19 Approach to a Bleeding Patient

Question 1

Bleeding is prevented through the process of ____

Answer 1

Hemostasis

Question 2

Vessel wall

Platelets

Answer 2

Primary hemostasis

Question 3

Plasma proteins e.g. clotting and fibrinolytic factors

Answer 3

Secondary hemostasis

Question 4

Follows a cell-based model of hemostasis

Answer 4

Secondary hemostasis

Question 5

Secondary hemostasis begins with the release of ____ and ____ during the initiation phase

Answer 5

Tissue factor

FVII

Question 6

The most important aspect of initiation is the production of a _____

Answer 6

Thrombin burst

Question 7

Coagulation tries to perpetuate itself, multiplying its effects
FIX along with FVIIIa as the intrinsic tenase compex will activate FX

Answer 7

Propagation phase

Question 8

FXa and FVa complex produced during the propagation phase will activate FII

Answer 8

Clot formation

Question 9

Responsible for the conversion of fibrinogen to fibrin

Answer 9

FIIa

Question 10

Important question to ask in the history of a bleeding patient

Answer 10

Spontaneous bleeding or trauma induced?

Question 11

Systemic diseases associated with bleeding disorder

Answer 11

Liver disease

Renal disease

Question 12

Tells us the adequacy of anti-coagulation factors with vitamin K antagonists

Answer 12

International normalized ratio

Question 13

Measured after the addition of tissue factor, phospholipid and calcium

Answer 13

Prothrombin time

Question 14

If PT is prolonged, there is likely an issue with _____

Answer 14

Vitamin K dependent factors

Question 15

Measured after the addition of negatively charged particles

Answer 15

Partial thromboplastin time

Question 16

To differentiate between factor deficiency or factor inhibition

Answer 16

Mixing test

Question 17

If mixing test corrects the prolonged PTT then suspect for ___

Answer 17

Factor deficient

Question 18

If PTT is still prolonged after a mixing test then suspect for ____

Answer 18

Anticoagulation or inhibitors

Question 19

Thromobocytopenia can result from 3 mechanisms

Answer 19

Decreased production
Increased sequestration
Increased destruction

Question 20

Immune mediated destruction of platelets

Possibly immune-mediated inhibition of platelet release from megakaryocyte

Answer 20

Immune thrombocytopenia

Question 21

Acute and self-limiting ITP

Usually presents after a viral infection

Answer 21

Childhood ITP

Question 22

ITP is treated if bleeding occurs, usually if the platelet count is ____

Answer 22

<30 (but bleeding occurs at <20)

Question 23

If the patient has to undergo a surgery, transfuse a blood until platelet count reaches ___

Answer 23

100 (50 for other procedures)

Question 24

To suppress immune responses for treating patients ITP

Answer 24

Prednisone
Steroids
IV immunoglobulin

Question 25

Monoclonal antibody that acts against protein CD20 found on the surface of B cells

Answer 25

Rituximab

Question 26

Due to mutations in genes encoding FVIII or FVIX, which are found on chromosome ______

Answer 26

Hemophilia

10

Question 27

Causes for hemophilia among women

Answer 27

Turner syndrome
Lyonization
Mutation
Inhibitors

Question 28

Christmas disease

Answer 28

Hemophilia B

Question 29

Bleeding in the joints

Answer 29

Hemarthrosis

Question 30

Joint which is affected in hemophilia

Answer 30

Target joint

Question 31

Treatment modalities for hemophilia

Answer 31

Desmopressin
Transfusion
Gene therapy

Question 32

Used as a spray

Stimulates release of FVIII from storage site

Answer 32

Desmopressin

Question 33

Side effect of using desmopressin

Answer 33

Tachyphylaxis

Question 34

Exposure of circulation to pathologic levels of tissue factor leading to organ failure

Answer 34

Disseminated intravascular coagulation

Question 35

Important causes of DIC

Answer 35

Bacterial sepsis
Obstetric complications
Acute promyelocytic leukemia

Question 36

Signs of microangiopathy

Answer 36

Schistocytes and cell fragments under the microscope

Question 37

Treatment for DIC

Answer 37

Heparin
Resolve underlying cause
Platelets