Blood Disorders (Exam III)

Question 1

What is the number 1 most common bleeding disorder?

Answer 1

vWF disorder (platelet adhesion dysfunction)

Question 2

What are the S/S of vWF disorder?

Answer 2

Easy bruising
epistaxis
menorrhagia (menstrual bleeding)

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 (Vaso)
• 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 (max effect)
• Duration: 6-8hrs

Don’t bolus DDAVP; drip slowly.

Question 8

What are the side effects of DDAVP?

Answer 8

• HA
• Stupor
• hypotension (if given quickly)
• tachycardia
• hyponatremia (d/t retention of water, pt needs to be on strict fluid restriction- no toilet water!)
• water intoxication(excessive water retention)

Question 9

What is the major side effect of DDAVP?

Answer 9

Hyponatremia due to water retention (dilutional)

Na+ 120: Confusion, restlessness, wide QRS
Na+ 115: Somnolence, nausea, elevated ST, wide QRS
Na+ 110 Seizure, coma, V-tach, V-fib

Question 10

Someone that gets DDAVP needs to be on what?

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) and it is pooled from many donors

Question 14

What is Factor VIII concentrate made of?

Answer 14

Pool of plasma from a large number of donors.
Contains Factor VIII and vWF

Question 15

When is Factor VIII given?

Answer 15

Preop or intraop

Question 16

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

Answer 16

• Cryoprecipitate
• Not sent for viral attenuation

Question 17

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

Answer 17

• Dural Hematoma
• Nerve compression

Question 18

What are the anesthesia considerations for someone with vWF deficiency?

Answer 18

• Avoid trauma (Get the best intubator performing DL)
• avoid IM sticks (Will cause localized tissue trauma)
• avoid arterial lines (if feasible) not the patient for you to practice A-lines on
• avoid spinals- the spine is not easy to hold compression on if the patient is bleeding

Question 19

How does heparin work?

Answer 19

• Heparin activates antithrombin III
• AT-III then inhibits thrombin to stop clots from ever forming

Question 20

What labs are monitored with heparin?

Answer 20

PTT &/or ACT

Question 21

What is the mechanism of action of Coumadin?

Answer 21

Inhibition of vitamin K-dependent factors.
That is why vitamin-k is the antidote for Warfarin

Question 22

Which factors are vitamin-K dependent?

Answer 22

II, VII, IX & X
(2, 7, 9, 10)

Question 23

What is the onset for Vitamin K?

Answer 23

6-8hrs
So don’t think it is a quick reversal!

Question 24

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

Answer 24

• Prothrombin complex concentrates
• Factor VIIa
• FFP

Question 25

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

Answer 25

**Convert plasminogen to plasmin**, which cleaves fibrin (clot buster)

Question 26

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

Answer 26

**Inhibit conversion of plasminogen to plasmin** Plasmin that is never formed cannot break up the clot, so it is PRO-CLOT

Question 27

What is the **best** way to treat DIC?

Answer 27

Treat the underlying cause

Question 28

What will labs show for someone in DIC?

Answer 28

- ↓PLTs - Prolonged PT, PTT & TT. - ↑ fibrin degradation products

Question 29

When is antifibrinolytic therapy given to someone in DIC?

Answer 29

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

Question 30

What is factor V Leiden?

Answer 30

- Protein for clotting. *Activated protein C inactivates factor V thus stopping clot growth (negative feedback)*.

Question 31

What is Factor V Leiden deficiency?

Answer 31

Genetic mutation of Factor V Leiden where Activated protein C cannot complete the negative feedback loop of clot promation thus excessive fibrin/clots are created.

Question 32

What does Activated Protein C do?

Answer 32

Inactivates factor V when enough fibrin has been made.

Question 33

Who is usually tested for Factor V Leiden?

Answer 33

**Pregnant women.** Especially ones with unexplained late stage miscarriages

Question 34

What anticoagulant medications could a pregnant woman with Factor V Leiden be put on?

Answer 34

- LMWH - For individuals with severe Factor V, they will be placed on Coumadin

Question 35

What is the hallmark sign of HIT?

Answer 35

Plt count <100,000 *Thrombocytopenia occurs 5-14 days after initial heparin therapy and affects 5% of patients exposed to unfractionated heparin and rare cases LMWH.*

Question 36

HIT results in ____ activation and potential____?

Answer 36

platelet; thrombosis/microclots

Question 37

What is heparin replaced with when HIT is diagnosed and why?

Answer 37

Argatroban or bivalirudin (direct-thrombin inhibitors) Bc they still need anti-clot meds for whatever they were on the heparin for in the first place

Question 38

What is Fondaparinaux & when is it used?

Answer 38

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