Bleeding Disorders

Question 1

these 2 drugs elevate PTT and PT b/c both at common pathway

Answer 1

heparin and warfarin

Question 2

in adults, most commonly due to disease or IV drug therapy; PTT and PT elevated

Answer 2

vitamin K deficiency

Question 3

2 roles of vWF

Answer 3

binds activated platelets on subendothelium AND prolongs half-life of factor VIII

Question 4

can present as teenage girl w/ heavy flow; PTT elevated

Answer 4

vWF disease

Question 5

factor VIII deficiency w/ severe bleeding after trauma or surgery (into joints and muscles); PTT elevated

Answer 5

Hemophilia A

Question 6

Answer 6

hemarthrosis (hemophilia A)

Question 7

factor IX deficiency; looks the same as hemophilia A but not as common

Answer 7

Hemophilia B

Question 8

breakdown of clots due to bacterial infection, medical disorder, or medicine

Answer 8

secondary fibrinolysis

Question 9

lady presents to clinic and has history of miscarriages; (autoimmune)

Answer 9

Antiphospholipid syndrome

Question 10

coagulation disorder most commonly due to infection and burns

Answer 10

Disseminated Intravascular Coagulation (DIC)

Question 11

20% of patients w/ gram - sepsis can develop this

Answer 11

DIC

Question 12

clots form and consume coagulation factors; result is hemorrhage

Answer 12

DIC

Question 13

signs of this include bleeding into surgical wounds and at venous access sites; petechiae and ecchymoses

Answer 13

DIC (clotting factors taken up by disseminating clots)

Question 14

Answer 14

L: petechiae
R: ecchymoses

Question 15

tests for DIC

Answer 15

PT/PTT elevated
D-dimer elevated
low fibrinogen
platelet count

Question 16

Ab mediated accelerated platelet destruction

Answer 16

Idiopathic Thrombocytopenic Purpura (ITP)

Question 17

Increased arterial flow in large arteries and heart chambers can hamper platelet clot formation and repair of the endothelium leading to thrombosis

Answer 17

endothelial injury

Question 18

disruption of blood flow causes what to come in contact with endothelium

Answer 18

platelets

Question 19

most commonly due to endothelial injury and turbulent blood flow

Answer 19

arterial thrombi

Question 20

more commonly due to stasis

Answer 20

venous thrombi

Question 21

gross and microscopic alternating pale lines (platelets and fibrin) and dark line (red blood cells)

Answer 21

Lines of Zahn

Question 22

this can make coagulation cascade more active (hypercoagulability)

Answer 22

birth control

Question 23

3 components of Virchow’s triangle:

Answer 23

1. endothelial injury
2. hypercoagulability
3. abnormal blood flow

Question 24

besides birth control, what other factors affect hypercoagulability

Answer 24

antithrombin III deficiency
elevated factor V
immobilization

Question 25

prevents protein C from inactivating factor V; thrombus in veins

Answer 25

Factor V Leiden mutation

Question 26

nonblanching rash
no platelets (b/c in clots)
fatigue and fever
women in 30s-40s

Answer 26

Thrombotic Thrombocytopenic Purpura (TTP)

Question 27

Fever
thrombocytopenia
hemolytic anemia

Answer 27

TTP triad

Question 28

any patient who comes in complaining of fatigue

Answer 28

draw blood

Question 29

patient presents w/ warm painful swollen leg and jaundice; discomfort in abdomen (mass on pancreas)

Answer 29

Trousseau syndrome

Question 30

lots of clots due to cancer
thromboembuli
paraneoplastic syndrome

Answer 30

Trousseau syndrome