Unit 7 Patho

A client who underwent a bone marrow aspiration has been scheduled for a bone marrow biopsy. The client asks the nurse what the difference is between these two procedures. How should the nurse respond?

"Aspiration obtains a sample of the cells from the marrow, but a biopsy obtains a larger sample to examine structure."

A 23-year-old female client has been diagnosed with von Willebrand disease following a long history of "heavy periods" and occasional nosebleeds. Which of the client's statements demonstrates a sound understanding of the new diagnosis?

"I'll make sure to take acetaminophen instead of aspirin when I get aches and pains."

A woman who has given birth 12 hours ago is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of excessive coagulation can result in bleeding. Which of the nurse's explanations best characterizes DIC?

"So much clotting takes place that there are no available clotting components left and bleeding ensues." -DIC hemorrhage results from an insufficiency of clotting proteins after large scale coagulation.

The staff educator is teaching the nurse orientee about red cell changes in the neonate. The educator knows that the orientee understands the neonatal changes and care when she states:

"The hemoglobin concentration falls after birth due to reduced red cell production and plasma dilution."

The neonate displays a yellow discoloration of her skin on the second day of life. The neonatologist explains this condition to the parents. Which statement is most accurate?

"The increase in bilirubin, which causes the jaundice, is related to the increased red blood cell breakdown."

The pathophysiology student is studying erythropoiesis. Which statement demonstrates understanding of this process?

"The reticulocyte count serves as an index of erythropoietic activity of the bone marrow."

what 3 conditions make up pancytopenia?

-anemia -thrombocytopenia -granulocytopenia if someone is diagnosed with the above conditions, it is called "aplastic anemia"

Hemophilia A treatment

-antifibrinolytics: used to prevent clots from breaking down -fibrin sealant: used to promote clotting -hormone therapy -include more vitamins/minerals in diet such as fruit/veg, calcium, protein -avoid supplements that might adversely affect bleeding and clotting times such as: ginseng, gingko biloba, bromelain, flaxseed, garlic, ginger, bilberry fruit

What is primary antiphospholipid syndrome?

-autoantibodies that attack protein-binding phospholipids causing an increase in coagulation.

antiphopholipid syndrome

-autoimmune disorder -immune system produces antibodies and attacks the normal proteins in the blood. -increased risk for blood clots in legs, kidneys, lungs, and brain If untreated: rapid organ failure, risk for bleeding, recurrent miscarriages, retardation in newborns, risk for stroke/dvt

Eosinophils

-bilobed (two-lobed) nuclei -1%-3% of total WBCs -reside in tissues and not circulation -fight against allergic reactions, parasitic infections, and chronic immune responses r/t conditions like asthma -they release histaminase to inactivate histamine and other inflammatory substances to decrease the severity of the reaction

HOW TO MANAGE THALASSEMIA ?

-blood disorder w/formation of abnormal form of hgb- -eat healthy balanced diet and limit iron-rich food -regular exercise

s/s of multiple myeloma

-bone destruction -hypercalcemia -hyperviscosity of body fluids (increased thickness) -heart failure -nephropathy (damage to kidneys/failure) -recurrent bacterial infections -proteinuria (bence jones protein) -anemia -bone pain -neutropenia

Risk factors for multiple myeloma

-chronic immune stimulation -autoimmune disorders -exposure to ionizing radiation -occupational exposure to pesticides/herbicides -exposure to Agent Orange in Vietnam War

What is von Willebrand disease?

-common hereditary bleeding disorder presenting with a lack of, or defect in, the von Willebrand factor (required for platelet adhesion) necessary in the clotting process. -Type 1 is the most common type, presenting in approximately 70% of the cases -associated with mild to moderate bleeding. -Other than avoiding aspirin, there is typically no treatment advised because the bleeding is usually mild.

Infectious Mononucleosis

-commonly caused by Epstein-Barr virus (EBV); herpesvirus family -can also be caused by cytomegalovirus -occurs in adolescents and young adults -once infected, virus stays in B lymphocytes for lifetime -insidious onset (4-6wks) -high chance of causing splenomegaly (50%-60%) 2-3x its norm size

What is splenomegaly?

-enlarged spleen -can cause pooling of platelets within organ causing decreased circulating platelets leading to thrombocytopenia -if necessary, splenectomy may occur, but only as last resort as spleen produces platelets

B lymphocytes (B cells)

-form antibodies involved in humoral mediated immunity to fight infections -Once exposed, the cells retain memory and are able to quickly fight off pathogens during re-exposure and prevent the disease from reoccurring.

Factor V Leiden Gene Mutation

-inherited hypercoagulability disorder (high mortality/morbidity) -excessive clotting -causes activated protein C resistance -pt at increased risk for developing a DVT/PE

Monocyte characteristics

-kidney shaped nucleus -large amt of cytoplasm

In advanced stages of HL, what organs are affected?

-liver -spleen -lungs -GI tract -occ. the CNS

Diagnostic tests for non-Hodgkin lymphoma (NHL)

-lymph node biopsy with confirmation of Reed-Sternberg cell in specimen sample -immunophenotyping(determines lineage and clonality) -imaging (including bipedal lymphangiogram; special imaging of lymphatic system)

S/S of infectious mononucleosis

-malaise -anorexia -chills/fever -pharyngitis -lymphadenopathy -enlarged lymph nodes commonly in cervical, axillary, and groin areas -sore throat -rash (3%-15%)

Manifestations of HL

-painless enlargement of single node/group of nodes -first node usually develops above level of diaphragm (neck, subclavian, axilla) -fever/chills -night sweats -wt loss -pruritis -fatigue (indicative of disease spread) -anemia (indicative of disease spread)

what is a cytokine?

-part of a healthy immune system -small proteins that help control the growth and activity of your blood cells and immune cells. -Cytokines tell your immune system to do its job. But when too many cytokines are released, it can cause your immune system to go into overdrive, resulting in cytokine storm

Thrombocytopenia causes

-reduced circulation platelets <150,000- -greater risk for bleeding- Causes: -decrease in platelet production r/t bone marrow loss from chemo/radiation -increased sequestration of platelets in spleen (excessive pooling of platelets in spleen r/t splenomegaly) -decreased platelet survival

4 preventions to reduce the risk of hypercoagulability(excess clotting) disorders

-smoking cessation -blood glucose screening -cholesterol screening/mgmt -weight loss(obesity increases risks)

Hodgkin's lymphoma (HL)

-specialized form of lymphoma that features abn cell called "Reed-Sternberg cell" (mononuclear tumor cell) -occurs in early adulthood (15-40years) and older adults 55+ yrs -cause is unk

Granulocytes characteristics

-spherical -multilobular nuclei -phagocytic cells -granules in cytoplasm

A 25-year-old female client with primary antiphospholipid syndrome is discussing the possibility of becoming pregnant. The nurse shares which possible complication(s) that can occur as a result of this syndrome?

-spontaneous miscarriage -premature birth -placental insufficiency

bilirubin (0.3-1.0mg)

-yellowish substance in your blood -forms after red blood cells break down -travels through your liver, gallbladder, and digestive tract before being excreted.

3 types of globulins

1. Alpha: transport bilirubin and steroids 2. Beta: transport iron and copper 3. Gamma: antibodies of the immune system

2 major types of HL

1. nodular lymphocyte-predominant HL: small amt of cases; nodular growth pattern 2. classic HL: clonal proliferation of typical mononuclear Hodgkin cells and multinucleated Reed-sternberg cells

3 hemostasis stages

1. vascular constriction (narrowing of blood vessels r/t contraction of muscular wall of vessels) 2. platelet plug formation 3. blood coagulation

A female client with a diagnosis of psoriatic arthritis is currently taking a course of prednisone for the control of symptoms related to inflammation. Which erythrocyte sedimentation rate (ESR) would indicate that the medication course has decreased the inflammation within normal limits?

10 mm/hr (0-29mm/hr = normal)

absolute neutrophil normal value

1000 -<1000=neutropenia

Normal platelet(thrombocytes) count

150,000-450,000

basophils

A circulating leukocyte that produces histamine. -only 0.3%-0.5% make up of WBCs (least amt) -contain heparin(anticoagulant) and histamine(vasodilator) -involved in allergy and hypersensitivity reactions

What is pernicious anemia?

A condition in which not enough red blood cells are produced due to deficiency of vitamin B12 in the body. -stomach cannot create enough intrinsic factor that helps in absorbing vitamin B12 -extremely rare autoimmune condition -prevention includes increasing intake of vitamin b12

A client with a diagnosis of hemophilia A has been admitted with bilateral knee pain. The nurse should anticipate performing what intervention during the client's treatment?

Administration of factor VIII and implementation of fall prevention measures

thalassemia

An inherited blood disorder characterized by the formation of abnormal form of hemoglobin. -causes tiredness, yellowish skin, dark urine, abdominal swelling and facial bone deformities. -no way to prevent as it is inherited/genetic

Multiple Myeloma

B-cell malignancy of terminally differentiated plasma cells -high morbidity/mortality rates -common in older adults 60+ yrs -unk cause -bone lesions throughout body -ppl w/disease have Bence Jones proteins in their serum, but lack M component

Select the option that best describes the production of T lymphocytes.

Bone marrow → thymus → lymph nodes

A client is prescribed the recumbent granulocyte colony-stimulating factor (CSF) filgrastim. The nurse evaluates the effectiveness by monitoring which laboratory value?

CBC

What is factor IV

Calcium

Which client likely has the highest risk of developing an acquired hypocoagulation disorder and vitamin K deficiency?

Client with a diagnosis of liver failure secondary to alcohol use disorder -Liver disease is strongly associated with vitamin K deficiency due to decreased synthesis and impaired fat absorption. Protein C, a plasma protein, acts as an anticoagulant. It can be acquired if one has severe liver failure, vitamin K deficiency, or malignancy. Renal failure, decreased immune function, and dehydration are not common causes of vitamin K deficiency.

Which client is most susceptible to experiencing the effects of inadequate erythropoiesis?

Client with renal failure as a result of longstanding hypertension -Kidney failure causes an absence of erythropoietin production

A client comes to the clinic with symptoms of fatigue, fever, severe joint pain, and headache. A laboratory results reveal an erythrocyte sedimentation rate (ESR) rate of 60 mm/hour, and a diagnosis of polymyalgia rheumatica (PMR) is confirmed. The nurse anticipates which medications will be prescribed to manage this disease process?

Corticosteroids, such as prednisone

During a client's admission assessment prior to surgery, the nurse notes a reference to a factor V Leiden mutation in the client's history. The nurse assesses this client for an increased risk of developing which postsurgical complication?

DVT -The Leiden mutation predisposes to an increased risk of clotting (like deep venous thrombosis).

Hemophilia A is a hereditary blood disorder caused by inadequate activity or absence of which blood component?

Factor VIII

A client with hemophilia type A comes to the emergency department with severe pain and swelling in the right knee. To reduce musculoskeletal damage, the nurse anticipates the administration of:

Factor VIII replacement therapy -hemophilia A involve defects of factor VIII, which is required for platelet adhesion

The nurse is caring for a postsurgical client who is recovering from knee replacement surgery secondary to rheumatoid arthritis. When planning the client's care, the nurse should include what action?

Frequent assessment for signs of thrombosis or hemorrhage.

The nurse is working with a client awaiting a kidney transplant. The nurse teaches the client about what testing to determine an organ match (histocompatibility)?

Human leukocyte antigen typing

complications of thalassemia

If untreated for a prolonged period it may lead to: -Anemia -Enlarged spleen -Heart failure -Frequent infections -Bone deformities -Difficulty conceiving -Risks during pregnancy, e.g., heart problems, frequent infections, gestational diabetes, low bone density -Iron overload, generally due to frequent blood transfusion

The pathologic effects of the thalassemias are primarily due to which pathophysiologic process?

Impaired hemoglobin synthesis

A client undergoes a splenectomy following an automobile accident. The nurse monitors for which anatomical change most likely to occur following surgery?

Increased white blood cell (WBC) count

Prostacyclin (PGI2)

Inhibits platelet aggregation and prevents adhesion to uninjured endothelium; vasodilator

A nurse educator is explaining to a group of students the differences between leukemias and lymphomas. With respect to classification of these diseases, which explanation is most accurate?

Leukemia arises from precursors in marrow (involves T and B lymphocytes/granulocytes lymphomas originate in peripheral lymphoid structures (lymph nodes)

Which factor differentiates chronic leukemias from acute leukemias?

Leukemic cells are more fully differentiated in chronic than in acute leukemias. -acute is more common in Down syndrome

A nurse orienting to the surgical suite is studying medications that can cause increased risk for bleeding. Which class of medication will the nurse identify as being most commonly associated with decreasing platelet function?

NSAIDs

s/s of pernicious anemia

Pale skin Fatigue or tiredness Headache Swollen tongue or bleeding gums Nausea and vomiting Weight loss Bowel problems Diarrhea or constipation Shortness of breath Nervous system damage in severe cases may lead to: Numbness and tingling in the hands and feet Confusion and loss of concentration loss of balance

A female adolescent is reporting general malaise and lethargy. Which clinical assessment should the nurse perform in an effort to confirm or rule out infectious mononucleosis?

Palpating the client's lymph nodes

The client with a history of gastrectomy presents with severe anemia, mild jaundice, and spastic ataxia. The lab work demonstrates an elevated mean corpuscular volume (MCV). The practitioner suspects the client has which type of anemia?

Pernicious -form of megaloblastic anemia characterized by elevated MCV

A client has been diagnosed with aplastic anemia. The nurse correlates this diagnosis with which laboratory value?

Reduction of white blood cells -Aplastic anemia is caused by bone marrow suppression and usually results in a reduction of white blood cells and platelets, as well as red blood cells

What is petechiae?

Small, red pinpoint hemorrhages/lesions caused by bleeding under the skin -common in bleeding disorders

3 types of lymphocytes

T cells, B cells, NK cells -make up 20%-30% of total WBCs

What are the risks for an older woman (late 30s) to take oral contraceptives?

The incidence of stroke, thromboemboli, and myocardial infarction is greater in women who use oral contraceptives, particularly those older than 35 years of age

The erythrocyte sedimentation rate is a commonly performed blood test used for monitoring the clinical course of a disease. It is a measurement of how rapidly red blood cells will aggregate and drop to the bottom of a tube as a sediment in anticoagulated blood. What influences the rate of fall that would give information about the clinical course of a disease?

The rate of fall is faster in the presence of fibrinogen that is increased in an inflammatory disease.

The nurse is teaching a client about how a vaccine can help create immunity to a virus. What information does the nurse provide?

The vaccine causes B lymphocytes to create antibodies against the virus. -The B lymphocytes differentiate to form antibody-producing plasma cells and are involved in humoral-mediated immunity.

A nurse is discussing precautions necessary to avoid excessive bleeding with a client who has been diagnosed with type 1 von Willebrand disease. Which statement is most accurate to share with this client?

There is no treatment except to avoid aspirin.

A 6-year-old child is having a stem cell transplant using umbilical cord blood. What benefit does the nurse understand that this type of transplant will have for the child?

This type of transplant creates less risk of graft versus host disease

A client was started on 5000 units of heparin twice daily. For which immune response-associated health problem should the nurse monitor this client?

Thrombocytopenia

A nurse is treating a client with aplastic anemia. Due to the replacement of normal bone marrow with malignant cells, the nurse teaches the client to prevent scratches, scrapes, and cuts. What root cause likely underlies the client's increased risk for hemorrhage?

Thrombocytopenia -results from a decrease in megakaryocytes due to overcrowding of the bone marrow. With fewer megakaryocytes the client will have fewer circulating platelets and will be at risk for bleeding.

True or False: Hemophilia patients require transfusions for clotting factors

True

The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of:

Vitamin B12 deficiency anemia -b12 is found in all foods of animal origin

Thrombotic Thrombocytopenic Purpura (TTP)

a rare disorder that causes blood clots (thrombi) to form in small blood vessels throughout the body

During the administration of a blood transfusion, the client suddenly reports chills and fever. After stopping the transfusion, which treatment is recommended for this common blood transfusion reaction?

acetaminophen -A febrile reaction is the most common transfusion reaction. Recipient antibodies directed against the donor's white cells or platelets cause chills and fever. Antipyretics are used to treat this reaction.

A client suffered a laceration in his workshop and lost a significant amount of blood. The clots that formed have begun to retract. The process of clot dissolution has begun, which starts with:

activation of plasminogen

aplastic anemia

affect RBC, WBC, and platelet production

The nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is:

aggressive -evolve rapidly -heterogeneous group of germinal/post-germinal center neoplasms -occurs in all ages; more prevalent 60-70yrs

The most abundant plasma protein is:

albumin (54% of all plasma proteins) -too large to pass thru pores in capillary wall so it stays in circulation -also acts as a blood buffer

major types of plasma proteins

albumin, globulins, fibrinogen -produced by liver and secreted into blood

Which lymphatic tissue is associated with mucous membranes and is called mucosa-associated lymphatic tissue, or MALT?

alimentary canal and genitourinary systems

"pan-"

all, entire

The drug most closely associated with inhibition of platelet aggregation is _________.

aspirin

Hematopoiesis

blood cell formation

erythrocyte sedimentation rate

blood test that measures inflammation activity in the body -helps evaluate progression of inflammatory diseases -0-29mm/hr normal range

B and T lymphocytes development begins in _______ _______ and ends in _______ ________ structures.

bone marrow peripheral lymphoid

A client is suspected of having acute leukemia. Which diagnostic test does the nurse prepare for to verify that diagnosis?

bone marrow biopsy

T lymphocytes production (T-cells)

bone marrow-->thymus-->lymph nodes -involved in cell-mediated immune response

What element is required in all steps of clotting?

calcium (factor IV)

"-emia"

condition of blood

Regulation of blood cells is thought to be controlled in part by which hormone-like growth factor?

cytokines

Thrombocytopenia

decreased # platelets

The nurse is caring for a client who has a low level of T lymphocytes. The nurse plans care for a client with:

decreased immune response

"-enia"

decreased or deficient

What is pancytopenia?

deficiency of all blood cells -low RBCs (anemia) -low WBCs (Leukopenia) -low platelets (thrombocytopenia)

Fibrinolysis

dissolution of a clot -activated plasminogen utilizes in this process to dissolve the clot

A patient developed a hemorrhage during surgery. Which hematology lab results would be expected?

elevated reticulocyte count -reticulocyte is an immature RBC and when there is a hemorrhage, more immature RBCs are released from bone marrow into the bloodstream

The practitioner notes the client has a yellowish discoloration of the skin. Which lab result would the practitioner expect to see?

elevated unconjugated bilirubin

Which colony-stimulating factor (CSF) is given to clients with end-stage renal disease to help with chronic anemia?

erythropoietin (EPO)

Polycythemia

excess of red blood cells/increased blood viscosity -thick blood -increased risk for blood clots

hemophilia A

extremely rare blood clotting disorder r/t insufficient clotting factors -blood doesnt clot like it is supposed to -causes excess bleeding, pain, swelling/tightness in joints, blood in urine/stool, epistaxis

What lab test measures volume of RBCs?

hematocrit

sickle cell causes an abnormal ___________.

hemoglobin S (HbS) -sickle cell is an inherited disorder

purpura

hemorrhages in the skin and mucous membranes that result in the appearance of purplish spots or patches.

A client is diagnosed with pernicious anemia. The nurse determines the most likely cause of this condition is related to:

history of a gastrectomy. -Pernicious anemia is a specific form of megaloblastic anemia caused by atrophic gastritis and failure to produce intrinsic factor that leads to failure to absorb vitamin B12.

cytokines

hormone-like growth factors that are short-lived mediators that stimulate the proliferation, differentiation, and functional activation of various blood cells.

NK cells function

immune surveillance "The primary job of natural killer (NK) cells is to hunt down and destroy foreign cells in the body."

Thrombocytopathy

impaired platelet function that may have developed from inheritance(genetics), drugs, disease, or extracorporeal circulation (ECMO)

Increased sedimentation rate indicates __________ and is used as a baseline and trend indicator in managing, for example, psoriatic arthritis.

inflammation

A critical care nurse is preparing a case study on the treatment of acute coronary syndrome (ACS), which describes glycoprotein factor (GPIIb/IIIa) inhibitors and their role in decreasing thrombosis by:

interfering with the ability of platelets to bind to one another. -The glycoprotein receptor GPIIb/IIIa on the platelet surface enables fibrinogen to bind and platelets to link together to form larger aggregates. By inhibiting these receptor sites, as the GPII/IIIa inhibitors do, platelet aggregation and thrombus formation are decreased.

A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating?

leukemia

What organ is responsible for producing majority of the clotting factors?

liver

cliet has fatigue Labs: Hct 40% Hgb 8 WBC 8000 Platelets 175,000 The nurse will interpret these results as indicative of which diagnosis?

low Hgb/anemia -Hct is low (42%-52%) -hgb is low (14-17.4) -WBC is normal (4000-11000) -platelets normal (150,000-450,000)

The process of clot retraction squeezes serum from the clot, thereby joining the edges of the broken vessel. Through the action of actin and myosin, filaments in platelets contribute to clot retraction. Failure of clot retraction is indicative of:

low platelet count -clot retraction requires a large number of platelets

When collecting a client's history the client states that he is receiving treatment to maintain remission from leukemia. What does the nurse document that the client is receiving?

maintenance therapy

Thrombotic Thrombocytopenic Purpura (TTP) complications

neuro: personality changes, headaches, confusion, slurred speech) -fever -abn. kidney function -abdominal pain -heart problems

What cell makes up more than half of a WBC count?

neutrophils (55%-65%) -they are the first WBC to elevate in acute infection

A client undergoing chemotherapy has a critically low platelet count. To stimulate platelet cell production, the nurse expects to administer:

oprelvekin, which is a thrombopoietin -stimulates bone marrow cells(megakaryocytes)

A patient has red face, hands, feet, and ears; headache; drowsiness. Blood smear shows increased erythrocytes. Based on these findings, what disease does the pt have?

polycythemia -unregulated overproduction of the red cell mass

hemolytic anemia

premature destruction and hence a shortened RBC life span. Anemia results when bone marrow production can no longer compensate for the shortened RBC survival -RBCs destroyed faster than can be made

Erythropoiesis

production of red blood cells

Absolute Neutrophil Count (ANC)

real # of WBCs that are neutrophils -WBC x % of neutrophils in diff WBC count -normal range 2,500-6,000 - <1000 level = increased risk of infection

"erythro-" means:

red

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. The primary goal of his treatment will be to:

reduce the viscosity of his blood.

plasmapheresis

removal of plasma from withdrawn blood by centrifuge

Mononuclear cells

second type of leukocytes -round nucleus -no granules (agranulocytes)

Conjugated vs unconjugated bilirubin

solubility Conjugated is soluble(able to be dissolved) in water but not in fats Unconjugated is soluble in fats but not in water

What organ is associated with platelet storage and destruction?

spleen

When assessing the mouth of a client receiving chemotherapy, which of the following should the nurse interpret as a possible indicator of neutropenia?

stomatitis -other indications: skin lesions, pharyngitis, diarrhea

Hemostasis

stoppage of bleeding hair like fibrin strands glue the aggregated platelets together to form blood clot-->plasma becomes gel-like and traps RBCs-->hemostasis process finished when fibrous tissue grows into the clot and seals the hole in the vessel

Interleukins function

support the development of lymphocytes.

The nurse is caring for a client in the intensive care unit who has lung cancer and bacterial sepsis from a centrally inserted intravenous line. The nurse realizes that the client is at high risk of developing:

thrombosis -This client has three of the risk factors for hypercoagulability leading to the development of thrombosis: lung cancer, sepsis, and a centrally inserted intravenous line.

"-poiesis" means:

to make

True or False. Many hemolytic anemias are attributable to autoimmune disorders.

true

s/s hyperbilirubinemia

usually results in adults from an underlying condition (gallstones, Gilbert's syndrome, liver dysfunction, hepatitis, bile duct inflammation, hemolytic anemia) -jaundice -abdom pain/swell -chills/fever -chest pain -weakness -lightheadedness -fatigue -nausea/vomit -dark urine

A client presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which diagnosis should the medical team first suspect?

vit k deficiency -results from impaired fat absorption caused by liver or gallbladder disease

Many different proteins, enzymes, and hormones are involved in maintaining hemostasis. Which protein is required for platelet adhesion?

von Willebrand factor -required for platelet adhesion -produced by the endothelial cells of blood vessels and circulates in the blood as a carrier protein for coagulation factor VIII.