Term
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Definition
| confinement of blood to the cardiovascular system |
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Term
| 2 guardians of hemostasis and 1 balancing factor |
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Definition
| intact heart/blood vessels, functional platelets/clotting, and fibrinolytic system |
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Term
| 2 opposites of hemostasis? |
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Definition
| thrombosis and hemorrhage |
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Term
| Normal hemostasis is the ability to? |
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Definition
| Form local clots while maintaining blood fluidity |
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Term
| What is the result of hypocoagulability? Hypercoaguability? |
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Definition
| hemorrhage, thrombosis/embolism |
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Term
| Name 2 causes of hemorrhage |
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Definition
| vascular/heart defect, inability to form clot following vascular injury |
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Term
| List 3 results of extreme hemorrhage |
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Definition
| hypovolemic shock, multi-system organ failure, death |
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Term
| What 3 blood flow disturbances are primary causes of morbidity/mortality? |
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Definition
| MI, pulmonary embolism, cardiovascular accidents (CVA) |
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Term
| What are 4 essential components of hemostatic mechanisms? |
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Definition
| Intact vasculature, adequate platelets, intact coagulation system, intact fibrinolytic system |
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Term
| 4 questions to ask if a vessel is bleeding |
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Definition
| Is hemostatic plug forming? Is the coagulation cascade activating? Are antitrhombitic factors active? Is Fibrinolysis active? |
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Term
| What is the triggering event of hemostatic mechanisms? |
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Definition
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Term
| What cells modulate most aspects of hemostasis? |
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Definition
| Endothelial cells - have anti-platelet, anti-coagulant, and fibrinolytic properties - unless injured |
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Term
| Name 4 pro-coagulant factors |
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Definition
| Tissue factor, vWF, platelets, and clottting factors |
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Term
| Name 2 anti-coagulant players |
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Definition
| Endothelial cells and anticoagulant proteins |
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Term
| AT3 and proteins C and S are examples of? |
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Definition
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Term
| Besides pro/anti-coagulant factors, what is the third main player in hemostasis? |
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Definition
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Term
| What are the two players in Primary hemostasis? The main result? |
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Definition
| Platelets and vWF, formation of platelet plug |
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Term
| What is the sequence of events for platelet plug formation? |
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Definition
| Vascular injury, vasoconstriction, platelet adhesion/aggregation, pro-coagulation granule secretions, platelet plug forms |
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Term
| What is the normal platelet count? How long do they live? |
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Definition
|
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Term
| What is the most common cause of platelet dysfunction? |
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Definition
| Drugs - aspirin and plavix |
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Term
| Glanzmann, Bernard-Soulier and myelodysplasia are examples of? |
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Definition
| Congenital and acquired platelet disease |
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Term
| What is Secondary Hemostasis? |
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Definition
|
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Term
| What are the 3 parts of the coagulation cascade? |
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Definition
| The intrinsic, extrinsic and common pathways |
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Term
| What is the final product of the coagulation cascade? |
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Definition
| created the fibrin matrix around platelet/blood clot |
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Term
| A blood clot consists of? |
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Definition
| platelets, RBC, and fibrin matrix |
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Term
| What are common causes of secondary hemostatic disorders? |
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Definition
| Coagulation factor deficiencies (hemophilias), liver disease, Vit K, Warfarin, Firbrinogen deficiency |
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Term
| What are the routine tests completed to diagnose hemostasis problems? |
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Definition
| CBC, PT/PTT, fibrinogen, metabolic profile, and liver function tests |
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Term
| What are the components of a CBC? |
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Definition
| RBCs, WBC, hematocrit, hemoglobin, and platelet counts |
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Term
| What are the normal RBC values? |
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Definition
|
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Term
| What are normal WBC values? |
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Definition
|
|
Term
| What are normal hematocrit values? |
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Definition
|
|
Term
| What are normal Hgb levels? |
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Definition
|
|
Term
| What is the normal platelet count? |
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Definition
|
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Term
| What is PTT? What does it measure? |
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Definition
| partial thromboblastin time, efficacy of intrinsic pathway |
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Term
| What are normal PTT values? |
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Definition
|
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Term
| What is a PT test? What does it measure? |
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Definition
| prothrombin time, tests efficacy of extrinsic pathway (Factor VII) |
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Term
| What are normal PT test values? |
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Definition
|
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Term
| What does a fibrinogen test test? |
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Definition
|
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Term
| What are the components of a complete metabolic profile? |
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Definition
| Glc, Ca2+, Albumin, Total protein, Na+, K+, HCO3-, CO2, Cl-, BUN, Creatinine, ALP, AST, Bilirubin |
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Term
| What parts of the metabolic profile test kidney function? |
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Definition
|
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Term
| What part of the metabolic panel tests liver function? |
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Definition
| ALP, ALT, AST, and Bilirubin |
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Term
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Definition
| formation of blood clot inside blood vessel restricting flow |
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Term
| Name 3 abnormalities that cause thrombosis |
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Definition
| Injury to vascular epithelium, alterations in normal blood flow, hypercoagualbe state (inherited, acquired) |
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Term
| Thrombi formed in vein = ? aka? |
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Definition
| Venous Thrombosis, aka phlebothrombosis |
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Term
| Risk factors for Venous Thrombosis? |
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Definition
| Immobility, oral contraceptives, smoking and other risk factors of hypercoaguability (nephrotic syndrome, obesity) |
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Term
| Diseases and other causes of hypercoaguability? |
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Definition
| Factor V Leiden, prothrombin gene mutation, elevated homocysteine levels, antiphospholipid antibody syndrome, CANCER |
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Term
| How is cancer associated with Venous Thrombosis events? |
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Definition
| 10% of VTE patients are diagnosed with new malignancy |
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Term
| What is Trousseau Syndrome? Associated with? |
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Definition
| Recurrent migratory thrombophlebitis, mucinous adenocarcinoma |
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Term
| What is the presentation of a venous thrombus? |
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Definition
| Red - b/c of trapped RBC, laminated b/c blood flow |
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Term
| Main risk factors for Arterial Thrombosis? |
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Definition
| Athelerosclerosis with intimal injury, patients with antiphospholipid antibodies, homocysteine, malignancy (myeloproliferative), and dysfibrinogenemia |
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Term
| Where do arterial thrombi attach? |
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Definition
|
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Term
| What happens to arteries with atherosclerosis and thrombi formation? |
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Definition
| They are narrowed, can cause ischemia |
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Term
| Name 3 special considerations for thrombosis and anticoagulation |
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Definition
| HIT syndrome, malignancy, and antiphospholipid antibody syndrome |
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Term
| What causes HIT syndrome? |
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Definition
| Patient on heparin for 5-10 days that starts to complex with Factor IV and IgM/G antibodies |
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Term
| What is the presentation and risk of HIT? |
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Definition
| Platelet count drops by 50%, and 50% develop thrombosis in next 30 days |
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Term
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Definition
| Stop heparin, use alternative anticoagulant |
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Term
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Definition
| detached intravascular solid, liquid, or gas carried to a distant site that disturbs normal blood flow |
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Term
| What are the two types of embolism |
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Definition
|
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Term
| Potential non-thrombogenic emboli? |
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Definition
| Fat, Air, amnionic fluid, cholesterol, tumor, marrow, foreign bodies (bullet), septic, most are throbotic in origin |
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Term
| What are four components of amnionic fluid emboli? |
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Definition
| Epithelial squames, lanugo hair, fat, and mucin |
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Term
| Common sites of non-thrombogenic emboli? |
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Definition
| Kidney, pancreas, spleen, GI, brain, and bone marrow |
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|
Term
| What is a saddle embolus? |
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Definition
| straddles a vascular bifurcation |
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Term
| What is a paradoxical embolus? |
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Definition
| Hole in heart, arises in one side of circulation but enters other side |
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|
Term
| What is a septic embolus? |
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Definition
| An embolus containing an infectious agent |
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Term
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Definition
| hemodynamic condition caused by resistance or obstruction to the outflow of venous blood |
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Term
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Definition
| Local ischemic necrosis caused by occlusion or arterial supply or venous drainage |
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Term
| What is the primary cause of all infarctions? |
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Definition
| Thromboembolic events - almost all due to arterial occlusion |
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Term
| Severe Vasospasm, Expansion of atheroma, extrinsic compression, vessel twisting, entrapped/compressed blood vessel, and traumatic rupture of a blood vessel are examples of? |
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Definition
| Non-thromboembolic mechanism that disrupt blood flow |
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Term
| What are the two classifications of infarcts? |
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Definition
| Red-hemorrhagic, white - ischemic |
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|
Term
| What is a myocardial infarction? c/o? |
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Definition
| defined area of myocardial necrosis, by local ischemia, c/o thrombosis of atherosclerotic plaque |
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|
Term
| Gross presentation of MI at 1-2 days? |
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Definition
| difficult to visualize, some pallor |
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|
Term
| Gross presentation of MI at 3-4 days? |
|
Definition
| yellow necrotic zone surrounded by hyperemic zone |
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Term
| Gross presentation of MI at 1 week? |
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Definition
| Gelatinous granulation tissue, remote white fibrous scar |
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Term
| What are the four parts of MI histologic progression? |
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Definition
| Coagulative necrosis & inflammation, granulation tissue, resorption of necrotic debris, organization and scar |
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Term
| Day 1 MI Gross/Micro changes |
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Definition
| gross: softening, pallor, edema; micro: loss of eosinophils, hemorrhage, wavy fibers |
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Term
| 2-3 Day MI gross/micro changes? |
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Definition
| gross: opaque-yellow center with hemorrhagic border; micro: PMN infiltration, lose nuclei, striations |
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Term
| 3 days- 1 wk MI gross/micro changes? |
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Definition
| gross: rubbery center with shrinkage; micro: macrophage infiltration, phagocytosis, and early firbroblastic response |
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Term
| 10 day MI gross/micro changes? |
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Definition
| gross: thinning of myocardium, red-brown discoloration; micro: extensive phagocytosis, granulation tissue formation |
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Term
| 2 month MI gross/micro changes? |
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Definition
| gross: cicatrization (scarring); micro: fibrous replacement of myocardium |
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|
Term
| Presentation of brain/cerebral infarct? |
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Definition
| well defined hemorrhagic area = liquefactive necrosis (tissue disintegration) |
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|
Term
| Presentation of remote infarctions? |
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Definition
| Cystic cavity result of liequfactive necrosis |
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|
Term
| The severity (clinical significance) of an infarct depends on what 4 things? |
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Definition
| Nature of vascular supply effected, rate of occlusion development, vulnerability of tissue to hypoxia, blood oxygen content |
|
|
Term
| 2 organs with dual blood supplies? |
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Definition
|
|
Term
| 3 organs with end-arterial supply? |
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Definition
|
|
Term
| What tissues are most vulnerable to hypoxia? |
|
Definition
| Neurons (3-4 min), myocardial cells (20-30 min), fibroblasts (many hours survival) |
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|
Term
| Effect of Hgb/age on infarct? |
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Definition
| Older people have less Hgb which makes the consequences of infarct happen more quickly |
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|
Term
| Gross appearance of pulmonary infarct? |
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Definition
| solid, airless area c/o coagulative necrosis and loss of oxygen |
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|
Term
| Common cause of segmental pulmonary anoxia? |
|
Definition
| detached venous thrombus from leg |
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|
Term
| Why is a pulmonary infarct red? |
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Definition
| hemorrhage of blood into necrotic area, favored by dual blood supply |
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|
Term
| Microscopic appearance of pulmonary infarct? |
|
Definition
| loss of air spaces, solid eosinophilic area, coagulative necrosis, no intact nuclei, pulmonary airspaces filled with debris |
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