Bleeding Patient Review excel

Question 1

How big are platelets?

Answer 1

2-3 uM in diameter

Question 2

How long to platelets live?

Answer 2

9-10 in circulation

Question 3

T or F: Newly formed platelets are smaller than normal platelets?

Answer 3

False. Larger (megathrombocytes)

Question 4

T or F: Platelets have mitochondria?

Answer 4

TRUE

Question 5

What are the platelet granules and what do they contain?

Answer 5

Dense - ATP, ADP, serotonin, calcium. Alpha - vWF, fibrinogen, Factor V, factors for platelet activation. Lysosomal - acid hydrolases.

Question 6

Which platelet receptor interacts directly with the exposed subendothelium.

Answer 6

GpVI

Question 7

T or F: A hemophiliac with normal platelet count and function will have a normal bleeding time?

Answer 7

True. Bleeding time is the platelet plug formation (primary hemostasis).

Question 8

Which disorders will have decreased bleeding time?

Answer 8

Disorders of low platelet count or abnormal platelet function.

Question 9

What is used more commonly instead of bleeding time now?

Answer 9

PFA-100 test (platelet function analyzer)

Question 10

T or F: vWF disease will cause increased bleeding time?

Answer 10

True. A disorder of primary and secondary hemostasis

Question 11

What type of vWF disease does DDAVP (arginine vasopressin treat)?

Answer 11

Type 1 only.

Question 12

How do you test for Bernard-Soulier syndrome?

Answer 12

Ristocetin test. According to pathoma, platelets will also be very large (Big Suckers)

Question 13

What is afibrogenemia?

Answer 13

Defects in fibrinogen. A primary and secondary hemostasis disorder due to lack of GpIIb/IIIa interaction and fibrin clot formation

Question 14

What does Clopidogrel (Plavix) do?

Answer 14

ADP receptor inhibitor

Question 15

What are the treatments for ITP?

Answer 15

corticosteroids, rituximab, IVIG, splenectomy, TPO agonist

Question 16

What is the differential for thrombocytopenia?

Answer 16

Bone marrow disorder - aplastic anemia, primary myelofibrosis, myeldysplatic syndrome, leukemia; Metastasic cancer; TB; Toxins; B12/folate deficiency; ITP - auto or alloimmunity; TTP; HUS; DIC

Question 17

What are the characteristics of TTP?

Answer 17

fever, renal insufficiency, microangiopathic hemolytic anemia with schistocytes, metal status changes, thrombocytopenia, release of large vWF multimers

Question 18

What causes TTP?

Answer 18

Deficiency in ADAMTS13, which cleaves vWF multimers

Question 19

What are the characteristics of HUS?

Answer 19

Similar to TTP but usually more renal failure

Question 20

What type of bleeding is associated with a primary hemostasis disorder?

Answer 20

Mucocutaneous bleeding

Question 21

What type of bleeding is associated with a secondary hemostasis disorder?

Answer 21

soft tissue/joint/deep bleeding

Question 22

How can you test for fibrinogen defects?

Answer 22

Thrombin clotting time (TCT)

Question 23

What is the main growth factor for megakaryocytes?

Answer 23

TPO (thrombopoetin)

Question 24

What are the 4 events in the formation of a platelet plug?

Answer 24

adhesion, activation, aggregation, fibrin formation

Question 25

Which platelet receptor binds to collagen?

Answer 25

Gp1a/2a

Question 26

What are the 4 major ways platelet count can be decreased quantitatively?

Answer 26

Decreased production, abnormal distribution, increased destruction, dilution

Question 27

What are the 2 major ways platelet count can be decreased qualitatively?

Answer 27

Inherited disorder, acquired disorder (medications, renal failure, cardiopulmonary bypass)

Question 28

What is a normal platelet count?

Answer 28

150-400, 000/ uL

Question 29

What is pseudothrombocytopenia?

Answer 29

appearance of platelet aggregation in a smear due to processing (typically caused by EDTA). Solution - run second smear using sodium citrate.

Question 30

What is the differential for impaired/decreased platelet production?

Answer 30

Bone marrow failure, nutrition, ETOH, malignancies, drug-induced, radiation, viral infection

Question 31

What is the differential for platelet disorders of dilution or distribution?

Answer 31

Hypersplenism, ETOH, hematologic disorders, storage diseases, consumption due to active bleeding or clotting, massive transfusion

Question 32

What are major risks of long-term TPO agonist use?

Answer 32

myelofibrosis, thrombosis

Question 33

What is the differential for disorders of increased destruction of platelets?

Answer 33

ITP, autoimmune (Lupus, RA), drugs, DIC, sepsis, TTP, post-transfusion purpura

Question 34

What is the inheritance pattern of von Willebrand Disease?

Answer 34

Autosomal dominant

Question 35

What does brisk bleeding from obvious trauma suggest about a bleeding disorder?

Answer 35

Local vascular defect

Question 36

What does prolonged/recurrent bleeding suggest about a bleeding disorder?

Answer 36

generalized hemostatic disorder

Question 37

What does sudden resumption of bleeding suggest about a bleeding disorder?

Answer 37

excessive fibrinolysis or abnormal crosslinking of fibrin

Question 38

What does multiple site bleeding suggest about a bleeding disorder?

Answer 38

More severe, generalized hemostatic disorder

Question 39

What other disorder may cause abnormal results in PFA-100 test?

Answer 39

anemia

Question 40

T or F: Medications can cause abnormal PFA-100 tests.

Answer 40

True, aspirin and NSAIDs.

Question 41

T or F: PFA-100 test can distinguish clotting disorder from low platelet count?

Answer 41

FALSE