Chapter 14: Clinical Disturbances of Blood Coagulation 2

Question 1

What does deficiencies of one or more coagulation factors often cause?

Answer 1

Hematomas

Question 2

Large area of hemorrhage

Answer 2

hematoma

Question 3

True or false: Deficiencies of phase I coagulation factors are relatively rare and are usually hereditary.

Answer 3

True

Question 4

Coagulation factors of which phase are deficient in people with Hemophilia A, Hemophilia B, and von Willebrand’s disease?

Answer 4

Phase I

Question 5

What coagulation factors are people with Hemophilia A and B deficient in? What causes this deficiency?

Answer 5

Phase 1; it is hereditary

Question 6

What coagulation factors are people with von Willebrand’s disease deficient in?

Answer 6

Phase 1 (von Willebrand Factor)

Question 7

What is the most common bleeding disorder? What causes it?

Answer 7

von Willebrand Disease; deficiency of von Willebrand Factor

Question 8

Which conditions caused by deficiencies of Phase I coagulation factors are relatively common (exceptions to the rule that most coagulation factor deficiencies are rare):

Answer 8

1) Hemophilia A
2) Hemophilia B
3) von Willebrand Factor

Question 9

Which phase of blood coagulation are Factors IX and X part of?

Answer 9

Phase I

Question 10

What is the most common bleeding disorder?

Answer 10

von Willebrand’s Disease

Question 11

What is the most common clotting disorder?

Answer 11

Thrombocytopenia

Question 12

What type of hereditary disease is hemophilia?

Answer 12

X-linked recessive

Question 13

What is the most common hereditary bleeding disease?

Answer 13

Hemophilia

Question 14

What are the symptoms of hemophilia?

Answer 14

Episodic bleeding in joints and internal organs after minor injury; potentially intracranial bleeds.

Question 15

True or false: Hemophilia affects only females.

Answer 15

False; it affects only males, unless an affected male and carrier female are parents.

Question 16

A decrease in which coagulation factor causes Hemophilia A? Which phase of coagulation is this factor part of?

Answer 16

factor VIII (anti-hemophilic factor); Phase I

Question 17

A decrease in which coagulation factor causes Hemophilia B? Which phase of coagulation is this factor part of?

Answer 17

factor IX (Christmas factor)

Question 18

A decrease in which coagulation factor causes von Willebrand’s Disease? Which role does this factor play?

Answer 18

vWF; required by platelets to adhere to the vessel wall at the injury site.

Question 19

How does vWF work?

Answer 19

Adheres to a damaged wall and forms a lattice framework, allowing platelets and coagulation factors to adhere, interact, and form a clot.

Question 20

Besides vWF, what other factor do von Willebrand Disease patients have low levels of in their circulation?

Answer 20

factor VIII (they make enough of it, but b/c of the low vWF, cannot bind and maintain normal levels in circulation).

Question 21

How can patients with Hemophilia or von Willebrand’s Disease be treated?

Answer 21

With factor concentrates

Question 22

True or false: Phase I coagulation disturbances are usually hereditary.

Answer 22

True

Question 23

True or false: Phase II hereditary disturbances are usually hereditary.

Answer 23

False; usually acquired.

Question 24

What are the two causes of Phase 2 coagulation disturbances?

Answer 24

1) Prothrombin deficiency

2) Deficiency of factors required to convert prothrombin to thrombin.

Question 25

Where are the factors required to convert prothrombin to thrombin located?

Answer 25

In the liver

Question 26

Which key vitamin is required for the synthesis of most phase II coagulation factors?

Answer 26

Vitamin K (fat soluble)

Question 27

What is required for vitamin K absorption?

Answer 27

Bile

Question 28

Where does most of our vitamin K come from?

Answer 28

Mostly made by intestinal bacteria; also from green, leafy veggies

Question 29

What can phase 2 disturbances be caused by?

Answer 29

1) Drugs that reduce vit K synthesis (e.g., anticoagulants)
2) Inadequate bacterial synthesis of vit K (e.g., b/c of prolonged antibiotic use)
3) Inadequate absorption of vit K (blockage of common bile duct)
4) Severe liver disease (impairs synthesis of coagulation factors)

Question 30

What are anticoagulant drugs that inhibit of vitamin K-dependent factors used for?

Answer 30

To decrease the risk of clotting in certain patients

Question 31

Why might prolonged antibiotic use cause a phase II clotting disorder?

Answer 31

It could eradicate the intestinal bacteria needed for the synthesis of vitamin K.

Question 32

True or false: Newborns lack gut bacteria.

Answer 32

True

Question 33

What does DIC stand for? What causes it?

Answer 33

Disseminated (widespread) Intravascular Coagulation; caused by products being released into the circulation that have thromboplastic activity (i.e., activate the coagulation mechanism)

Question 34

Activate the coagulation mechanism

Answer 34

thromboplastic

Question 35

When might you see DIC (disseminated intravascular coagulation)?

Answer 35

1) Disease associated with shock or tissue necrosis.
2) Sepsis (overwhelming bacterial infection)
3) Amniotic fluid entering circulation postpartum
4) Other causes of tissue necrosis.

Question 36

formation of a blood clot that obstructs blood flow in a vessel

Answer 36

thrombosis

Question 37

An abnormal bleeding state that leads to rapid and widespread activation of blood coagulation.

Answer 37

Disseminated Intravascular Coagulation Syndrome (Consumption Coagulopathy)

Question 38

What is the net result of DIC?

Answer 38

Widespread hemorrhaging

Question 39

Why does DIC result in hemorrhaging?

Answer 39

1) Platelets and plasma coagulation factors are consumed quickly, so their blood levels drop.
2) Body activates fibrinolysin system, leading to fibrin degradation products that further inhibit coagulation.

Question 40

What is the comparative frequency of occurrence of platelet problems, coagulation disturbances, or DIC (disseminated intravascular coagulation)?

Answer 40

Platelet problems > Coagulation disturbances > DIC