Bleeding Disorders Flashcards
Measures effectiveness of the Intrinsic Pathway.
Partial Thromboplastin Time (PTT)
(PITT = Intrinsic)
Measures effectives of the Extrinsic Pathway.
Prothrombin Time (PT)
(PET = Extrinsic)
X-linked recessive disorder that affects the clotting cascade due to a lack of Factor VIII (8). Occurs predominantly in males.
Hemophilia A
X-linked recessive disorders that affects the clotting case due to a lack of Factor IX (9). Occurs almost exclusively in males.
Hemophilia B
What will a CBC and Coagulation study shown in patients with Hemophilia?
Prolonged PTT
Normal bleeding time
What medication can be used to increase Factor III (8) and von Willebrand Factor in patients with Hemophilia A?
Desmopressin (DDAVP)
What is the first line therapy for Hemophilia A
Factor VIII (8) Infusion
What is the first line therapy for Hemophilia B
Factor IX (9) Infusion
What type of bleeding is seen in patients with Hemophilia
Deep Tissue Bleeding
Soft Tissue Bleeding
Most common inherited cause of hypercoagulability (thrombophilia) especially in Whites.
Factor V Leiden Mutation
(Activated Protein C Resistance)
What is the pathophysiology of Factor V Leiden Mutation?
Mutated activated Factor V is resistant to normal breakdown by Protein C
What are the signs and symptoms of Factor V Leiden Mutation?
Venous Thromboembolism
DVT
Pulmonary Embolism
Thrombosis in Unusual Veins
How do you diagnose Factor V Leiden Mutation?
Activated Protein C Resistance Assay
(confirm with DNA testing)
How do you treat a patient for Factor V Leiden Mutation?
Anticoagulation Medications
(Oral or Warfarin)
Inherited Autosomal Recessive disorder most prevalent among individuals of Ashkenazi Jewish descent. Mild bleeding is most common, and diagnosis is often made after unexpected, excessive bleeding following surgery or trauma
Hemophilia C (Factor XI)
What may not be prolonged in Hemophilia C (Factor XI) that is prolonged with Hemophilia A and B?
Partial Thromboplastin Time (PTT)
What is the mainstay of treatment for patients with Hemophilia C (Factor XI)
Factor XI Replacement
Fresh Frozen Plasma if it is not available
Adjunctive Aminocaproic Acid or Tranexamic Acid
Most commonly inherited bleeding disorder (autosomal dominant) with ineffective platelet adhesion due to a specific deficient or defective factor.
von Willebrand Disease
What types of bleeding problems are especially common in patients with von Willebrand Disease?
Gynecologic
What factor may be slightly low in a patient with von Willebrand Disease?
Factor VIII (8)
What is the criterion standard for the diagnosis of von Willebrand Disease?
Ristocetin-Induced Platelet Aggregation
What is the primary treatment medication for a patient with Mild to Moderate von Willebrand Disease?
Desmopressin
What is the primary treatment of a patient with severe von Willebrand Disease or a patient who lacks von Willebrand Factor entirely?
Infusion of von Willebrand Factor-containing product
An acquired Thrombocytopenia that typically occurs within the first 5 - 10 days of initiation of a specific anticoagulant
Heparin Induced Thrombocytopenia
Heparin Induced Thrombocytopenia is caused by the formation of autoantibodies that are attacking what targets?
Hapten Complex of Heparin + Platelet Factor 4
What happens to the platelets during Heparin Induced Thrombocytopenia?
Platelets drop by at least 50% in 5 - 10 days after Heparin treatment
What is the Gold Standard test for the diagnosis of Heparin Induced Thrombocytopenia?
Serotonin Release Assay
What are the 4 Ts of Predicting Heparin Induced Thrombocytopenia?
Thrombocytopenia
Timing of Platelet Drop
Thrombosis
OTher causes Absent
A 4Ts score of 6 - 8 would indicated what with HIT?
High Probability
A 4Ts score of 4 - 5 would indicate what with HIT?
Intermediate Probability
A 4Ts score of 0 - 3 would indicate what with HIT?
Low Probability
How do you treat Heparin Induced Thrombocytopenia?
Stop Heparin + Start Agatroban
Order diagnostic test
Doppler all 4 extremities for thrombosis
Consumptive coagulopathy due to uncontrolled fibrin production leading to widespread micro-thrombi and clotting factors as well as platelets are consumed.
Disseminated Intravascular Coagulation (DIC)
What infections are common causes of Disseminated Intravascular Coagulation?
Bacterial Sepsis
Rocky Mountain Spotted Fever
In most cases of Disseminated Intravascular Coagulation, what gains entry into the blood?
Pro Coagulant Tissue Factor
(lipoprotein)
What are the signs and symptoms of DIC?
Diffuse Bleeding
Thrombosis
Gangrene
Multi-organ Dysfunction
What lab value will be markedly elevated in a patient with DIC?
D-Dimer
What would a peripheral smear show in a patient with DIC?
Schistocytes
Fragmented Red Blood Cells
How will DIC affect:
PT
PTT
Bleeding Time
Platelet Count
PT = Increased
PTT = Increased
Bleeding Time = Increased
Platelet Count = Decreased
What is the treatment for DIC?
Supportive (Treat the Underlying cause)
Platelet Transfusion
Fresh Frozen Plasma
Cryoprecipitate to replace Fibrinogen
