Coagulation / Bleeding Disorders

Question 1

What type of vessels use primary hemostasis the most?

Answer 1

arteries

Question 2

What type of vessels use secondary hemostasis the most?

Answer 2

veins

i.e: DVT

Question 3

Platelet function assay

Answer 3

another name for closure time

measures how long for primary hemostasis to form platelet plug in test tube

Question 4

vWF antigen vs. activity

Answer 4

antigen is more specific

low vWF antigen and activity can mean vWD

Question 5

Ristocetin co-factor

Answer 5

another term for vWF activity

Question 6

Type I vWD

Answer 6

reduced vWF number but it functions correctly overall

Question 7

thrombocytopenia

Answer 7

low platelet count

Question 8

What is common signs of thrombocytopenia?

Answer 8

purpura and petechiae

Question 9

what is there a risk of with Thrombocytopenia?

Answer 9

spontaneous bleeding due to lack of platelets

Question 10

high risk of bleeding thrombocytopenia values

Answer 10

<10,000

Question 11

low risk of bleeding thrombocytopenia values

Answer 11

<20,000

Question 12

Immune Thrombocytopenic Purpura

Answer 12

viral infection causes an immune response against platelets

Question 13

Immune Thrombocytopenic Purpura treatment

Answer 13

platelet transfusion will not work as antibodies will just degrade them

need immunosuppression or splenectomy

problem with platelets = primary hemostasis problem

Question 14

What conditions cause thrombocytopenia by increased consumption of platelets?

Answer 14

DIC, HUS, Heparin Induced Thrombocytopenia

Question 15

What specifically does aspirin affect?

Answer 15

aspirin = antiplatelet

prevents step 2 of primary hemostasis (no degranulation of platelets)

Question 16

COX1 and platelets

Answer 16

aspirin activates COX1 which releases prostaglandins

prostaglandins prevent platelet granulation release

Question 17

what type of bleeding indicates primary hemostasis?

Answer 17

mucosal

Question 18

what type of bleeding indicates secondary hemostasis?

Answer 18

deep / joint

Question 19

for secondary hemolysis, what labs are checked next?

Answer 19

PT and PTT

then mixing studies

Question 20

why are platelets seen more in the arteries?

Answer 20

platelets are more stable in that higher pressure system

Question 21

what is the primary tests for primary hemostasis?

Answer 21

vWF and ITP

*looking for a platelet problem

Question 22

what are the vitamin K dependent factors?

Answer 22

2, 7, 9, 10

Question 23

What 2 things should you think about if both PTT and PT are delayed?

Answer 23

fibrinogen or vitamin K def.

common pathway problem

Question 24

hemarthrosis

Answer 24

swollen, hot joint

common in hemophilia patients

Question 25

ITP stands for …

Answer 25

immune thrombocytopenia purpura

Question 26

difference and similaries in vWD and ITP

Answer 26

both: affect the primary hemostasis pathway

difference: ITP is more diffuse. Platelets are also normal in vWD but low in ITP

Question 27

platelet count in vWD

Answer 27

normal!

have a deficiency of vWF, not platelets

Question 28

What do you treat vWD with?

Answer 28

DDAVP

releases more vWF from endothelial cells

could also give recombinant vWF infusions

Question 29

What do you treat non-immune thromocytopenia with?

Answer 29

platelet transfusion

Question 30

What do you treat secondary hemostasis disorders with?

Answer 30

either recombinant factors or fibrinogen transfusion

Question 31

What 4 conditions can lead to an unprovoked clot?

Answer 31

Factor V Leiden

Prothrombin

Protein C/S not working

Antithrombin III not working

Question 32

What can an EKG show in setting of PE?

Answer 32

a right heart strain due to blockage of the pulmonary vein putting more pressure on the heart

Question 32

What is most definitive way to look for PE?

Answer 32

CTA of chest

Question 33

antiplatelet drugs

Answer 33

aspirin and clopidigrel

Question 34

anticoagulation drugs

Answer 34

warfarin, heparin, NOAC

Question 35

how does clopidigrel work?

Answer 35

binds to the GPIIb/GPIIIa complex through P2Y12

Question 36

why don’t we give thrombolytics, like tPA more?

Answer 36

they have high associated bleeding risk

use for acute PE

Question 37

why don’t we need to check PT/PTT for coagulation disorders?

Answer 37

those tests look at bleeding disorders