Professional Documents
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Platelets (Thrombocytes)
Function interact with injured vascular wall structures, plasma proteins, other circulating blood cells
a. Adhesion: adhere to basement membrane of injured blood vessel b. Release action: release of alpha & dense granules, & lysosomes c. Aggregation: formation of secondary, irreversible platelet aggregation
Coagulation:
Starts with activation of Thromboplastin, from injured tissue
Fibrinolytic System:
Endothelial cells
Heparin
Antithrombin
Physical Exam:
Test of choice for monitoring anticoagulant therapy by Vit K antagonists (II, VII, IX, X) Principle: Thromboplastin + Platelet-poor plasma & Ca++ react w/ FVII to activate FX --convert Prothrombin to Thrombin
Specimen source:
Citrated platelet-poor plasma (PPP) Reference Range: Values differ
10 12 seconds or 12 14 seconds
Reporting:
1. Patient time in sec w/ Ref range 2. Patient time in sec w/ control time 3. Prothrombin ratio (PT divided by mean of Ref range multiplied by 100) 4. Percent Activity (outdated?)
5. International Normalized Ratio (INR): - Widely used nowadays - Comparison of Patient value with the normal value =
result is normalized to an international reference preparation (IRP) of thromboplastin
Interpretation of results:
Sensitivity: detect deficiencies of <40% - 50% of normal Prolonged PT indicates abnormality in:
Common pathway Extrinsic pathway Abnormality may be acquired or hereditary Factor inhibitors
Specimen source:
Citrated platelet-poor plasma (PPP)
Reagents:
Phospholipid w/ Activators (PTT reagent) 0.025 M CaCl2
Reporting:
Reported in seconds, to the nearest tenth, along with reference range.
Interpretation:
Prolonged PTT in the absence of Heparin use indicate:
Factor deficiency Acquired circulating anticoagulant (e.g. Lupus inhibitor) Antibody to a specific Factor (e.g. anti-FVIII)
Sources of Error:
1. Sample collection & preparation
a. b. c. d. e. Improper collection & specimen processing Incorrect anticoagulant-to-plasma ratio Hemolysis Platelets in plasma sample Unexpected heparin contamination
2. Reagent preparation
a. Improper storage b. Water impurities c. Incorrect dilution
3. Instrumentation
a. b. c. d. Failing light source Fluctuations in temperature Loss of calibration of tubing Contamination
Specimen:
Capillary blood from finger puncture
Values are lower because of clumping at puncture site
Method of Determination:
1. Manual Count
a. Unopette system b. Hemacytometer
Clinical Significance:
Thrombocytopenia:
Platelet values lower than normal
Thrombocytosis:
Platelet values higher than normal
CLOTTING TIME Time required for a blood sample to coagulate/clot in vitro under standard conditions. Most common method: Capillary Tube Method. Affected by calcium ion levels and many diseases.
BLEEDING TIME Principle: BT is the time it takes for a standard wound to stop bleeding Comprehensive test of platelet action in vivo & is sensitive to the following abnormalities:
1. Platelet numbers & function 2. Plasma VIII:vWF deficiencies 3. Vessel wall composition
Reference range:
2 to 9 minutes