors in coagulation disorders?
Which clotting factor is deficient in Hemophilia B?
Which clotting factor is deficient in Hemophilia B?
Octaplas differs from standard Fresh Frozen Plasma in that it has decreased levels of which protein?
Octaplas differs from standard Fresh Frozen Plasma in that it has decreased levels of which protein?
What is the effect on fibrinogen levels following one adult therapeutic dose of cryoprecipitate?
What is the effect on fibrinogen levels following one adult therapeutic dose of cryoprecipitate?
Which of the following factors is part of the cryoprecipitate?
Which of the following factors is part of the cryoprecipitate?
In terms of blood type compatibility, which of these is crucial for platelet transfusions?
In terms of blood type compatibility, which of these is crucial for platelet transfusions?
Which enzyme is involved in breaking down fibrin during DIC?
Which enzyme is involved in breaking down fibrin during DIC?
What is the treatment strategy for managing DIC?
What is the treatment strategy for managing DIC?
Which gene is located on the telomeric end of the X chromosome and associated with Hemophilia A?
Which gene is located on the telomeric end of the X chromosome and associated with Hemophilia A?
What is the most common inheritance pattern of von Willebrand Disease (vWD)?
What is the most common inheritance pattern of von Willebrand Disease (vWD)?
What is one of the main risk factors associated with prophylactic treatment for haemophilia?
What is one of the main risk factors associated with prophylactic treatment for haemophilia?
Which stage follows the proerythroblast in the process of erythropoiesis?
Which stage follows the proerythroblast in the process of erythropoiesis?
Which factor is essential for the differentiation of proerythroblasts into mature red blood cells?
Which factor is essential for the differentiation of proerythroblasts into mature red blood cells?
What is a common symptom of von Willebrand Disease?
What is a common symptom of von Willebrand Disease?
What regulates thrombopoiesis in the body?
What regulates thrombopoiesis in the body?
What causes quantitative platelet disorders?
What causes quantitative platelet disorders?
Which type of von Willebrand Disease is characterized by total vWF deficiency?
Which type of von Willebrand Disease is characterized by total vWF deficiency?
What is the role of von Willebrand factor in relation to Factor VIII?
What is the role of von Willebrand factor in relation to Factor VIII?
What growth factor stimulates granulopoiesis?
What growth factor stimulates granulopoiesis?
What is one potential benefit of using plasma-derived clotting factors for haemophilia treatment?
What is one potential benefit of using plasma-derived clotting factors for haemophilia treatment?
What cellular process describes the development of platelets from megakaryocytes?
What cellular process describes the development of platelets from megakaryocytes?
What is the role of erythropoietin (EPO) in haemopoiesis?
What is the role of erythropoietin (EPO) in haemopoiesis?
What triggers the occurrence of extramedullary haemopoiesis?
What triggers the occurrence of extramedullary haemopoiesis?
Which cytokine is primarily responsible for stimulating platelet production?
Which cytokine is primarily responsible for stimulating platelet production?
What is myelofibrosis?
What is myelofibrosis?
What cells differentiate from the myeloid lineage?
What cells differentiate from the myeloid lineage?
What does the presence of reticulocytes in circulation indicate?
What does the presence of reticulocytes in circulation indicate?
Which condition is characterized by the failure of bone marrow to produce sufficient blood cells?
Which condition is characterized by the failure of bone marrow to produce sufficient blood cells?
What are the two types of bone marrow transplants?
What are the two types of bone marrow transplants?
What stimulates the production of monocytopoiesis?
What stimulates the production of monocytopoiesis?
What is a common symptom of polycythaemia vera?
What is a common symptom of polycythaemia vera?
What effect does hypoxia have on erythropoietin (EPO) production?
What effect does hypoxia have on erythropoietin (EPO) production?
What is the primary function of granulocyte-colony stimulating factor (G-CSF)?
What is the primary function of granulocyte-colony stimulating factor (G-CSF)?
Which condition is commonly treated with erythropoietin injections?
Which condition is commonly treated with erythropoietin injections?
What is the most common stain used for blood films preparation in the UK?
What is the most common stain used for blood films preparation in the UK?
What might occur if a blood smear is prepared too thick?
What might occur if a blood smear is prepared too thick?
What is hypochromia in red blood cells indicative of?
What is hypochromia in red blood cells indicative of?
What is the normal myeloid-to-erythroid ratio in bone marrow?
What is the normal myeloid-to-erythroid ratio in bone marrow?
What is the primary purpose of fixing a blood smear in methanol before staining?
What is the primary purpose of fixing a blood smear in methanol before staining?
What happens to red blood cells when a smear is too thin?
What happens to red blood cells when a smear is too thin?
What is the typical fixation time for bone marrow slides in methanol?
What is the typical fixation time for bone marrow slides in methanol?
Which white blood cell types can be identified on a stained smear?
Which white blood cell types can be identified on a stained smear?
What is the normal range for metamyelocytes?
What is the normal range for metamyelocytes?
What is the primary purpose of a bone marrow aspirate?
What is the primary purpose of a bone marrow aspirate?
What microscopy technique is utilized for examining bone marrow aspirates?
What microscopy technique is utilized for examining bone marrow aspirates?
What fixative is used for trephine biopsies?
What fixative is used for trephine biopsies?
What is indicated by the presence of tear-drop cells on a blood smear?
What is indicated by the presence of tear-drop cells on a blood smear?
Which staining technique is used to assess iron stores in the bone marrow?
Which staining technique is used to assess iron stores in the bone marrow?
What does a positive Perls’ stain reveal?
What does a positive Perls’ stain reveal?
What blood cell findings are typically associated with iron deficiency anaemia?
What blood cell findings are typically associated with iron deficiency anaemia?
What indicates increased reticulin fibers in the bone marrow?
What indicates increased reticulin fibers in the bone marrow?
Which condition is characterized by markedly hypocellular marrow and increased fat content?
Which condition is characterized by markedly hypocellular marrow and increased fat content?
What color does PAS-positive material appear when stained?
What color does PAS-positive material appear when stained?
What is the normal cellularity range of bone marrow in adults?
What is the normal cellularity range of bone marrow in adults?
What is typically observed in acute leukaemia on a bone marrow smear?
What is typically observed in acute leukaemia on a bone marrow smear?
What is the most critical step in the preparation of a blood film?
What is the most critical step in the preparation of a blood film?
What is the optimal duration for fixing a bone marrow slide in methanol?
What is the optimal duration for fixing a bone marrow slide in methanol?
Which staining procedure is followed immediately after fixing in methanol in blood smear preparation?
Which staining procedure is followed immediately after fixing in methanol in blood smear preparation?
What does anisocytosis refer to in red blood cells?
What does anisocytosis refer to in red blood cells?
What would be the appearance of red blood cells if a blood smear is too thin?
What would be the appearance of red blood cells if a blood smear is too thin?
Which stage of a blood smear's preparation is performed after the slide is air dried?
Which stage of a blood smear's preparation is performed after the slide is air dried?
Which staining method is NOT used for trephine biopsies?
Which staining method is NOT used for trephine biopsies?
What does a positive Perls’ Prussian Blue stain indicate?
What does a positive Perls’ Prussian Blue stain indicate?
What is the typical finding in acute leukaemia on a bone marrow smear?
What is the typical finding in acute leukaemia on a bone marrow smear?
What role does the May-Grunwald Giemsa (MGG) stain serve?
What role does the May-Grunwald Giemsa (MGG) stain serve?
What are typical red cell findings in iron deficiency anaemia?
What are typical red cell findings in iron deficiency anaemia?
What is the hallmark finding in myelofibrosis?
What is the hallmark finding in myelofibrosis?
What is the significance of hypocellular bone marrow?
What is the significance of hypocellular bone marrow?
What does reticulin staining help assess?
What does reticulin staining help assess?
What are common findings in myelodysplastic syndrome (MDS)?
What are common findings in myelodysplastic syndrome (MDS)?
What is the range of normal cellularity in adult bone marrow?
What is the range of normal cellularity in adult bone marrow?
What is the role of iron stain (Perls’ reaction) in bone marrow examination?
What is the role of iron stain (Perls’ reaction) in bone marrow examination?
Flashcards
Haemostasis purpose
Haemostasis purpose
Preventing and controlling bleeding while keeping blood flowing normally.
Primary haemostasis
Primary haemostasis
Initial stage of clotting involving platelets and vessels to form a temporary plug.
Secondary haemostasis
Secondary haemostasis
Later clotting stage using clotting factors to make a stronger fibrin clot.
Fibrinolysis
Fibrinolysis
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Blood Vessel Layers
Blood Vessel Layers
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Intima layer function
Intima layer function
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Media layer function
Media layer function
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Adventitia layer function
Adventitia layer function
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Von Willebrand Factor (vWF)
Von Willebrand Factor (vWF)
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Platelet Adhesion
Platelet Adhesion
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Platelet Activation
Platelet Activation
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Platelet Plug
Platelet Plug
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Coagulation Cascade
Coagulation Cascade
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Intrinsic Pathway
Intrinsic Pathway
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Extrinsic Pathway
Extrinsic Pathway
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Coagulation Factors
Coagulation Factors
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Thrombin
Thrombin
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Fibrin
Fibrin
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Platelet Rolling
Platelet Rolling
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GPIb
GPIb
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Common pathway in coagulation
Common pathway in coagulation
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Extrinsic pathway initiation
Extrinsic pathway initiation
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TF-FVIIa complex activation
TF-FVIIa complex activation
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FXa's function
FXa's function
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Extrinsic prothrombinase
Extrinsic prothrombinase
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Thrombin's role: Fibrinogen to Fibrin
Thrombin's role: Fibrinogen to Fibrin
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FXIIIa's role
FXIIIa's role
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Vitamin B12 Source
Vitamin B12 Source
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Vitamin B12 Storage
Vitamin B12 Storage
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Megaloblastic Anemia Cause
Megaloblastic Anemia Cause
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Intrinsic Factor (IF) Role
Intrinsic Factor (IF) Role
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R-protein role
R-protein role
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Antithrombin Role
Antithrombin Role
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Protein C activation
Protein C activation
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Protein C function
Protein C function
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Tissue Factor Pathway Inhibitor (TFPI)
Tissue Factor Pathway Inhibitor (TFPI)
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Chief cells secretion
Chief cells secretion
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Pepsin's role in B12
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Free B12 binding in stomach
Free B12 binding in stomach
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B12, R-protein, IF destination
B12, R-protein, IF destination
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Pancreatic enzymes and B12
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B12 after R-protein digestion
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Intrinsic factor (IF) purpose
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B12-IF complex absorption
B12-IF complex absorption
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Folate synthesis
Folate synthesis
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Folate absorption site
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Folate storage
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Macrocytosis
Macrocytosis
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Hypersegmented neutrophils
Hypersegmented neutrophils
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B12 deficiency and folate levels
B12 deficiency and folate levels
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Low red cell folate
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Transferrin's role
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Iron storage location
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Iron loss mechanisms
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Iron excretion regulation
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Iron absorption site
Iron absorption site
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Iron membrane transport
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Dietary iron form
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Fe³⁺ to Fe²⁺ conversion
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Haemosiderin location
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Haemosiderin composition
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Hepcidin's role
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Hepcidin's action
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IDA peripheral blood film
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Serum ferritin in IDA
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Oral IDA treatment
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Serum MMA in B12 deficiency
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Normal MMA and homocysteine
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Macrocytic anemia investigation steps
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Main cause of B12 deficiency
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Main causes of folate deficiency
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Schilling test
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Schilling test - Step 1
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Schilling test - Step 2
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Schilling test - Step 3
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Schilling test - Step 4
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Drugeffect on B12/Folate
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B12 treatment
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Folate deficiency treatment
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Anaemia
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Parenteral Iron Treatment
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Risks of Parenteral Iron
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Blood Transfusion for IDA
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Lifestyle and Dietary Advice for IDA
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IDA Treatment Response Indicators
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Dimorphic Blood Film in IDA Treatment
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Primary Haemostatic Testing
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Secondary Haemostatic Testing
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Prolonged Clotting Times Investigation
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Correct Order of Draw for Coagulation Samples
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Anticoagulant for Coagulation Samples
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Sodium Citrate Reversibility
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Centrifugation for Coagulation Samples
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Poor Venepuncture and Coagulation Samples
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Analytical Principles of Coagulation Analysers
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APTT Evaluation
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APTT & Heparin Therapy
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Prolonged APTT Causes (1)
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Prolonged PT & APTT
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Normal PT, Abnormal APTT
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Factor Deficiencies Detection
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Clauss Fibrinogen Test Purpose
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Clauss Fibrinogen Test Procedure
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Clauss Fibrinogen Test Requirements
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Fibrinogen Test: Diluted Plasma
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Thrombin Time (TT) Measurement
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Thrombin Time (TT) Factors
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D-dimer Test
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Elevated D-dimer
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D-dimer Diagnostic Use
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Liver disease effect on clotting factors
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Thrombopoietin role in platelets
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Liver disease effect on platelet count
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Liver disease and activated factors
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Massive haemorrhage definition
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Components lost in massive haemorrhage
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Consumptive coagulation definition
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Transfusion risks in massive haemorrhage
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Platelet transfusions indication
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Platelet transfusion compatibility
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Plasma product thawing time
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Fresh Frozen Plasma (FFP) dose
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FFP donor criteria
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FFP administration ratio
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Cryoprecipitate content
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When does extramedullary haematopoiesis occur?
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Erythropoietin (EPO)
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How is EPO production stimulated?
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Thrombopoietin (TPO)
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Granulocyte-Colony Stimulating Factor (G-CSF)
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Monocyte-Colony Stimulating Factor (M-CSF)
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Aplastic Anemia
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Bone Marrow Transplant
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Autologous Bone Marrow Transplant
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Allogeneic Bone Marrow Transplant
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Factor Assay Interpretation
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Factor Deficiency Impact
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Coagulation Inhibitors
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Inhibitor Targets
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Inhibitor Effect on Clotting
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Time-Dependent Inhibitors
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Inhibitor Development
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Bethesda Assay
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Bethesda Unit (BU)
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vWF Antigen Test
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vWF Antigen Detection Methods
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vWF Activity Test
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Ristocetin Cofactor (vWF:RCo) Assay
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Ristocetin's Role
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Bleeding Disorders Symptoms
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Primary Haemostatic Defects
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Secondary Haemostatic Defects
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Factor IX Gene Location
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Factor IX Protein Size
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F9 Gene Mutations
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Haemophilia in Females
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What is von Willebrand Disease?
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vWD Presentation
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Types of vWD
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vWF's Role in Factor VIII Protection
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Treatments for von Willebrand Disease
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Platelet Transfusions in vWD
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Cryoprecipitate and FFP in vWD
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What are Platelet Disorders?
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Quantitative Platelet Disorders
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Qualitative Platelet Disorders
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Platelet Disorders Symptoms
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Thrombocytopenia Bleeding Severity
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Intima Layer
Intima Layer
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Media Layer
Media Layer
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Adventitia Layer
Adventitia Layer
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What are the main components of haemostatic mechanisms?
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What is von Willebrand factor (vWF)?
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What is the function of thrombomodulin in anticoagulation?
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What does protein C do in the anticoagulation process?
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How does tissue plasminogen function in anticoagulation?
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How does thromboxane A2 and PAF function in procoagulation?
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How is fibrinolysis inhibited in procoagulation?
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What is platelet activation?
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What does the localization of coagulation factor activation achieve?
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What is the intrinsic pathway in the coagulation cascade?
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What is the extrinsic pathway in the coagulation cascade?
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Common Pathway
Common Pathway
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Tissue Factor (TF) & Factor VII Activation
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Factor Xa (FXa) Function
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Extrinsic Prothrombinase Complex
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Prothrombinase Complex Function
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Factor XIIIa Role in Clot Formation
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Amplification Stage
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Factor Va (FVa) Role
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Factor IXa (FIXa) Function
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Propagation Stage
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Tenase Complex (FIXa + FVIIIa + FX)
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Prothrombinase Complex
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Thrombin Function
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Fibrinogen Conversion to Fibrin
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What is vitamin B12?
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How is vitamin B12 absorbed in the gut?
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What's the role of pepsin in vitamin B12 absorption?
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What does vitamin B12 do in the cell?
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What happens when vitamin B12 is deficient?
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Can humans synthesize folate?
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What is macrocytosis?
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What are hypersegmented neutrophils?
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What is red cell folate?
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Why is red cell folate a better indicator than serum folate?
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MMA in B12 deficiency
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Macrocytic anemia investigation
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B12 deficiency cause
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Folate deficiency causes
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Schilling test purpose
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B12 treatment methods
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Folate treatment
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Anaemia definition
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Iron location and supply
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Ferric Iron Reduction
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Dcytb: The Iron Reducer
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DMT1: The Iron Transporter
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Ferritin: The Iron Safe
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Haemosiderin: The Iron Reserve
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Hepcidin: The Iron Gatekeeper
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Hepcidin's Action on Ferroportin
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Iron Deficiency Anaemia Signs
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TIBC in Iron Deficiency
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Transferrin Saturation Calculation
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Treatment of Iron Deficiency Anaemia
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Factor Deficiency Effect
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Inhibitor Development in Patients
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vWF Antigen Test Methods
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Latex Immunoassay (LIA) for vWF
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Ristocetin's Role in vWF Activity Assay
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Factor Xa (FXa) Testing
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APTT (Activated Partial Thromboplastin Time)
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APTT and Heparin
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Prolonged APTT
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Clauss Fibrinogen Test
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Fibrinogen Test Procedure
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Thrombin Time (TT)
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Thrombin Time & Heparin Therapy
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Bleeding Time Test
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Mixing Studies
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Factor Assays
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Prophylactic Treatments for Haemophilia
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Prophylaxis Risks in Haemophilia
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von Willebrand Disease (vWD)
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vWF and Factor VIII Protection
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Platelet Disorders
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Autologous Transplant
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Allogeneic Transplant
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What are the types of leukaemia?
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Liver Disease & Clotting Factors
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Liver Disease & Platelet Count
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Massive Haemorrhage Components Lost
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Consumptive Coagulation
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Plasma Products Defrosting
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FFP Source & Administration
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Cryoprecipitate Contents & Effect
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Octaplas: Solvent Detergent-Treated Plasma
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Disseminated Intravascular Coagulation (DIC)
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DIC Main Consequences
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DIC Causes
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Haemostasis's main purpose
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Primary haemostasis: what's involved?
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Secondary haemostasis: what happens?
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Fibrinolysis: its role
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Blood vessel layers: what are they?
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Intima layer: its function
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Media layer: its function
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Adventitia layer: its function
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How do platelets contribute to haemostasis?
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What are the key steps of normal haemostasis?
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What inhibits platelet function and acts as a vasodilator?
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How does thrombomodulin contribute to anticoagulation?
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What is the function of protein C in anticoagulation?
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What does tissue factor do in procoagulation?
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How do thromboxane A2 and PAF (platelet-activating factor) contribute to procoagulation?
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How is fibrinolysis inhibited during procoagulation?
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Where is von Willebrand factor (vWF) produced?
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What gene encodes von Willebrand factor (vWF) and where is it located?
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What happens during vessel injury to promote haemostasis?
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What is platelet adhesion?
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Common Pathway Convergence
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TF-FVIIa Complex Function
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Factor Xa (FXa) in Extrinsic Pathway
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FXIIIa Role in Clot Formation
FXIIIa Role in Clot Formation
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Amplification Stage of Coagulation
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Factor IXa (FIXa) in Amplification
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Propagation Stage of Coagulation
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Tenase Complex Function
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Prothrombinase Complex Components
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Thrombin's Key Roles in Coagulation
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Thrombin Converting Fibrinogen to Fibrin
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Iron Transport Across Membranes
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Ferric to Ferrous Conversion
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Ferrous Iron Transporter
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Haem Iron Absorption
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Iron Release from Haem
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Iron Transport Out of Enterocytes
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Hephaestin's Role in Iron Absorption
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Major Forms of Stored Iron
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Ferritin's Role
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Hepcidin's Role in Iron Regulation
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B12 Deficiency Main Cause
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Folate Deficiency Main Causes
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Drugs and B12/Folate
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B12 Treatment Options
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Anaemia Overview
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Parenteral Iron Therapy
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Risks of Parenteral Iron Therapy
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Myelodysplastic Syndrome (MDS)
Myelodysplastic Syndrome (MDS)
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Stromal Cells
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Hypoxia-Inducible Factor (HIF)
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Thrombopoietin and Platelets
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Massive Haemorrhage
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Components Lost in Haemorrhage
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FFP Dose
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FFP Donors
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Cryoprecipitate Components
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Cryoprecipitate Effect
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DIC Consequences
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Inhibitors in Coagulation
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Autoantibodies and Inhibitors
Autoantibodies and Inhibitors
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Haemophilia Categories
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Haemophilia Prophylaxis
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Prophylaxis Benefits
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Prophylaxis Risks
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vWD Types
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vWF and Factor VIII
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Thrombocytopenia Causes
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Prolonged APTT Causes
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Clauss Fibrinogen Calibration
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Thrombin Time Applications
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Elevated D-dimer Indication
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Mixing Studies in Coagulation
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Factor Assays in Coagulation
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Factor Deficiency in Assay
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Ristocetin Cofactor Assay (vWF:RCo)
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Primary vs Secondary Haemostatic Defects
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Acquired Bleeding Disorders
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Inherited Bleeding Disorders
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May-Grunwald Giemsa (MGG) Stain
May-Grunwald Giemsa (MGG) Stain
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Blood Film Preparation Steps
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Oil Immersion Microscopy
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Hypochromia in Red Cells
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Polychromasia in Red Cells
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Normal Myeloid-to-Erythroid Ratio
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Bone Marrow Components
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Normal Range for Myeloblasts
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Metamyelocytes
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Neutrophils
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Eosinophils
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Basophils
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Lymphocytes
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Monocytes
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Plasma cells
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Erythroblasts
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Bone Marrow Aspirate
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Bone Marrow Trephine Biopsy
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Perls' Prussian Blue Stain
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Reticulin Stain
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Blood Film Preparation
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May-Grunwald Giemsa Stain
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Smear Thickness
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Hypochromia
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Polychromasia
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Myeloid-to-Erythroid Ratio
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Normal Bone Marrow Cell Types
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Myeloblast Percentage
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Normal Metamyelocyte Range
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Normal Neutrophil Range
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Normal Eosinophil Range
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Normal Basophil Range
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Normal Lymphocyte Range
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Normal Monocyte Range
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Normal Plasma Cell Range
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Normal Erythroblast Range
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Bone Marrow Aspirate Purpose
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Bone Marrow Trephine Biopsy Purpose
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Periodic Acid-Schiff (PAS) Stain
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Sudan Black B Stain
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Study Notes
Haemostasis
- Haemostasis's primary purpose is preventing and controlling bleeding while maintaining blood fluidity.
- Haemostasis mechanisms maintain blood fluidity, stop bleeding, and remove clots after healing.
- These mechanisms involve blood vessels, platelets, and coagulation factors.
Clotting Trilogy
- The clotting trilogy comprises blood vessels, platelets, and coagulation factors.
Primary Haemostasis
- The immediate response to vessel injury, involving platelet adhesion to form a plug.
- Involves von Willebrand factor (vWF) for platelet adhesion to the damaged site.
- vWF is produced in Weibel-Palade bodies, alpha granules, and subendothelial connective tissue.
Secondary Haemostasis
- Coagulation factors interact to create fibrin strands, strengthening the primary platelet plug.
- Fibrin reinforces and stabilizes the clot.
Fibrinolysis
- The process of clot breakdown following healing.
- Important for preventing vascular occlusion.
Blood Vessel Wall Layers
- The intima (inner layer) is composed of endothelial cells.
- The media (middle layer) is composed of smooth muscle cells regulating blood pressure.
- The adventitia (outer layer) provides structural support and anchors the vessel.
Anticoagulation Factors
- Prostacyclin and nitric oxide inhibit platelet function and act as vasodilators.
- Thrombomodulin binds thrombin, reducing clot formation.
- Heparin sulfate enhances antithrombin's action on coagulation factors.
- Protein C inactivates factors Va and VIIIa.
- Protein S acts as a co-factor for protein C.
- Tissue plasminogen promotes clot lysis.
Procoagulation Factors
- Endothelial cells release endothelin-1, a vasoconstrictor.
- Tissue factor (TF) initiates the coagulation cascade by binding with factor VIIa (FVIIa).
- Thromboxane A2 and PAF activate platelets.
Von Willebrand Factor (vWF)
- A large multimeric glycoprotein (2050 amino acids) essential for hemostasis.
- Encoded by the VWF gene on chromosome 12.
- vWF facilitates platelet adhesion to exposed collagen.
- vWF protects factor VIII (FVIII) from degradation.
- Regulated by ADAMTS13.
Vessel Injury and Haemostasis
- Vessel injury exposes procoagulant material, causing vasoconstriction and platelet aggregation.
- vWF activates platelets and mediates their adhesion to sites of injury.
Platelet Response
- Platelets are positioned to rapidly respond to vessel damage by flowing near the vessel walls.
- Platelet adhesion involves binding to exposed subendothelial matrix, vWF, or collagen.
- Platelets aggregate and recruit more platelets to the injured site.
- Fibrinogen mediates platelet bridge formation in the platelet plug.
Coagulation Factors
- Coagulation factors are serine proteases, inactive precursors (zymogens).
- Activation occurs primarily at membrane surfaces with specific binding sites.
- Factors interact in a cascade, leading to fibrin formation.
- Intrinsic pathway uses plasma factors.
- Extrinsic pathway uses tissue factor.
- Common pathway combines intrinsic and extrinsic pathways to generate fibrin.
- The tissue factor-factor VIIa complex activates factor X.
Coagulation Amplification and Propagation
- Thrombin activates factors V, VIII, and platelets, amplifying coagulation.
- The tenase complex (FIXa + FVIIIa + FX) significantly increases thrombin production.
- The prothrombinase complex (FXa + FVa + phospholipids + Ca²⁺) cleaves prothrombin to form thrombin.
Thrombin Role
- Thrombin crucial for fibrinogen to fibrin conversion and clot stabilization.
- Thrombin activates platelets and other factors (factors V, VII, VIII, XI, XII, protein C, and TAFI).
- Thrombin promotes tissue repair.
Fibrinogen
- Synthesized by hepatocytes, stored in platelets' alpha granules.
- Thrombin converts soluble fibrinogen to insoluble fibrin.
FXIIIa
- Stabilizes fibrin by forming cross-links, strengthening the clot to prevent degradation.
- FXIIIa interacts with α2-antiplasmin to inhibit plasmin's action.
Natural Coagulation Inhibitors
- Antithrombin, protein C, and TFPI inhibit coagulation.
- Antithrombin inhibits thrombin and factor Xa.
- Protein C, with Protein S, inactivates Factors Va and VIIIa.
- TFPI blocks the tissue factor-factor VIIa complex.
Megaloblastic Anaemias
- Megaloblastic anemias are characterized by delayed nuclear maturation in erythroblasts due to defective DNA synthesis.
- Common causes are vitamin B12 or folate deficiencies.
Vitamin B12 (Cobalamin)
- B12 is essential for DNA synthesis and is found in animal products.
- Vitamin B12 is stored in the liver (3-4 years supply).
- Dietary deficiency usually not problematic due to body's sufficient stores.
- B12 must bind to intrinsic factor (IF) for absorption.
Vitamin B12 Absorption
- B12 is bound to dietary proteins.
- Salivary glands secrete R-protein.
- Stomach parietal cells secrete intrinsic factor (IF).
- Pepsin breaks down dietary proteins.
- Free B12 binds to R-protein in the stomach.
- Pancreatic proteases digest R-protein, releasing B12.
- B12 binds to intrinsic factor (IF).
- B12-IF complex absorbed in the terminal ileum.
- B12 passes into the portal blood and binds to transcobalamin for transport.
Folate
- Humans cannot synthesize folate and need dietary intake.
- Folate is stored in the liver.
- Absorbed as methyl-THF in the small intestine.
- Converted to folate polyglutamates within cells.
- Folate deficiency develops faster than B12 deficiency due to its rapid turnover.
Folate and B12 Interaction
- Vitamin B12 is needed for folate metabolism by the enzyme methionine synthetase.
- Methionine synthetase converts methyl-THF to THF and methylates homocysteine to methionine.
- Deficiency in either vitamin affects DNA synthesis.
Clinical Features of Anemia
- Fatigue, shortness of breath, pallor, jaundice, glossitis, nervous system/psychiatric disturbances are characteristic symptoms.
Lab Findings in Megaloblastic Anemia
- Macrocytosis (enlarged, often oval-shaped red blood cells).
- Anisocytosis (variation in red blood cell size).
- Hypersegmented neutrophils (6+ lobes).
- Poikilocytosis (abnormal red blood cell shapes).
- Howell-Jolly bodies (nuclear remnants).
- Basophilic stippling (ribosomal RNA aggregation).
- Elevated serum unconjugated bilirubin and lactate dehydrogenase.
Red Cell Folate
- Low red cell folate reflects folate deficiency.
- Low red cell folate can occur in B12 deficiency too.
Homocysteine and Methylmalonic Acid (MMA)
- Increased serum homocysteine in B12 and folate deficiencies.
- Increased serum MMA only in B12 deficiency.
Investigations
- Clinical assessment of anaemia → blood tests → macrocytic on blood smear → serum B12 levels → MC V, serum folate levels → LDH/unconjugated bilirubin → MMA/homocysteine.
Causes of B12 and Folate Deficiencies
- B12: Lack of absorption (Congenital IF lack, Autoimmune conditions, Transcobalamin deficiency).
- Folate: Poor diet, pregnancy, chronic digestive disease.
Schilling Test
- A test to diagnose B12 malabsorption from dietary issues.
- Uses radiolabeled B12 to measure intestinal absorption.
B12 and Folate Treatment
- Treat B12 deficiencies with supplements (oral or IM).
- Folate deficiency treated with increased intake of folate-rich foods or supplements.
Anemia
- A condition where there are insufficient red blood cells or abnormal function.
- Defined by reduced oxygen-carrying capacity of blood.
- Risk factors include age, female gender, premature birth, illness, and poor diet.
- Different blood parameters of haemoglobin, vary by sex and pregnancy state.
Iron: Role in Haemostasis
- Iron predominantly found in erythroid bone marrow and mature erythrocytes.
- Iron supplied by reticuloendothelial macrophages for new red blood cell synthesis.
- Transferrin carries iron.
Iron Absorption
- Iron absorbed in the duodenal epithelium.
- Divalent metal transporter 1 (DMT1) facilitates iron uptake.
- Haem iron absorbed via haem carrier protein 1 (HCP1) and oxygenase-aided release of iron from protoporphyrin ring.
- Ferroportin transports iron.
- Hephaestin oxidizes iron, assisting in transferrin binding.
Iron Storage
- Stored iron mainly in liver hepatocytes as ferritin and haemosiderin.
- Ferritin stores and releases iron.
- Haemosiderin, aggregates of iron, proteins, and lipids, releases iron slowly.
Hepcidin
- The master iron-regulating hormone produced in the liver.
- A negative regulator of iron transport.
- Hepcidin binds to ferroportin on cell surfaces, leading to its degradation.
- Factors influencing hepcidin synthesis: infections, hypoxia, inflammation
Iron Homeostasis
- Iron overload can arise from increased absorption or multiple transfusions.
- Iron deficiency stems from inadequate intake, impaired absorption, or increased loss.
Iron Deficiency Anaemia (IDA)
- IDA characterized by small, pale red blood cells (microcytic, hypochromic).
- IDA involves variation in red blood cell size (anisocytosis), and occasional target cells or poikilocytes.
Lab Results in IDA
- Serum ferritin typically low in IDA.
- Serum iron typically low in IDA.
- Total iron-binding capacity (TIBC) usually high in IDA.
- Transferrin saturation less than 20% indicative of iron deficiency.
Perls Stain and Zinc Protoporphyrin
- Perls stain detects haemosiderin stores.
- Zinc protoporphyrin (ZPP) levels increase in iron deficiency.
Treatment and Management of IDA
- Common oral treatment is ferrous sulfate.
- Alternatives include ferrous fumarate or ferrous gluconate.
- Therapy typically for 3 months.
- Parenteral iron for non-responsive cases.
- Response indicators: reticulocyte and hemoglobin improvement along with iron replenishment (6 months).
Lab Investigation of Coagulation
- Evaluate platelet function through assays and coagulation cascade through prothrombin time (PT), APTT, fibrinogen levels, thrombin time, and D-dimers.
Sample Collection and Coagulation Analysers
- Sodium citrate prevents coagulation by removing calcium ions.
- Samples centrifuged at high speed (3500 rpm for 5 minutes) to yield platelet-poor plasma (PPP).
- Coagulation analysers employ optical or mechanical principles to measure clotting times.
Platelet Function Assays
- Used to investigate platelet adhesion and aggregation.
- ADP and EPI used in assays to stimulate platelet function.
- Samples kept at room temperature, delivered by hand, processed within 4 hours.
Platelet Dysfunction
- Platelet function assay results vary depending on the specific platelet disorder (e.g., vWD types).
Prothrombin Time (PT)
- PT assesses the extrinsic and common pathways of coagulation.
- Assesses Factor II, V, VII, and X.
INR (International Normalized Ratio)
- INR derived from PT to monitor anticoagulant therapy (e.g., warfarin).
APTT (Activated Partial Thromboplastin Time)
- APTT assesses intrinsic and common pathways of coagulation.
- APTT particularly sensitive to factors VIII, IX, and XI deficiencies.
Clotting Screen Interpretation
- Prolonged PT and APTT indicate common pathway issues.
- Prolonged APTT, normal PT suggests intrinsic pathway issue.
Clauss Fibrinogen Test
- Used to measure fibrinogen levels in plasma.
- Uses thrombin to initiate fibrin formation.
Fibrinogen Testing
- Measures fibrinogen using plasma dilutions.
Thrombin Time (TT)
- TT measures fibrinogen conversion to fibrin.
Bleeding Disorders: Symptoms, Mechanisms, and Example Conditions
- Symptoms include epistaxis, bruising, purpura, petechiae, menorrhagia, joint/muscle bleeds, and anaemia.
- Primary haemostatic defects feature small bruises and easy bleeding from cuts.
- Acquired bleeding disorders: Vitamin K deficiency, liver disease, DIC, and autoantibodies/inhibitors.
Vitamin K Deficiency
- A fat-soluble vitamin found in green leafy vegetables and liver.
- Causes: Fat malabsorption, liver disease, oral anticoagulants, antibiotics.
- Crucial cofactor for gamma-carboxylation of clotting factors.
- Deficiency leads to prolonged PT and APTT.
Vitamin K Cycle
- Gamma-carboxylation is crucial for vitamin K-dependent proteins.
- Calcium chelation enables binding to phospholipids.
Coagulation Cascade and Vitamin K
- Crucial vitamin in activating Factors II, VII, IX X.
- Activated factors require vitamin K.
Liver Disease and Coagulation
- Liver produces factors I (Fibrinogen), II, V, VII, IX, X and part of VIII.
- Liver disease impairs factor production, leading to prolonged PT and APTT, decreased platelet count.
Massive Haemorrhage
- Significant blood loss (>50% circulating volume in 3 hours).
- Consumptive coagulation due to depletion of clotting factors and platelets.
Platelet Transfusions
- Indications include thrombocytopenia, platelet dysfunction.
Plasma Products
- Fresh Frozen Plasma (FFP), Cryoprecipitate, Octaplas (SD-FFP) used in coagulation replacement therapy.
Disseminated Intravascular Coagulation (DIC)
- Inappropriate intravascular fibrin deposition consumes clotting factors and platelets, leading to bleeding and organ damage.
- Treatment focuses on the underlying cause and replacement therapy.
Autoantibodies/Inhibitors in Coagulation
- Antibodies targeting clotting proteins, often found with autoimmune conditions.
- Common targets include factors VIII and IX.
- Antiphospholipid antibodies affect multiple coagulation proteins.
Haemophilia A and B
- Both are X-linked bleeding disorders, representing deficiency in clotting Factor VIII (Haemophilia A) and IX (Haemophilia B) respectively.
- Haemophilia inherited through the X chromosome.
- Severity ranges from mild to severe cases in terms of Factor presence.
Haemophilia Treatment
- Prophylaxis with plasma-derived or recombinant clotting factors.
- Desmopressin (DDAVP) can increase factor VIII levels (in some mild cases)
von Willebrand Disease (vWD)
- vWD is an inherited bleeding disorder with varying severity.
- vWD caused by quantitative or qualitative deficiency of von Willebrand factor (vWF).
- vWD classified into types 1, 2, and 3.
Platelet Disorders
- Characterized by abnormal or excessive bleeding due to platelet abnormalities.
- Quantitative defects (thrombocytopenia) or qualitative defects (platelet dysfunction).
Haemopoiesis
- Haemopoiesis: Formation of blood cells in the bone marrow.
- Adult haemopoiesis primarily in axial skeleton bone marrow.
- HSCs (Haematopoietic Stem Cells).
- Differentiation pathways: Myeloid (RBCs, platelets, myeloid WBCs) and Lymphoid (lymphocytes).
- Stages of erythropoiesis, thrombopoiesis, granulopoiesis, monocytopoiesis, and lymphopoiesis.
- Haemopoietic growth factors regulate these processes.
Haemopoiesis Regulation
- Bone marrow microenvironment and cells (stromal, matrix) are crucial.
- Regulation includes cytokines, EPO, TPO, adhesion molecules, and transcription factors like HIF.
- Extra-medullary production possible due to bone marrow failure or high need.
Haemopoietic Disorders
- Aplastic anemia, MDS, Polycythemia vera, Leukaemias.
- Treatments range from EPO injections, TPO agonists, GCSF, Bone marrow transplant.
Cell Production Rates
- High cell production rates of Red Blood cells (RBCs), White Blood cells (WBCs), and platelets in normal haematopoiesis.
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This quiz covers the essential mechanisms of haemostasis, including primary and secondary haemostasis. Learn about the roles of blood vessels, platelets, coagulation factors, and the process of fibrinolysis in preventing and controlling bleeding. Test your knowledge on how these components work together to maintain blood fluidity and promote healing.
