Bleeding disorders

Question 1

Primary hemostasis

Answer 1

Platelet plug

Question 2

Secondary Hemostasis

Answer 2

coagulation cascade

Question 3

Epistaxis with gingival bleeding, easy bruising and menorrhagia is hallmark

Answer 3

primary hemostasis failure

Question 4

Delayed bleeding, or bleeding into muscles and joints is consistent with

Answer 4

secondary hemostasis failure

Question 5

Identifies platelet disorders and vessel-wall integrity

Answer 5

Bleeding time

Question 6

Tests conversion of fibrinogen to fibrin

Answer 6

Thrombin time

Question 7

Used to identify excessive fibrinolysis

Answer 7

Fibrinogen, fibrinogen degradation products, d-dimer

Question 8

Common acquired bleeding disorders

Answer 8

Liver Disease
Vit K def
Factor inhibitors
DIC

Question 9

Bleeding due to Vit K def should be treated with

Answer 9

FFP

Question 10

Bleeding due to factor inhibitor should be treated with

Answer 10

Activated factor concentrate (kcentra?)

Immunosuppression

Question 11

Peripheral smear in DIC

Answer 11

Schistocytes

Question 12

Treatment for bleeding in DIC

Answer 12

platelets and coag factory replacement

Treat underlying disorder

Question 13

Serious bleeding at any INR in patient on warfarin

Answer 13

Kcentra/ 4f=PCC
or
3fPCC with FFP
or 
rfVIIa

Question 14

Differentials for Prolonged PT and normal aPTT

Answer 14

Factor VII deficiency or inhibitor
Liver disease
Vit K def
Warfarin ingestion

Question 15

Differentials for normal PT, prolonged aPTT

Answer 15

Deficiency of Factors VIII, IX, XI or XII
vWD (if factor VIII is low)
Heparin exposure

Question 16

Differentials for Prolonged PT and aPTT

Answer 16

Deficiency of factors V, X, II or fibrinogen
Severe liver disease, DIC, Vit K def, warfarin toxicity
Heparin overdose

Question 17

Differentials for Normal PT and aPTT in a patient who is bleeding

Answer 17

Platelet dysfunction
vWD (if mild bleeding and FVIII is not too low)
Scurvy
Ehlers-Danlos
Hereditary hemorrhagic telangiectasia
Factory XIII deficiency

Question 18

Factor associated with Hemophilia A

Answer 18

Factor VIII

Question 19

Factor associated with Hemophilia B

Answer 19

Factor IX

Question 20

Factor XI deficiency is rare and mild. It is found in

Answer 20

Ashkenazi Jews

Prolonged PTT, normal PT, thrombin time and bleeding time

Question 21

PT and PTT findings in hemophilia

Answer 21

PT normal, PTT prolonged

Question 22

What should mild Hemophilia A patients receive for acute bleeding and before minimally invasive procedures

Answer 22

Desmopressin

Question 23

How to differentiate Liver disease labs from DIC

Answer 23

Factor VIII

Made by endothelial cells

Question 24

Most common inherited bleeding disorder

Answer 24

vWD

Question 25

Normal function of vWF

Answer 25

vWF adheres platelets to injured vessels and carries VIII

Question 26

Lab findings in vWB

Answer 26

elevated bleeding time, normal PT, normal or prolonged PTT

Question 27

Treatment for vWD

Answer 27

Estrogen- can regulate menstrual cycle and increase vWF
DDAVP before minor procedures
Pure factor VIII (contains vWF)

Question 28

Cryo should not be used to treat vWD because of its

Answer 28

increased transfusion infection risk