Bleeding and Clotting Disorders

Question 1

Medical history to consider when diagnosing bleeding disorders

Answer 1

epistaxis (>5/yr), gingival bleeding, easy bruising, oozing from minor wounds, GI bleeding, procedural bleeding, menorrhagia, muscle hematomas, hemarthrosis, CNS hemorrhage

Question 2

Four main etiologies of bleeding disorders

Answer 2

coag deficiencies, fibrinolytic defects, vascular disorders, platelet disorders

Question 3

Lab tests to begin diagnosis of bleeding disorder

Answer 3

CBC, plt fx assay, PT/PTT, thrombin time, fibrinogen level

Question 4

How to test for quantitative vWF

Answer 4

antigen

Question 5

How to test for ability of vWF to bind to platelets

Answer 5

cofactor

Question 6

How to test for ability of vWF to protect or enable FVIII

Answer 6

FVIII

Question 7

MOA desmopressin

Answer 7

allow release of vWF from endothelial cells and platelets

Question 8

Inheritance pattern of types 1, 2A, and 2B vWD

Answer 8

autosomal dominant

Question 9

Factor deficiencies that will prolong aPTT

Answer 9

VIII, IX, XI

Question 10

Factor deficiencies that will prolong PT

Answer 10

VII

Question 11

Usefulness of genetic test for hemophilia A

Answer 11

can predict disease severity, eliminates other diseases in the differential

Question 12

What other disease may have decreased FVIII besides hemophilia A?

Answer 12

von Willebrand dz

Question 13

Inheritance pattern of hemophilia A

Answer 13

x-linked recessive

Question 14

Standard therapy for hemophilia A

Answer 14

recombinant FVIII

Question 15

What does a failure to correct in a mixing study for PTT indicate?

Answer 15

inhibitory antibody

Question 16

Acquired primary hemostatic disorders

Answer 16

drug-induced plt destruction/dysfx, aplastic anemia, ITP, hypersplenism

Question 17

Acquired secondary hemostatic disorders

Answer 17

autoimmune inhibitors, other abs, drug-induced factor inhibition, consumption of factors

Question 18

Acquired hemophilia A

Answer 18

typically seen in older adults, may occur postpartum; often associated with autoimmune disease

Question 19

DVT presentation

Answer 19

originates in calf as a painful, “cramping” sensation

Question 20

Pulmonary embolus

Answer 20

complication of thromboembolism, acute hypoxia and right heart failure may ensue

Question 21

How to suspect thromboembolism?

Answer 21

Wells, Geneva criteria: PE/DVT before? CA pt? recent hospitalization, surgery, fracture? Any hemoptysis? Tachycardia? Are you older than 65?

Question 22

How do you diagnose a thromboembolism?

Answer 22

D dimer test, ultrasound for DVT, CT angiogram for PE

Question 23

Compression US for DVT

Answer 23

if there is a DVT, lumen will not compress because of the space-occupying clot

Question 24

Ventilation/Perfusion scan

Answer 24

breathe radiotracer dye to measure ventilation, then inject radiotracer dye to measure perfusion; mismatch can indicate PE

Question 25

White thrombus

Answer 25

arterial, platelet-rich, high shear stress, ATHEROSCLEROSIS

Question 26

Red thrombus

Answer 26

venous, red cell rich, STASIS

Question 27

Paradoxical embolism

Answer 27

passage of embolus from venous circulation to arterial circulation