Hemostasis | Hematology Extravascular

Notes taken from the lecture Concerned with tissues surround the blood
Description of Hemostasis: vessels
All biochemical reaction that is going on in our Muscles around the blood vessels contract to
blood which maintains blood in a free-flowing, prevent further bleeding
fluid-state contained inside a blood vessel o Reason why head trauma is very bloody; due
Thrombotic Tendency (hypercoagulability) to few muscles being on the head
Vascular
May be present when there is an on-going
disease process: Concerned with the blood vessel
o Can cause blocking of blood vessels leading Problem with blood vessels causes prolonged
to diseases like: healing
Stroke May promote clotting if needed or prevent it
Myocardial infarction when it is not needed by the body
o Different cardiovascular diseases may trigger Anti-coagulant & procoagulant activity
a condition which is secondary to disease Diseases of the blood vessels:
called disseminated intravascular o Ehlers-Danlos syndrome
coagulation or DIC Connective tissue problem which affects
Characterized by excessive intravascular the blood vessels
coagulation in various parts of the body Whenever there is a skin wound, healing
Usually caused by the hypercoagulability will be prolonged
of the blood in the vessels Characteristic feature:
Triggered by: Highly-stretchable skin
Trauma during pregnancy o Scurvy (severe lack of Vitamin C)
o Can cause amniotic fluid to go into Vitamin C maintains blood vessel
circulation causing clot to form due resiliency by formation of collagen
to presence of many proteins Lack of collagen causes fragile vessels
Neisseria meningitidis infection Senile purpura in elderly due to
o Leads to Waterhouse-Friderichsen decreased collagen formation by age
syndrome leading to DIC o Normal occurrence with old age due
AKA. Consumptive coagulopathy to more fragile blood vessels
Because it consumes all the clotting Intravascular
factors in the blood Concerned with substances in our blood which
Bleeding Tendency (hypocoagulability) help achieve hemostasis
Diseases causing excessive bleeding: Components:
o Hemophilia A or classic hemophilia o Platelets
Factor 8 deficiency o Clotting factors (I-XIII except for VI)
o Hemophilia B Lack of these causes bleeding tendency
Factor 9 deficiency o Regulating proteins / fibrinolytic system(five)
o Hemophilia C Lack of these causes thrombotic tendency
Factor 11 deficiency Test for intravascular components:
o Usually caused by hypocoagulability of the o CT/BT (Clotting time / Bleeding time)
blood leading to continuous bleeding In order to test for secondary and primary
Types of bleeding: hemostasis; respectively
o Petechial hemorrhages Done before operations / surgeries
Pinpoint hemorrhages Done before pregnancy
Possible test: To evaluate the entire hemostasis of the
o Platelet function test patient
o Idiopathic thrombocytopenic purpura (ITP) May cause extensive bleeding when
Disease that destroys the platelet due to operation is done with faulty clotting factor
the autoantibodies produced against Hemostasis:
platelets Primary hemostasis:
Triggered by viral infection o Objective is to form platelet plug
Possible test: o Analogy: Function as the hollow blocks while
o Platelet function test secondary hemostasis is the cement in
o Test for clotting factor between the blocks
Components of Hemostasis Secondary hemostasis:
Extravascular o Objective is to stabilize the platelet plug
o Tissue surrounding the blood vessel o Produces clot between the platelet spaces
Vascular
o Blood vessels
Intravascular
o Clotting factors
Primary Hemostasis Blood to anticoagulant ratio:
Components: o 9 : 1 ratio
o Platelets Reason for Citrate
o Von Williebrand Factor o It preserves all clotting factors especially the
o Factor I Fibrinogen labile factors:
o Blood vessels Labile factors
Reason why Ehler-Danlos syndrome Factors V and VIII
causes problem with primary hemostasis o Factor VIII is easily destroyed when
o Calcium left for more than two (2) hours
Any disease which affects any of the o Other anticoagulants cannot be used:
components will cause problems with primary EDTA (lavender)
hemostasis Destroys factor V
Test for primary hemostasis: Heparin (green)
o Bleeding time (BT) Has anti-thrombin property
Detects any problems with primary o Inhibits factor II (which when
hemostasis activated is thrombin)
An abnormal bleeding time will warrant All coagulation tests depend on
further tests to pinpoint the problem thrombin capability of the blood
Methods: Oxalate
Dukes method Cannot be used especially when the
Ivys method test will be done with a machine
Modified-Ivys method Can affect turbidity by forming
Secondary Hemostasis precipitate with calcium
Functions to produce a clot o Will cause a false reading with the
Pathways (3) of secondary hemostasis: photo-optical reading machine or the
o Extrinsic pathway coag-nate machines
Tested via prothrombin time (PT) Machines used for coagulation
o Intrinsic pathway studies
Tested via partial thromboplastin time Prevent premature activation of the platelets &
(PTT) premature activation of the clotting factors
o Common pathway o Can cause clotting prior to testing
Tested via prothrombin time (PT) and o Decreases concentration of clotting factors
partial thromboplastin time (PTT) False-deficiency of clotting factors
Test for secondary hemostasis: o Causes prolonged PT/PTT
o Clotting time (CT) o Ways to prevent premature activation
Factors I-XIII are evaluated Prevent thromboplastin contamination from
All factors are needed to produce a clot tissue fluid
Deficiency of any of the clotting factors Thromboplastin activates factor VII
causes prolonged bleeding Excess thromboplastin from the tissue
Abnormality in any of the tests is a fluid causes increase in clotting factors
contraindication for surgery, bone-marrow Can shorten PT/PTT
evaluation etc. Prevents by two evacuated tube
Deficiency may be caused by liver failure method or two syringe method
(cirrhosis) because all of the clotting factors are o Two evacuated tube is preferred
synthesized in the liver because it is easier
o Causes generalized hematoma o Use a discard tube before taking the
Specimen Collection & Handling sodium citrate tube
Specimen is very sensitive Remove the tourniquet when blood enters
Anticoagulant of choice for coagulation studies: the tube for the blue top (citrate)
o Sodium citrate (two types) Prolonged tourniquet application can
3.2% (0.109M) Sodium Citrate possibly introduce hemolysis in the
Used for polycythemia specimen
o >52% or >54% hematocrit o Destroyed red-cell can cause the
o Causes reduced plasma leading to release of ADP or thromboplastin-
decreased hemostasis components like components
o Using a higher concentration will Promotes platelet aggregation
cause an excess of citrate o Causes prolonged PT/PTT due to
Can react with recalcification premature activation of platelets
process in PT/PTT leading to a decrease in platelets
Will nullify the calcium added o Spin & check for hemolysis
Causes prolonged PT/PTT Reject the specimen if hemolyzed
3.8% (0.129M) Sodium Citrate causing errors in the PT/PTT
 Tube used for coagulation studies: Beta-thromboglobulin & platelet-derived growth
o Glass factor testing:
Must be coated with micronized silica o Exception to the rule that plasma should not
Prevents direct contact with the glass be put in refrigerator temperature
Plasma should not be in contact with glass o While spinning the blue top, it must be under
Glass surface activates the contact the refrigerator temperature
clotting factors such as: o Increased levels of either substances mean
o Factor XI, XII, high molecular weight that the platelet has been activated
kininogen, prekallikrein
AngeloBautista
o Activates the entire intrinsic pathway
o Prematurely activates of the clotting
factors prolonging the PT/PTT
Glass provides a negative charge
which mimics the negative charge of
the collagen; which in vivo, activates
the contact clotting factors
o Mimics the collagen surface
Processing:
o Must be within two (2) hours
PT/PTT
o Upon receiving, spin for about 10-15 minutes
in heavy spin (2000 3000G)
To prepare platelet poor plasma (PPP)
which is used for PT/PTT
Must be less than 10000 cells / uL
Too much platelets may allow fast
clotting or shortened PT/PTT
o Transfer the plasma into another tube
immediately after spinning and then covered
with paraffin or cork
Plasma is transferred immediately
because blood cells can consume the
glucose present which will make the
plasma acidic
Acidic pH is not acceptable for
coagulation tests
Plasma must be covered immediately
because CO2 is released from the plasma
which will make the plasma alkaline
Alkaline pH is not acceptable for
coagulation tests
Optimal working pH of PT/PTT:
Around pH 7 for best enzyme activity
Optimal enzyme activity is around the
neutral pH (7)
o Time of processing:
Plasma must be processed within two (2)
hours if the tests are PT/PTT @ RT
If it cannot be processed within two (2)
hours, it must be kept at freezer
temperature (-18 -20oC)
o Putting it in freezer temperature will
preserve all clotting factors
Fresh frozen plasma in blood-
banking contains all factors
o Putting it in refrigerator temperature
only will prematurely activate:
Factors VII and XI
o Allows plasma to be used for several
days
Plasma may be stored for twenty-four (24)
hours if the test is only PT @ RT