Coagulation Disorders

Question 1

Bleeding Disorder Presentation

Answer 1

Increased bruising
bleeding with trauma more than expected
frequent nosebleeds
bruising without trauma
Menstrual blood is abnormally clotted

Question 2

Coagulation Disorder Labs

Answer 2

CBC with PLT count
Blood smear
PT
aPTT
thrombin time
fibrinogen level
plt fucntion analysis

Question 3

PT

Answer 3

measures the extrinsic system and common coagulation pathway

-factors VII, X, V, II, and fibrinogen

Question 4

aPTT

Answer 4

Measures function of intrinsic and common pathway

Preallikrein, Factors XII, X, IX, V, II and fibrinogen

Question 5

Prolonged PT or INR

Answer 5

Liver disease
Early Vitamin K deficiency
Warfarin therapy
Factor VII deficiency
Factor Xa inhibitors

Question 6

Prolonged aPTT

Answer 6

Factor VIII, IX, XI, XII deficiency
von Willebrand Disease
Heparin therapy
Dabigatran effects

Question 7

Prolonged PT and aPTT

Answer 7

DIC
Advanced liver disease
Severe vitamin K deficiency or warfarin

Question 8

Negative Bleeding History but abnormal blood tests

Answer 8

Consider effects of meds such as NSAIDs, ASA, anticoagulants, allergies, concurrent illness

Question 9

Bleeding Disorder Lab Testing Instructions

Answer 9

Free of medications for 2 weeks

Overnight fasting

Question 10

Hematology Refer

Answer 10

Patients with bleeding disorder required hematology evaluation unless it is definitive result of excess warfarin or heparin / aspirin

Question 11

von Willebrand Disease

Answer 11

Most common congenital bleeding disorder
Defect in vWF
CBC usually normal
PT/aPTT usually normal
vWF antigen decreased

Requires extensive testing to confirm, dont rely on one test

Question 12

Hemophilia

Answer 12

Low levels of Factor VIIi - Type A Hemophilia (A rhymes with 8 sorta)

Low levels of Factor IX - Type B Hemophilia

Question 13

Hemophilia Symptoms

Answer 13

Delayed bleeding
Hypertrophy and joint inflammation
Psoas muscle bleeding can cause diffuse abdominal or hip pain
aPTT is usually delayed and further investigation shows low Factor VIII or Factor IX

Question 14

Hemophilia Categories

Answer 14

Mild - little spontaneous bleeding
Moderate - some spontaneous bleeding
Severe - Often spontaneous bleeding

Moderate and Severe require infusions of missing factor, may respond to DDAVP temporarily

Question 15

Thrombosis Risks

Answer 15

Arterial = atherosclerosis is the biggest risk

Venous = smoking, obesity, diabetes, chronic inflammatory state, immobility

Question 16

Virchow Triad

Answer 16

Pathogenesis for VTE

Changes in blood vessel walls, blood flow, coagulability of blood

Question 17

Superficial v. Deep Thrombi

Answer 17

Thrombi in the superficial veins manifest with localized tenderness at the site, redness, a feeling of warmth, and possible swelling of the affected limb. Because the vein is close to the surface, it may feel hard or ropelike when examined.

The clinical features of DVT include pain, swelling, and erythema of the affected extremity.

Question 18

Pulmonary Embolus Warning Signs

Answer 18

May be asymptomatic

Dyspnea, chest pain, palpitations, syncope, feeling of impending doom

Question 19

D-Dimer Test

Answer 19

Test for suspected VTE

Negative can rule out a VTE, but positive does not rule it in!

Question 20

DVT Diagnostics

Answer 20

D-Dimer test
Ultrasound for limbs, but not good in calf
CT with contrast is best
V/Q scan no longer recommended

Question 21

DVT Management

Answer 21

Is suspected PE or risk, refer to ED

Heparin (LMW) is given and warfarin started. Heparin is used to bridge until warfarin effectiveness, usually 5 days.

Question 22

If a patient reports taking too much warfarin for the last five days, what should you do?

Answer 22

Vitamin K antagonizes warfarin. If INR is greater than 5, they need treatment

Normal INR is 1, Warfarin treatment goal is 1-2.

Question 23

A patient with diagnosed vWD reports bleeding episodes, what is the treatment?

Answer 23

Desmopressin and refer to the ED or hematology

Question 24

Treatment for Hemophilia A bleeding issues

Answer 24

Factor VIII infusion