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PRE LECTURE QUIZ (TRUE/FALSE)
Platelets are also known as leukocytes. Idiopathic thrombocytopenic purpura (ITP) is
an autoimmune disorder that affects the normal function and formation of platelets.
Disseminated intravascular coagulation is a condition that results in massive systemic bleeding, but coagulation function remains normal.
The use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been identified as a cause of impaired platelet function.
Bleeding can occur as a result of a decrease in the number of circulating platelets or because of impaired platelet function.
F
T
T
T
T
PRE LECTURE QUIZ _________________ is the orderly, stepwise
process for stopping bleeding that involves vasospasm, formation of a platelet plug, and development of a fibrin clot.
A decrease in the number of circulating platelets is known as _________________________.
Hemophilia A is an X-linked recessive disorder that involves a deficiency of factor _________________.
________________ disorders are caused by defects associated with platelets, coagulation factors, and vessel integrity.
Vitamin _______________, a fat-soluble vitamin that is continuously being synthesized by intestinal bacteria, is necessary for normal activity of factors VII, IX, and X and prothrombin.
Bleeding
K
Hemostasis
thrombocytopenia
VIII
HEMOSTASIS
Stopping blood flow Normal:
Blood usually fluid Seals broken blood vessels
Abnormal: Inappropriate clotting Insufficient clotting
PLATELETS (THROMBOCYTES)
Thrombopoietin Made in liver, kidney, smooth
muscle, bone marrow Megakaryocytes formed in bone
marrow Break apart to form many platelets
Platelets live 8–9 days in circulation Many are stored in spleen Released when needed
QUESTION
All but which of the following are true about platelets?
a. An enzyme called erythropoietin stimulates their production.
b. They are made from megakaryocytes.c. They originate from the bone marrow.d. They are stored in the spleen.
ANSWER
a. An enzyme called erythropoietin stimulates their production.
Rationale: Erythropoietin stimulates the production of RBCs (erythrocytes). The word literally means erythrocyte production. Platelet formation is stimulated by thrombopoietin (thrombus/clot production).
MEDIATORS OF HEMOSTASIS
Chemicals produced by platelets Released at an injury to:
Start clotting by reacting with blood proteins
Help platelets stick together Stimulate wound healing Help platelets stick to vessel wall Constrict blood vessels
COAGULATION FACTORS
Plasma proteins Most are synthesized by liver von Willebrand factor made by
endothelium Circulate as inactive
procoagulation factors Calcium
QUESTION
What is the effect of von Willebrand disease on the platelets?
a. Increased platelet aggregationb. Decreased platelet aggregationc. Increased platelet formationd. Decreased platelet formation
ANSWER
b. Decreased platelet aggregationRationale: Von Willebrand disease is the
most common hereditary bleeding disorder. It is caused by a deficiency or defect in vWF (which carries a clotting factor). The result of less clotting factor is an inability to clot.
CYCLOOXYGENASE ENZYMES (COX) PRODUCE MEDIATORS OF HEMOSTASIS
Celebrex is a drug that blocks COX-2
Given to block inflamation
People taking Celebrex develop increased TXA2 levels
What problems might they have?
COX-1 COX-2
arachidonic acid
thromboxane A 2 ProstacyclinMacrophage Activation & Inflamation mediationNSAIDs inhibit both COX 1 &2
COX 1 is needed for intestinal mucosaProblems here?
SCENARIO
A man had a stroke and the doctor gave him tissue plasminogen activator (TPA).
Why? What is the doctor trying to accomplish? One of the man’s relatives wondered why they did
not give him heparin or warfarin instead What is the difference? Why might TPA be
more appropriate?
HYPERCOAGULABILITY
Increased platelet number Platelet aggregation Endothelial damage Increased procoagulation
factors Decreased anticoagulation
factors
ANSWER
TrueRationale: Hyper- as a prefix means
“over” or “too much.” Coagulation/coagulability means “clotting/the ability to clot.” Hypercoagulability means “increased ability to clot or form thrombi.”
SCENARIO:
A woman with lupus develops breast cancer.
She is given radiation therapy She begins to develop nosebleeds and bruising Her menstrual period is abnormally heavy
Question:Why did this happen?
PLATELET DISORDERS
Decreased platelet levels (thrombocytopenia) Decreased production Increased destruction Platelets used up in forming clots
Impaired platelet function