Acquired Coagulopathies

Question 1

Acquired Coagulopathies

Answer 1

1. Trauma-induced Coagulopathy
2. Liver Disease Coagulopathy
3. Chronic Renal Failure and Hemorrhage
4. Vitamin K Deficiency and Hemorrhage
5. Autoanti-Factor VIII Inhibitor and Acquired Hemophilia
6. Von Willebrand Disease
7. Disseminated Intravascular Coagulation

Question 2

is defined as any single or multiple coagulation factor or platelet deficiency

Answer 2

Coagulopathy

Question 3

Accounts for most instances of fatal hemorrhage. Is triggered by the combination of injury-related acute inflammation,
hypothermia, acidosis, and hypoperfusion (elements of systemic shock)

Answer 3

Trauma-Induced Coagulopathy

Question 4

Trauma-Induced Coagulopathy Systemic shock leads to:

Answer 4

1. Acute reduction of ADAMTS-13
2. A rise in UL-vWF
3. VWF-triggered platelet activation
4. Tissue factor release
5. Coagulation factor activation
6. Loss of coagulation control proteins
7. Hyperfibrinolysis

Question 5

1.Blood loss exceeding total blood volume within 24 hours Loss of 50% of blood volume within a 3 hour period
2. Blood loss exceeding 150 mL/min
3. Blood loss that necessitates

Answer 5

Massive Hemorrhage

Question 6

TIC Management-Trauma-Induced Coagulopathy

Answer 6

1. Plasma: is the key TIC management component
2. Freeze plasma for 24 hours (FP-24)
3. VWF and Factors V and VIII activities decline to approximately 60% after 5 days of refrigerator storage

Question 7

Bleeding associated may be localized or generalized, mucocutaneous or anatomic

Answer 7

Liver Disease Coagulopathy

Question 8

are a complication of chronic alcohol cirrhosis

Answer 8

Esophageal varices

Question 9

occurs in liver disease-associated thrombocytopenia

Answer 9

Mucocutaneous bleeding

Question 10

is the consequence of procoagulant dysfunction and deficiency

Answer 10

Anatomic bleeding

Question 11

Liver Disease Coagulopathy

Answer 11

Procoagulant deficiency
Platelet abnormalities
DIC

Question 12

Liver produces nearly all of the plasma coagulation factors and regulatory proteins
Hepatitis, cirrhosis, obstructive jaundice, cancer, poisoning, congenital disorders of bilirubin metabolism (may suppress
the biosynthetic function of hepatocytes)

Answer 12

Liver Disease Coagulopathy:
Procoagulant Deficiency

Question 13

alters the production of the Vitamin K-dependent factors (des-y-carboxyl forms)

Answer 13

Liver Disease

Question 14

serves as the sensitive early marker for liver disease

Answer 14

Factor VII

Question 15

is a more specific marker of liver disease than
deficient factors II, VII, IX, and X (used in conjunction with the factor VII assay)

Answer 15

Factor V

Question 16

becomes elevated in early or mild liver disease

Answer 16

Fibrinogen

Question 17

fibrinogen is coated with excessive sialic acid (in moderately to severely diseased liver)

Answer 17

Dysfibrinogenemia

Question 18

fibrinogen may fall to this level in end-stage
liver disease

Answer 18

<100 mg/dL

Question 19

may result from sequestration and shortened platelet survival

Answer 19

Platelet count of <150,000/uL

Question 20

also suppresses platelet production

Answer 20

Acute alcohol toxicity

Question 21

is a significant complication of liver disease

Answer 21

Chronic or compensated DIC

Question 22

1. Decreased liver production of regulatory proteins
   2.Release of activated procoagulants from degenerating liver cells

Answer 22

Disseminated Intravascular Coagulation

Question 23

Treatment to Resolve Liver Disease-Related Hemorrhage

Answer 23

1. Oral or intravenous vitamin K therapy
2. Plasma transfusion: provides a volume of 200-280 mL

Question 24

Is often associated with platelet dysfunction and mild to moderate mucocutaneous bleeding (anemia and thrombocytopenia)

Answer 24

Chronic Renal Failure and Hemorrhage

Question 25

Fibrin deposits in renal microvasculature reduce glomerular function

Answer 25

Chronic Renal Failure and Hemorrhage

Question 26

Guanidinosuccinic acid or phenolic compounds coat the platelets

Answer 26

Chronic Renal Failure and Hemorrhage

Question 27

Chronic Renal Failure and Hemorrhage, Corrected by:

Answer 27

dialysis RBC transfusions erythropoietin therapy

Question 28

is a state of increased glomerular permeability associated with a variety of conditions. Clotting factors II, VII, IX, X, XII, antithrombin, and protein C have been detected in the urine

Answer 28

Nephrotic syndrome

Question 29

Acquired by patients fed only with parenteral (intravenous) nutrition for an extended period or when people embark upon fad diets

Answer 29

Vitamin K Deficiency and Hemorrhage

Question 30

Vitamin K is fat soluble and requires___for absorption (biliary duct obstruction, fat malabsorption, chronic diarrhea)

Answer 30

bile salts

Question 31

Vitamin K Deficiency

Answer 31

Hemorrhagic Disease of the Newborn Vitamin K Antagonists

Question 32

Newborns are constitutionally vitamin K deficient because:

Answer 32

1. sterile intestines 2. Minimal concentration of vitamin K in human milk 3. Breastfeeding

Question 33

Vitamin K Deficiency and Hemorrhage: Vitamin K Antagonists

Answer 33

Warfarin (Coumadin)

Question 34

disrupts the vitamin K epoxide reductase and vitamin K quinone reductase reactions

Answer 34

Warfarin (Coumadin)

Question 35

the single most common reason for hemorrhage-associated emergency department visits

Answer 35

Coumadin overdose

Question 36

Vitamin K Deficiency and Hemorrhage: Vitamin K Antagonists The liver releases

Answer 36

PIVKA factors

Question 37

the most common acquired autoantibodies

Answer 37

Autoanti-factor VIII

Question 38

Patients who have acquired hemophilia are often: ○ Older than 60 ○ Have no apparent underlying disease

Answer 38

Autoanti-factor VIII

Question 39

Autoanti-Factor VIII Inhibitor and Acquired Hemophilia. Is occasionally associated with:

Answer 39

1. Rheumatoid arthritis 2. Inflammatory bowel disease 3. SLE 4. Lymphoproliferative disease 5. Pregnancy

Question 40

Factor Inhibitors other than Autoanti-Factor VIII

Answer 40

1. Antiprothrombin antibodies 2. Autoanti-factor XIII 3. Autoantibodies to factor V 4. Autoanti-factor X

Question 41

Develop as lupus anticoagulant

Answer 41

Antiprothrombin antibodies

Question 42

Documented in patients receiving isoniazid treatment for tuberculosis

Answer 42

Autoanti-factor XIII

Question 43

May arise spontaneously in autoimmune disorders and after exposure to bovine thrombin in fibrin glue

Answer 43

Autoantibodies to factor V

Question 44

In amyloidosis

Answer 44

Autoanti-factor X

Question 45

With symptoms similar to those of congenital vWD

Answer 45

Acquired von Willebrand Disease

Question 46

Has been described in hypothyroidism, benign monoclonal gammopathies, Wilms tumor, intestinal angiodysplasia, congenital heart disease, pesticide exposure, uremia, lupus erythematosus, autoimmune, lymphoproliferative, and myeloproliferative disorders

Answer 46

Acquired von Willebrand Disease

Question 47

Acquired von Willebrand Disease ● Treatment for bleeding:

Answer 47

DDAVP or plasma-derived factor VIII/VWF concentrate (Humate-P, Wilate, Alphanate)

Question 48

Acquired von Willebrand Disease Cryoprecipitate: NO longer recommended for treatment

Answer 48

True