Skill #26
Kirstin Krueger #21839116
Video: BMBT https://youtu.be/NslDVnN9y-g Coagulation is the term used to describe a series of events that result in the formation of a clot. Coagulation should occur naturally in the body after any bodily injury to a blood vessel or soft tissue, in order to stop the bleeding. This involves the interaction of cells called endothelial cells, which are cells that line the injured blood vessel, platelets, which are cells that help form a plug in the region of the damaged blood vessel, and circulating coagulation factors.
The Buccal Mucosal Bleeding Time, or BMBT
This is a test that can be performed quickly in the clinic in order to evaluate the ability of platelets to form a platelet plug. The BMBT is usually reserved for patients that have normal platelet numbers but have questionable platelet function. The BMBT tests contain a small spring-loaded cassette that is used to produce a small, precise cut on the inside of the patients upper lip, in order to measure the length of time required for bleeding to stop. This time may be lengthened by a decreased platelet count or by decreased platelet function.
Instructions for Buccal Mucosal Bleeding Time (BMBT) Test
A BMBT test is a screening test only. This test only measures the time it takes for bleeding to stop. The test is useful for evaluating primary hemostasis but will not differentiate between platelet function and vascular defects.
MATERIALS NEEDED
Bleeding time device
Small BMBT
This test is used to detect the hemolytic activity in the bacteria. A darkish green color on the media around the bacteria would represent incomplete hemolysis. A transparent media around the bacteria colony represents complete lysis of the red blood cells. If no change is observed around the bacteria colony then the bacteria is non-hemolytic. For my
What impact does the illness have on the blood’s ability to clot? Include the role of vitamin K and the specific clotting proteins affected. Also discuss platelet production. Describe the test that is typically run to test the blood’s clotting ability.
A person with a normal platelet count has between 150,000 to 450,000 per each microliter of blood in the body. With Thrombocytopenia, patients have platelet counts that are less than 150,000 per microliter of blood. Platelets help to promote blood clotting. When a person receives a cut, or injures themselves, platelets come to the site of injury and bind to damaged vessel, thus causing a blood clot and helping to stop the bleeding that accompanies the injury (Williams). However, with a reduced platelet count, this function can be impaired. Patients can easily bruise or bleed due to even a slight bump, as well as experience nosebleeds. Bleeding gums are another symptom of Thrombocytopenia (MDS Foundation). Based on symptoms, doctors might decide to test a patient for Myelodysplastic
Verbally or in writing, screen the individual for blood components, transfection factors deficiencies, which are critical to the cascade of the clotting of blood after injury.
A focused assessment is an assessment that centers directly on the chief complaint that a patient presents with when they arrive to seek out care. In this case, our assessment is focused on a potential deep vein thrombosis (DVT). A DVT is a essentially a ball of blood cells that are clumped together impeding blood flow which can cause irritation to the vein and potentially more dangerous problems. If the thrombus moves, it can travel through the body and into the lungs and impeded breathing which is not good. Therefore, it is essential to catch DVT’s right away and treat them to prevent them from moving. The first thing that needs to be assessed when a patient presents with a suspected DVT is their level of consciousness and their vital signs including the heart rate, blood pressure, respirations, temperature and oxygen saturation. Next, assess the site of the expected DVT, and perform a neurovascular assessment which comparing to the same site on the opposite side of the patients body. Check for adequate circulation by assessing for pink color distal to the site. While performing this assessment, you want the area distal to the site to be pink to ensure there is adequate blood flow. If it is whitish in color, this is a sign of a DVT and needs to be documented. While assessing color, also assess the site directly for any color deviation from the clients natural skin color. If the
A hematocrit test. This test measures how much space your red blood cells take up.
The bleeding occurs following trauma to the tissue this could be an overload of a tissue or even external force. One of the bodies first initial haemodynamic responses to bleeding is vasoconstriction which narrows the blood vessels causing decreased blood velocity, in 2008 (Watson) states that this is due to the release of noradrenaline(norepinephrine); the reaction last lasts only a few seconds to a minute. It is also explained by (Terkeltaub & Ginsberg, 1988) that both lymphatic and blood vessels are plugged to limit any fluid loss and platelet, aggregation is stimulated by the presence of thrombin. Vasoconstriction responds primarily to haemostasis which is a response to prevent blood loss and a platelet plug is formed to support the prevention of excessive
Disseminated intravascular coagulation (DIC) is a serious problem involving abnormal clotting of blood throughout the body. Normally, when you get cut, special proteins help your blood clot at the injury site. In DIC, the protein factors that control blood clotting become abnormally active. Small blood clots form that can clog up blood vessels and can cut off the blood supply to important organs, such as the liver, brain, or kidneys. As DIC worsens, the blood does not clot very well and serious bleeding can occur. This can be life-threatening. DIC can be sudden onset (acute) or long-term (chronic).
Rotational Thromboelastometry (ROTEM, TEM Innovations GmbH, Munich, Germany) and thromboelastography (TEG, Haemoscope, Braintree, MA) are whole blood coagulation analyzers that measure viscoelastic changes of the entire clotting process. Compared to the prothrombin time (PT/INR) and partial thromboplastin time (aPTT), which measure coagulation factor function, TEG/ROTEM can evaluate platelet function, clot strength, and fibrinolysis, (de Laz, Nascimento, & Rizoli, 2013). This additional information can help guide resuscitation efforts by classifying bleeding due to coagulopathy. As a result, the need for platelets, cryoprecipitate (fibrinogen, Factor VIII, von Willebrand factor, &
The occlusion, caused by a haemostatic plug or thrombus is comprised of a fibrous protein called fibrin. This protein polymerises to create a tightly woven mesh, trapping platelets within the fibrin fibre meshwork, resulting in the
Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
The resultant factor XIIa causes thrombin activation, which in turn cleaves circulating soluble fibrinogen to generate an insoluble fibrin. Factor Xa an intermediate in the clotting cascade, causes increase in vascular permeability and leukocyte emigration. Thrombin participates in inflammation by enhancing leukocyte adhesion to endothelium and by generating fibrinopeptides that increase vascular permeability and are chemotactic for leukocytes. While activated Hageman factor is inducing clotting, it is concurrently activating the fibrinolytic system. The resulting product, plasmin also cleaves the complement C3 to component C3a, causes vasodilation and increase vascular permeability.47
The precursor to thrombin is prothrombin, an inactivated protein produced in the liver. Upon injury prothrombin converts to thrombin with the purpose of catalyzing the conversion of fibrinogen to fibrin. The process changes the blood plasma soluble fibrinogen to fibrin, which is not plasma soluble. In order to do this the interaction removes two peptide chains from the ends of fibrinogen. Once this reaction is complete fibrin will begin to form a blood clot around the site of injury. While the interaction between fibrinogen is important it is not the only major
Second question is about ABGs. I began shadowing and sticking ABGs to complete my competency check off. During my observation I noticed everyone reruns the blood. This is new to me, so I was just curious to know the significance of rerunning it. I know in the hospital we didn't unless we questioned the results but then
Haemostasis occurs in three stages, vascular platelet phase, activation of coagulation cascade producing a clot and initiation of control mechanisms. Coagulation tests are used measure the functions associated with clotting, which involves drawing blood, chelating out the calcium and beginning the clot in a controlled environment, to discover if an individual has a clotting disorder or a factor deficiency. There are many disorders that cause problems with coagulation for example thrombophilia and haemophilia. (Hillyer 2009)