Blood Disorders (Exam II)

Question 1

What is the most common hereditary bleeding disorder?

Answer 1

vWF disorder

Question 2

What are the S/S of vWF disorder?

Answer 2

• Easy bruising
• epistaxis
• menorrhagia

Question 3

What would lab values be for someone with vWF deficiency?

Answer 3

• Normal PT & aPTT
• Bleeding time is prolonged

Question 4

What are the treatments for vWF deficiency?

Answer 4

• Desmopressin (DDAVP)
• Cryoprecipitate
• Factor VIII

Question 5

How does DDAVP work in regards to treatment of von Willebrand deficiency??

Answer 5

Stimulates vWF release from endothelial cells

Question 6

What is the dose for DDAVP?

Answer 6

0.3 mcg/kg in 50 mL over 15-20 mins (Do not bolus)

Question 7

What is the onset & duration of DDAVP?

Answer 7

• Onset: 30mins
• Duration: 6-8hrs

Question 8

What are side effects of DDAVP?

Answer 8

• HA
• rubor/flushing
• hypertension? hypotension?
• tachycardia
• hyponatremia
• water intoxication (excessive water retention)

Question 9

What is the most major side effect of DDAVP?

Answer 9

Hyponatremia

Question 10

Someone that gets DDAVP needs to be on what to prevent water intox and hyponatremia?

Answer 10

Fluid restriction 4-6hrs before & after DDAVP

Question 11

What blood product can be utilized for vWF disease if the patient is unresponsive to DDAVP?

Answer 11

Cryoprecipitate

Question 12

1 unit of Cryo raises the ____ level by ___?

Answer 12

Fibrinogen by 50 mg/dL

Question 13

What is a potential risk factor with cryoprecipitate?

Answer 13

Increased risk of infection (not submitted to viral attenuation)

Question 14

What is Factor VIII concentrate made of?

Answer 14

Pool of plasma from a large number of donors.

Question 15

What stage of surgery is Factor VIII given?

Answer 15

Preop or intraop

Question 16

When should DDAVP be given prior to surgery?

Answer 16

60mins before Sx

Question 17

What blood product poses an increase risk for infection? Why?

Answer 17

• Cryoprecipitate
• Not sent for viral attenuation

Question 18

Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?

Answer 18

• Hematoma
• Nerve compression

Question 19

What are the anesthesia considerations for someone with vWF deficiency?

Answer 19

• Avoid trauma (particularly airway)
• avoid IM sticks
• avoid arterial lines (if feasible)
• avoid spinals

Question 20

How does heparin work?

Answer 20

• Inhibition of Thrombin (needed to convert fibrinogen to fibrin)
• Antithrombin III activation

Question 21

What labs are monitored with heparin?

Answer 21

PTT &/or ACT

Question 22

What is the mechanism of action of Coumadin?

Answer 22

Inhibition of vitamin K-dependent factors.

Question 23

Which factors are vitamin-K dependent?

Answer 23

II, VII, IX & X

Question 24

What is the onset for Vitamin K reversal of coumadin?

Answer 24

6-8hrs

Question 25

What drugs/products can be given to reverse coumadin faster than Vit K?

Answer 25

• Prothrombin complex concentrates
• Factor VIIa
• FFP

Question 26

What is the mechanism of action for fibrinolytics (UK, streptokinase & tPA)?

Answer 26

Convert plasminogen → plasmin, which cleaves fibrin ⇒ lysis of clot

Question 27

How do tranexamic acid (TXA) and aminocaproic acid work?

Answer 27

Inhibit conversion of plasminogen to plasmin (prevents lysis of clot)

Question 28

What is the best way to treat DIC?

Answer 28

Treat the underlying cause

Question 29

What will labs show for someone in DIC?

Answer 29

• ↓Platelet count
• Prolonged PT, PTT & TT.
• ↑ fibrin degradation products

Question 30

When is antifibrinolytic therapy given to someone in DIC?

Answer 30

Trick question, it shouldn’t. Can lead to catastrophic thrombotic complications

Question 31

What is factor V?

Answer 31

• Protein for clotting, plays role in prothrombin → thrombin.

Activated protein C inactivates factor V thus stopping clot growth.

Question 32

What is Factor V Leiden?

Answer 32

Genetic mutation where Activated protein C cannot stop factor V Leiden thus => excessive fibrin.

Question 33

What does Activated Protein C do?

Answer 33

Inactivates factor V when enough fibrin has been made.

Question 34

Who is usually tested for Factor V Leiden?

Answer 34

Pregnant women. Especially ones with unexplained late stage abortions

Question 35

What anticoagulant medications could someone with Factor V Leiden be put on?

Answer 35

• Warfarin
• LMWH & UFH

Question 36

What is the hallmark sign of HIT?

Answer 36

Plt count <100,000

thrombocytopenia

Question 37

HIT results in ____ activation and potential____?

Answer 37

platelet; thrombosis

risk thombosis 30-75%

Question 38

What is heparin replaced with when HIT is diagnosed?

Answer 38

Agratroban, bivalirudin, lepirudin (direct-thrombin inhibitors)

Question 39

What is Fondaparinux & when is it used?

Answer 39

• A synthetic Factor Xa inhibitor
• used to treat VTE in HIT

Question 40

Serum Na+ of 120 mEq/L CNS changes? EKG changes?

Answer 40

CNS: confusion, restless

EKG: widened QRS

Question 41

Serum Na+ of 115 mEq/L CNS changes? EKG changes?

Answer 41

CNS: somnolence, nausea

EKG: Elevated ST, widened QRS

Question 42

Serum Na+ of 110 mEq/L CNS changes? EKG changes?

Answer 42

CNS: seizures, coma

EKG: Vtach or Vfib

Question 43

How does Factor VIII compare to cryo in terms of infection?

Answer 43

Undergoes viral attenuation, poses less infection risk

Question 44

What should be confirmed before surgery in vWF disorder pt?

Answer 44

Normalized bleeding time and improved F VIII levels

Question 45

Rapid reversal of heparins anticoagulant effect by?

Answer 45

Protamine (+ polypeptide)

Question 46

What benefits does LMWH have compared to UFH?

Answer 46

• fewer effects on platelet function
• reduced risk of HIT

Question 47

How would you describe DIC?

Answer 47

systemic coagulation activation leading to excess clotting ⇒ exhaustion of platelets and coagulation factors

Question 48

When would you often see thrombocytopenia in HIT?

Answer 48

5-14 days after initial therapy