Blood Disorders (Exam III) Marcus's Cards

Question 1

What are the S/S of vWF disorder?

Answer 1

Easy bruising
epistaxis
menorrhagia

Question 2

What would lab values be for someone with vWF deficiency?

Answer 2

• Normal PT & aPTT
• Bleeding time is prolonged

Question 3

What are the treatments for vWF deficiency?

Answer 3

• Desmopressin
• Cryoprecipitate
• Factor VIII

Question 4

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

Answer 4

Stimulates vWF release from endothelial cells

Question 5

What is the dose for DDAVP?

Answer 5

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

Question 6

What is the onset & duration of DDAVP?

Answer 6

• Onset: 30mins
• Duration: 6-8hrs

Question 7

What are side effects of DDAVP?

Answer 7

• HA
• rubor
• hypotension
• tachycardia
• hyponatremia
• water intoxication (excessive water retention)

Question 8

What is the most major side effect of DDAVP?

Answer 8

Hyponatremia

Question 9

Someone that gets DDAVP needs to be on what?

Answer 9

Fluid restriction 4-6hrs before & after DDAVP

Question 10

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

Answer 10

Cryoprecipitate
- 1 unite increases fibrinogen by 50mg/dL

Question 11

1 unit of Cryo raises the ____ level by ___?

Answer 11

Fibrinogen by 50 mg/dL

Question 12

What is a potential risk factor with cryoprecipitate?

Answer 12

Increased risk of infection (not submitted to viral attenuation)

Question 13

What is Factor VIII concentrate made of?

Answer 13

Pool of plasma from a large number of donors.

Question 14

When is Factor VIII given?

Answer 14

• give to in vWF disease if unresponsive to DDAVP (type 3! Maybe type 2B & 2N)
• Preop and intraop
• contains F VIII & vWF

Question 15

When should DDAVP be given prior to surgery?

Answer 15

60mins before Sx

On set of DDAVP is 30 min. It needs to be infused over 15 to 20 minutes

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

• Hematoma
• Nerve compression

Question 18

What are the anesthesia considerations for someone with vWF deficiency?

Answer 18

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

Question 19

How does heparin work?

Answer 19

• indirect thrombin inhibition
• Antithrombin III activation

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.
II, VII, IX, X

Question 22

Which factors are vitamin-K dependent?

Answer 22

II, VII, IX & X

Question 23

What is the onset for Vitamin K administration?

Answer 23

6-8hrs

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

Question 26

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

Answer 26

**Inhibit conversion of plasminogen to plasmin**

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

- ↓Platelet count - 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*.

Question 31

What is Factor V Leiden deficiency?

Answer 31

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

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 abortions

Question 34

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

Answer 34

- Warfarin - LMWH & unfractionated heparin

Question 35

What is the hallmark sign of HIT?

Answer 35

Plt count <100,000 *thrombocytopenia*

Question 36

HIT results in ____ activation and potential____?

Answer 36

platelet; thrombosis

Question 37

What is heparin replaced with when HIT is diagnosed?

Answer 37

Agratroban or bivalirudin (direct-thrombin inhibitors)

Question 38

What is Fondaparinux & when is it used?

Answer 38

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