Coagulation Bleeding

Question 1

What is an abnormal PT/aPTT finding?

Answer 1

if times are prolonged

Question 2

What are the 2 main coagulation tests?

Answer 2

• PT and aPTT

Question 3

PT pathway is also called what?

Answer 3

extrinsic pathway

Question 4

aPTT pathway is also called what?

Answer 4

intrinsic pathway

Question 5

What does activated factor X do?

Answer 5

converts prothrombin (factor II) into thrombin (factor IIa)

Question 6

What 4 factors make up the common pathway?

Answer 6

Factors I, II, V, X

Question 7

What does thrombin (IIa) do?

Answer 7

converts fibrinogen (factor I) into fibrin

Question 8

What are the 2 factors in the extrinsic pathway?

Answer 8

• VII and X

- 7, 10

Question 9

What are the 5 factors in the intrinsic pathway?

Answer 9

• XII, XI, IX, VIII, X

- 12, 11, 9, 8, 10

Question 10

Deficiency in the vWF results in what change to the PT/aPTT?

Answer 10

No change

trick question

Question 11

If you have a severe deficiency in vWF what other factor deficiency will you have? This will prolong which coagulation test?

Answer 11

• VIII

- will prolong aPTT

Question 12

What are the only 2 factors NOT made in the liver?

Answer 12

• VIII, vWF

Question 13

What are the 3 natural anticoagulants?

Answer 13

• antithrombin
• Protein C
• Protein S
• Protein C degrades Va/VIIIa
• Protein S cofactor of protein C

Question 14

What enzyme is necessary to convert plasminogen to plasmin to break down a fibrin clot?

Answer 14

• tPA

Question 15

Vitamin K is required for synthesis of what factors and proteins?

Answer 15

• II, VII, IX, X (2, 7, 9, 10)

- protein C and S

Question 16

Action of vitamin K is blocked by this medication

Answer 16

warfarin (coumadin)

Question 17

What time do you expect to be prolonged with vitamin K deficiency?

Answer 17

PT only

why PT? because Factor VII has the shortest half-life

Question 18

vitamin K deficiency usually results from what?

Answer 18

malnutrition and antibiotics

Question 19

What coag findings do you expect to see in liver disease?

Answer 19

• decrease in most clotting factors results in elevation in PT/INR
• decrease in protein C, protein S
• aPTT elevated when severe
• creates a state of both bleeding and thrombotic susceptibility

Question 20

What are the lab abnormalities that will tell you a patient is in DIC? (5 findings)

Answer 20

• elevated aPTT
• elevated PT
• decreased fibrinogen
• elevated D-Dimer
• low platelets + schistocytes

Question 21

A patient presents with recurrent hemarthroses, soft tissue hematomas. Labs demonstrate a prolonged aPTT but normal PT. What is the diagnosis? What is the treatment?

Answer 21

• hemophilia

- factor replacement via IV infusion

Question 22

How is an acquired factor inhibitor diagnosed?

Answer 22

PT/aPTT mixing studies

Question 23

You suspect a patient has acquired factor inhibitor. What results on a PT/aPTT mixing study indicates a factor deficiency vs. a antibody present?

Answer 23

• factor deficiency = mix will correct abnormal time

- antibody present = mix will NOT correct abnormal time

Question 24

How is an acquired factor inhibitor condition treated?

Answer 24

immunosuppressants

Question 25

What is the most common inherited bleeding disorder?

Answer 25

von Willebrand disease

Question 26

How is von Willebrand disease diagnosed? how is it treated?

Answer 26

• diagnosed with a von Willebrand panel

- treat with DDAVP and products containing vWF

Question 27

What is the first thing you should do if you see an unexplained abnormal coagulation test?

Answer 27

repeat the test! maybe not enough blood collected in the tube

Question 28

A 24 year old female presents to clinic complaining of excessive menses. This is a typical presensation for which coagulopathy?

Answer 28

von Willebrand disease

Question 29

What factor deficiency is seen in hemophilia A vs. hemophilia B?

Answer 29

• factor 8 (hemophilia A)

- factor 9 (hemophilia B)