Acquired Coagulopathies

Question 1

Commonly associated with bleeding are liver disease, vitamin K deficiency, and renal failure.

Answer 1

Chronic Disorders

Question 2

Accounts for most instances of fatal hemorrhage, and 3000 to 4000 hemorrhage-related deaths can be prevented through coagulopathy management

Answer 2

Trauma-induced coagulopathy (TIC)

Question 3

Defined as any single or multiple coagulation factor or platelet deficiency, and TIC is triggered by the combination of injury-related acute inflammation, hypothermia, acidosis, and hypoperfusion

Answer 3

Coagulopathy

Question 4

Poor distribution of blood to tissues associated with low blood pressure

Answer 4

Hypoperfusion

Question 5

Leads to acute reduction of ADAMTS13 with a related rise in ultra-large VWF multimers and VWF-triggered platelet activation.

Answer 5

Systemic shock

Question 6

ADAMTS13 means

Answer 6

a-disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13

Question 7

ADAMTS13 is also known as

Answer 7

vWF cleaving protease

Question 8

Also leads to tissue factor release, coagulation factor activation, loss of coagulation control proteins, and hyperfibrinolysis.

Answer 8

Shock

Question 9

Defined as blood loss exceeding total blood volume within 24 hours, loss of 50% of blood volume within a 3-hour period, blood loss exceeding 150 mL/min, or blood loss that necessitates plasma and platelet transfusion

Answer 9

Massive Hemorrhage

Question 10

Trauma center MTPs specify that unmatched ___ or ___ be warmed and administered to the victim en route or immediately on hospital arrival

Answer 10

Thawed group AB or group A plasma

Question 11

T/F: Clinicians may continue administering equal amounts (1:1:1) of warmed red blood cells (RBCs), plasma, and single (random) donor platelet concentrate, approximating the makeup of whole blood

Answer 11

TRUE

Question 12

A key TIC management component.

Answer 12

Plasma

Question 13

Donor services separate and freeze plasma within 24 hours of collection, officially naming the product

Answer 13

FP-24

Question 14

FP-24 may be subsequently thawed and stored at

Answer 14

1-6degC for up to 5 days

Question 15

FP-24 plasma product officially named

Answer 15

Thawed Plasma

Question 16

These components decline to approximately 60% after 5 days of refrigerator storage, so thawed plasma may require supplementation with factor concentrates, especially in patients with VWD or hemophilia

Answer 16

VWF and coagulation factor V and VIII activities

Question 17

Generally ineffective when the patient has immune thrombocytopenia, thrombotic thrombocytopenic purpura, or heparin-induced thrombocytopenia

Answer 17

Platelet concentrate therapy

Question 18

TACO means

Answer 18

Transfusion-Associated Circulatory Overload

Question 19

TRALI means

Answer 19

Transfusion-Related Acute Lung Injury (TRALI)

Question 20

Shows promise in early TIC intervention and may reduce the need for MTP

Answer 20

ADAMTS13

Question 21

May be used at a dosage of 50 units/kg every 12 hours, not to exceed 200 units/kg in 24 hours

Answer 21

Activated prothrombin complex concentrate

Question 22

T/F: Nonactivated prothrombin complex concentrates (PCCs) such as four-factor concentrate Kcentra (CSL Behring) are safer and may also be employed.

Answer 22

TRUE

Question 23

Either activated or non-activated, may be used in conjunction with the antifibrinolytic lysine analog tranexamic acid

Answer 23

ADAMTS13 concentrate and PCCs

Question 24

is effective and commonly employed for TIC, though this too is an off-label application

Answer 24

Trenexamic Acid (TXA)

Question 25

indicated when there is microvascular bleeding and the fibrinogen concentration is less than 100 mg/dL.

Answer 25

Cryoprecipitate

Question 26

A 15 to 20 mL cryoprecipitate unit provides how many mg of fibrinogen?

Answer 26

150 to 250mg of fibrinogen

Question 27

Dosage of 30 􏰀g/kg is rapidly effective in halting microvascular hemorrhage in nonhemophilic trauma victims

Answer 27

NovoSeven

Question 28

May be used to measure post-therapy platelet function, and coagulation factor assays are valuable as follow-ups to PT and PTT to determine whether the target activity of 30 units/dL has been met for each

Answer 28

Platelet aggregometry