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Questions and Answers
What is the main cause of inappropriate blood clotting or insufficient clotting in hemostasis disorders?
What is the main cause of inappropriate blood clotting or insufficient clotting in hemostasis disorders?
Which protein molecule is required for platelet adhesion during platelet plug formation?
Which protein molecule is required for platelet adhesion during platelet plug formation?
Which vitamin is essential for the synthesis of clotting factors in the liver?
Which vitamin is essential for the synthesis of clotting factors in the liver?
What is the primary role of thrombin in the blood coagulation process?
What is the primary role of thrombin in the blood coagulation process?
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In hypercoagulability, what leads to an increased risk of thrombosis and blood vessel occlusion?
In hypercoagulability, what leads to an increased risk of thrombosis and blood vessel occlusion?
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Which condition is associated with primary thrombocytosis?
Which condition is associated with primary thrombocytosis?
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What is the primary cause of thrombus formation due to activation of the coagulation system?
What is the primary cause of thrombus formation due to activation of the coagulation system?
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What is a characteristic feature of Von Willebrand Disease?
What is a characteristic feature of Von Willebrand Disease?
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What symptom is indicative of Hemophilia A?
What symptom is indicative of Hemophilia A?
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What clinical manifestations can impaired oxygen transport lead to?
What clinical manifestations can impaired oxygen transport lead to?
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What type of anemia is characterized by premature destruction of red blood cells and increased erythropoiesis?
What type of anemia is characterized by premature destruction of red blood cells and increased erythropoiesis?
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What is the main cause of iron deficiency anemia?
What is the main cause of iron deficiency anemia?
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Which condition results from bone marrow stem cell reduction affecting all three hematopoietic cell lines?
Which condition results from bone marrow stem cell reduction affecting all three hematopoietic cell lines?
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What can trigger sickling episodes in sickle cell disease?
What can trigger sickling episodes in sickle cell disease?
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What is a characteristic feature of megaloblastic anemia?
What is a characteristic feature of megaloblastic anemia?
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How does acute blood loss anemia differ from chronic blood loss anemia?
How does acute blood loss anemia differ from chronic blood loss anemia?
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What distinguishes polycythemia from other hematologic conditions?
What distinguishes polycythemia from other hematologic conditions?
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What is a common symptom experienced by geriatric individuals due to decreased RBC production?
What is a common symptom experienced by geriatric individuals due to decreased RBC production?
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What distinguishes folic acid deficiency from other types of anemia?
What distinguishes folic acid deficiency from other types of anemia?
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Study Notes
Disorders of Hemostasis
- Hemostasis: the stoppage of blood flow to prevent blood loss and hemorrhage
- Two main categories of disorders:
- Inappropriate formation of clots (thrombosis)
- Failure to clot in response to an appropriate stimulus (bleeding)
Mechanisms of Hemostasis
- Three stages:
- Vascular constriction
- Formation of the platelet plug
- Blood coagulation
States of Hemostasis
- Vascular constriction:
- Vessel spasm constricts the vessel and reduces blood flow
- Leads to a transient event that usually lasts minutes or hours
- Formation of the platelet plug:
- Small breaks in the vessel wall are sealed with a platelet plug
- Platelet plug formation involves activation, adhesion, and aggregation of platelets
- Change from smooth disks to spiny spheres
- Platelet adhesion requires the protein molecule Von Willebrand factor
- Blood coagulation:
- Clotting factors are synthesized in the liver using Vitamin K
- Coagulation process results from the intrinsic and extrinsic pathways
- Intrinsic pathway: slow process (clotting in 1-6 minutes)
- Extrinsic pathway: fast process (clotting in 15 seconds)
Clot Retraction and Clot Dissolution
- Clot retraction:
- Normally occurs over 20-60 minutes after clot formation
- Clot joins the edges of the broken blood vessel
- Requires a large number of platelets
- Clot dissolution:
- Fibrinolysis: the process by which a blood clot is dissolved
- Plasmin digests fibrin strands of the clot
- Naturally occurring plasminogen activators: tissue-type plasminogen activator
Hypercoagulability
- An exaggerated form of hemostasis
- Predisposes to thrombosis and blood vessel occlusion
- Two forms of hypercoagulable states:
- Conditions that create increased platelet function
- Conditions that cause accelerated activity of the coagulation system
Conditions Associated with Hypercoagulability
- Increased platelet function:
- Atherosclerosis
- Diabetes
- Smoking
- Elevated lipid and cholesterol levels
- Increased platelet levels
- Accelerated activity of the coagulation system:
- Pregnancy
- Use of oral contraceptives
- Postsurgical state
- Immobility
- Congestive heart failure
- Malignant disease
Thrombocytosis
- Primary thrombocytosis:
- Myeloproliferative (bone marrow) disorder
- Abnormalities in thrombopoietin receptor and platelet binding
- Secondary thrombosis:
- Leads to increased platelet production
- Disease state that stimulates thrombopoietin production
Bleeding Associated with Platelet Disorders
- Thrombocytopenia:
- Reduction in platelet number
- Decrease in the number of circulating platelets to less than 150,000
- Characterized by petechiae and purpura
- Results from:
- Decrease in platelet production
- Increased sequestration of platelets in the spleen
- Decreased platelet survival
Disorders of the Red Blood Cells
- Function of the Red Blood Cells:
- Transportation of oxygen to the tissues
- Hemoglobin binds to carbon dioxide and carries it from the tissues to the lungs
- Red Blood Cell Destruction:
- The RBC has a life span of 90-120 days
- Broken down in the spleen
- The degradation products (iron and amino acids) are recycled
Laboratory Tests for Red Blood Cells
- Red blood cell count (RBC)
- Hemoglobin (grams per 100 mL of blood)
- Hematocrit
- Percentage of reticulocytes (normally approximately 1%)
Transfusion Therapy
- Whole Blood
- Packed Red Blood Cells (PRBC)
- Platelets
- Cryoprecipitate
- Plasma
Anemia
- Anemia: an abnormally low number of circulating red blood cells or level of hemoglobin or both
- Results in diminished oxygen-carrying capacity
- Primary causes of anemia:
- Excessive loss of red cells from bleeding
- Destruction (hemolysis) of RBCs
- Defective RBC production
- Inadequate RBC production due to bone marrow failure
- Clinical manifestations:
- Fatigue, weakness, dyspnea
- Headache, faintness
- Pallor of skin, mucous membranes, conjunctiva, nail beds
- Tachycardia, low cardiac output, palpitations, ventricular hypertrophy
Acute Blood Loss Anemia
- Clinical and red cell changes depend on the rate of hemorrhage and whether bleeding loss is internal or external
- Causes circulatory collapse
- Up to 50% RBC mass may be lost without signs or symptoms
- RBC may also fall related to hemodilution
Chronic Blood Loss Anemia
- Chronic anemia leads to iron deficiency anemia
- Asymptomatic until Hgb is less than 8 d/dL
- GI bleeding, menstrual disorders
- RBCs produced have too little Hgb
- Is small and pale
Hemolytic Anemia
- Characterized by:
- Premature destruction of RBCs
- Shortened life-span
- Increased bone marrow activity causes increased release of reticulocytes
- Increase in erythropoiesis
- Is normocytic and normochromic
Sickle Cell Disease
- Abnormal substitution of an amino acid in the hemoglobin molecules
- Inherited disorder in which abnormal hemoglobin leads to chronic hemolytic anemia, pain, organ failure
- Recessive disorder:
- Sickle cell trait
- Sickle cell disease
- Clinical manifestations:
- Factors associated with sickling/vessel occlusion
- Acute pain
- Jaundice
- Vaso-occlusive crisis
- Sluggish blood flow causes chronic damage
- Acute chest syndrome
Iron Deficiency Anemia
- Etiology:
- Dietary deficiency
- Loss of iron through bleeding
- Iron is a component of heme
- Deficiency leads to decreased hemoglobin synthesis
- Impaired oxygen delivery
- Is microcytic and hypochromic
- Clinical manifestations:
- Related to impaired oxygen transport and lack of hemoglobin
- Pica
- Spoon-shaped deformity of fingernails
- Glossitis
- Angular cheilitis
- Dysphagia
Megaloblastic Anemia
- Caused by impaired DNA synthesis that results in enlarged red blood cells
- MCV > 100 fL
- Impaired maturation and division
- Develops slowly
- Megaloblastic anemia:
- Comes from Vitamin B12 deficiency and folic acid deficiency
- Vitamin B12 is essential for DNA synthesis and nuclear maturation
- Predisposes to myelin breakdown
- Causes neurologic symptoms
- Risk factors: proton pump inhibitors, GI disease, gastrectomy, or gastric bypass
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Description
Test your knowledge on disorders of hemostasis, including the stoppage of blood flow, normal and abnormal hemostasis, and the two main categories: inappropriate formation of clots (thrombosis) and failure to clot in response to a stimulus (bleeding). This quiz covers key concepts from Madisyn Johannessen's Week #5 lecture in Chapter 22 of pathophysiology.
