Bleeding Disorders

Question 1

In primary hemostasis, what is increased?

Answer 1

BLEEDING TIME

• Von Willebrand Dz (A.D.)
• Bernard-Soulier Dz
• COX inhibitors - ASA, NSAIDs
• Glanzmann’s Dz

Question 2

Pt with h/o HIT and platelet 4 Ab positive who needs urgent surgery. Best option for intraoperative anticoagulation and post-op ppx? if Ab negative?

Answer 2

DTI Bivalirudin for URGENT sx. But for ELECTIVE sx, delay surgery for 3 months.
If Ab negative - give IV heparin during surgery and subQ fondaparinux post-op

Question 3

Pt with hemophilia A with 10% factor VIII. Treatment?

Answer 3

desmopressin spray +/- tranexamic acid (anti-fibrinolytic agent)

Question 4

Tx of platelet dysfunction (mild vs severe)

Answer 4

mild –> DDAVP (stimulates vWF/facVIII)
severe –> VWF concentrates
NO CRYOPRECIPITATES

Question 5

What is the treatment of choice for patients with bleeding and hypofibrinogenemia secondary to disseminated intravascular coagulation?

Answer 5

Cryoprecipitate

Question 6

Patients with coagulopathy of liver disease and low fibrinogen levels who are experiencing bleeding should receive what transfusion immediately?

Answer 6

cryoprecipitate

Question 7

What is first-line therapy option in treating ITP in pregnancy?

Answer 7

IVIG; treat when plt is < 30K

Question 8

What is a cause of heparin resistance?

Answer 8

Antithrombin deficiency

Question 9

Increased PTT with bleed corrected by 1:1 mix of normal plasma

Answer 9

factor deficiency (e.g., Von willebrand dz, tx with DDAVP)

Question 10

Increased PTT with bleed NOT corrected by 1:1 mix of normal plasma
- tx?

Answer 10

acquired hemophilia (inhibitor of FVIII) aka Abs to FVIII
tx = activated FVII

Question 11

increased PTT with NO bleed NOT corrected by 1:1 mix of nl plasma with increased risk of thrombosis/abortions

Answer 11

Lupus anticoagulant (increased risk of thrombosis)