Bleeding and Clotting Disorders

Question 1

What are some possible problems when dealing with coagulopathy?

Answer 1

Bleeding
Clot formation
Both bleeding and clot formation

Question 2

What types of issues will you see with bleeding?

Answer 2

Immediate or delayed

Question 3

If you have immediate bleeding due to a platelet problem (van Willebrand problem) what could be the causes?

Answer 3

Low number (platelet count)
Poor function (bleeding time)

Question 4

What are clinical findings of immediate (primary) hemostasis defects? *

Answer 4

Mucosal and subcutaneous bleeding (Petechiae, purpura, ecchymoses) 
Spontaneous bleeding (platelet count less than 20 or 30 or non-functioning platelets)

Question 5

What is the main treatment for a low number of platelets?

Answer 5

Transfusion of platelets

Replace von Willebran factor (factor VIII and fibrinogen)

Question 6

What medications could be used in the instance of poor platelet function?

Answer 6

Aspirin (irreversibly)

Question 7

What types of issues will you see with delayed bleeding?

Answer 7

Intrinsic factor PTT

Extrinsic pathway PT (INR)

Question 8

What are the clinical findings of delayed secondary defects?

Answer 8

Hematoma and hemarthroses

Question 9

If there is an abnormal PT (INR)?

Answer 9

Extrinsic pathways affected
Vit K dependent factors depleted
Liver disease
Warfarin (Coumadin)

Question 10

If there is an abnormal PTT?

Answer 10

Intrinsic pathways affected

Inhibited by heparin

Question 11

If there an abnormal PTT and PT/INR?

Answer 11

Common pathway

Question 12

In a 1:1 mixing study, what could normalized test results mean? Non-normalized?

Answer 12

Factor deficiency, factor inhibitor

Question 13

What is the treatment for a elevated PT/PTT?

Answer 13

Immediate, fresh frozen plasma (FFP) medicine to clot blood

Question 14

For vitamin k dependent factor deficiency what should be done?

Answer 14

Vit K 10 units IV only
Vit K orally
Need to synth factors

Question 15

If there is a bleeding and clotting disorder what could occur?

Answer 15

Disseminated intravascular coagulopathy (DIC)

- Inc thrombin a clot formed

Question 16

What is the main product of fibrinolysis due to DIC?

Answer 16

D-dimer +

Question 17

What are some areas of clot formation?

Answer 17

Arterial, microcircular
Venous
Either

Question 18

What is arterial clotting disorder induced by?

Answer 18

Platelets

Question 19

What could arterial clotting lead to?

Answer 19

Myocardial infarction, CVA.stroke, peripheral arterial disease

Question 20

What is the platelet count for essential thrombocytosis?

Answer 20

450-999

Question 21

What would you see in microcirculation clotting disorders?

Answer 21

Thrombotic thrombocytopenic purpura (TTP)

Question 22

What is the the treatment for TTP/HELLP?

Answer 22

Glucocorticoidsteroid for immunosuppression
Immediate: fresh frozen plasma
(to replace the vWF)

Question 23

What is HELLP?

Answer 23

Hypertension, elevated liver enzymes and low platelets (in pregnancy)

Question 24

If you have arterial or venous or both in clotting, what can you expect?

Answer 24

Heparin-induced thrombocytopenia (HIT)
Antiphospholipid antibody syndrome *
Hyperhomocysteinemia

Question 25

Describe Antiphospholipid antibody syndrome *

Answer 25

Thrombosis, fetal loss

Lupus anticoagulant antibody

Question 26

What could occur in a venous clotting disorder?

Answer 26

Deep vein thrombosis

Pulmonary emboli

Question 27

How are venous clotting disorders treated?

Answer 27

Heparin/LMWH short term

Warfarin

Question 28

What is factor V leiden due to?

Answer 28

Venous clotting disorders

Question 29

Factor V leiden

Answer 29

Pts with recurrent VTE, most common hereditary cause
Antithrombin (AT) III deficiency
Protein C and S deficiency