Blood Disorders (Exam III) Marcus's Cards

Question 1

What are the S/S of vWF disorder?

Answer 1

• Easy bruising
• epistaxis
• menorrhagia
• Patients usually unaware until surgery

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 vWF?

Answer 4

• A synthetic analogue of vasopressin
• Stimulates vWF release from endothelial cells

Question 5

What is the dose for DDAVP?

Answer 5

0.3 mcg/kg-0.8mcg/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
• Stupor
• 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

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

• Prepared from pool of plasma from a large number of donors
• Undergoes viral attenuation, still high risk for infection

Question 14

When is Factor VIII given?

Answer 14

Preop or intraop

Question 15

When should DDAVP be given prior to surgery?

Answer 15

60mins before Sx

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

• Spinal and epidural hematoma
• Nerve compression

Question 18

What four things to avoid?

What are the anesthesia considerations for someone with vWF deficiency?

Answer 18

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

Question 19

How does heparin work?

Answer 19

• 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.

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

3

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 ---> causing clot lysis

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

# Prothrombin disorder What is factor V Leiden?

Answer 30

- Protein for clotting. * When enough fibrin has been made, activated protein C inactivates factor V thus stopping clot growth*.

Question 31

What is Factor V Leiden disease?

Answer 31

* Genetic mutation in factor V * Abnormal version of factor V that is resistant to activated protein C ---> excessive fibrin and clotting

Question 32

Factor V Leiden is usually silent until?

Answer 32

* Pregnancy * First presention of DVT, repeated late-stage abortions/fetal losses occurs

Question 33

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

Answer 33

- Warfarin - LMWH & unfractionated heparin

Question 34

What is the hallmark sign of HIT?

Answer 34

Plt count <100,000 *thrombocytopenia*

Question 35

What is HIT?

Answer 35

* An autoimmune-mediated drug reaction * HIT activates platelets --> causes clotting --> depletes platelet count

Question 36

Non-heparin anticoagulants used after HIT?

Answer 36

**Direct-thrombin inhibitors** * Agratroban * Bivalirudin **Factor Xa Inhibitor** * Fondaparinaux in place of lovenox

Question 37

Diagnosis of HIT should be entertained when?

Answer 37

* For any patient experiencing thrombosis or thrombocytopenia during/after heparin administration