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• Bleeding problem = Starts with plt count (starting point) e. Sensitive to abnormalities of : (PVV = Pinoy Vig Vroder)
• There should be 7-20 plts / OIF i. Plt numbers and functions
ii. Vessel Wall
FALSELY LOW PLT COUNT (EGI * EG) iii. vWF deficiencies
• EDTA induced plt satellitism
• Giant Platelets f. Affected by: (QTPM = Cute PM ^^)
• Incipient Clotting i. Quality of Blood Vessels
ii. Thickness of Skin
SPURIOUS ↑ PLT COUNT (Pray MedTech) iii. Plt Count & Plt Function
• Precipitated eryoglobulin (Marked ↑) iv. Medication (Aspirin--> Prolongs BT)
• RBC/WBC Cytoplasmic Fragments
• Microcytic RBC g. Methods: (DITG = Dick In Touch Geez)
• Turbid Plasma i. Duke Method
1) Puncture earlobe, 3rd or 4th finger
SIGNIFICANT PLT COUNT VALUES 2) NV = 1-5 minutes of 2 minutes
3) Wipe the 1st blood with filter paper
<100K / uL Abnormally Low 4) Wipe it every 30 seconds
30k - 80k / uL Bleeding Possible with Trauma ii. Ivy Method
1) It uses blood pressure cuff (sphygmomanometer) inflated at 40
<30K / uL Spontaneous Bleeding Possible
mmHg
<5K / uL Severe Spontaneous Bleeding iii. Template Bleeding Time
1) Modified Ivy Method
PLT ESTIMATE 2) Uses standardized lancet
• Use of blood smear a) 1 mm depth x 5 mm width
• 3-10 plts / 100 RBCs (Note: +2 x2 x2)
• 5-20 plts / 200 RBCs Interpretation:
1) Prolonged in (VVTA= ViVi TAyo)
SIGNIFICANT PLT ESTIMATES a) vWF Deficiency
• Ave # of plts x 20k b) Vascular Disorder
c) Thrombocytopenia
0 49k Marked ↓
d) Acquired and Inherited Plt Disorder
50k 99k Mod. ↓
100k 199k Slightly ↓ Plt Count BT
200k 400k NORMAL Normal Prolonged * Qualitative Disorder
401k 599k Slightly ↑ * Vessel Wall Structure Abnormalities
600k 800k Mod. ↑ Low Normal * Autoimmune thrombocytopenia
>800k Marked ↑ Low Prolonged *Qualitative and Quantitative Disorders
PLT SATELLITISM
• IgG antibody against GP2B3A (Note: GrouP 2 BEA) iv. Glass Bead Retention Time
• Plts surround WBC (Neutrophil) 1) Principle:
• Occurs when EDTA is used a) When blood is passed through a glass bead column, normal
• FALSE ↓ of plt count platelets that have access to normal vWF will adhere and
• To Correct aggregate to the beads such that effluent from the column
○ Use SODIUM CITRATE will have a much lower plt count than the starting sample
○ Multiply plt count by 1.1 b) Second plt count < First plt count
▪ PLT COUNT x 1.1 c) Detained plt = >70% = NV
i) Plt Count 1 - Plt Count 2/ Plt Count 1 x 100
2 TYPES OF PLT COUNT
1. Direct Plt Count PLT AGGREGATION
○ Not Accurate • Requires GP IIb/IIIa
○ Uses RBC pipet, Diluting Fluid or Unopette • Plt Activation Pathway
2. Undirect Plt Count • Function Test: Aids in the Dx of Hereditary and Acquired Plt Disorders
○ Plts are counted in relation to 100 RBCs • Substances causing Plt Aggregation: (EC TARA)
○ Uses Stained Smear ○ Epinephrine
○ Collagen
DIRECT METHOD ○ Thrombin (Human)
1. TOCATIN METHOD ○ ADP
Ristocetin