coagulopathies + hypercoaguable states

Question 1

↑PTT

normal PT/INR

Answer 1

hemophilia A or B (8 or 9)

Question 2

signs/symptoms of coagulation disorders: ↑ bleeding

Answer 2

microhemorrhages: nose bleed, gum bleed + macrohemorrhages: hemarthrosis, easy bruising
(vs platelet disorders only microhemorrhages)

Question 3

↑PT

↑PTT

Answer 3

vitamin K deficiency

Question 4

vitamin K

Answer 4

cofactor for synthesis of clotting factors:

2, 7, 9, 10 + protein C and protein S

Question 5

causes of vitamin K deficiency

Answer 5

inadequate vitamin K intake
newborn: sterile flora, give vit. K injection at birth (major source is intestinal flora)
warfarin: vitamin K antagonist
end-stage liver disease: can’t make CF (clinically looks like vitamin K deficiency)

Question 6

coagulopathies: ↑ bleeding

Answer 6

hemophilia A
hemophilia B
vitamin K deficiency

Question 7

hypercoagulable states

Answer 7

Factor V Leiden
prothrombin gene mutation
antithrombin deficiency
protein C or S deficiency

Question 8

signs/symptoms of hypercoaguable state:

Answer 8

DVT
cerebral vein thrombosis
spontaneous PE (with no preceding DVT)
arterial thrombosis (less common vs vein)

Question 9

mutant Factor 5a is resistant to inactivation by protein C → ↑coagulation

Answer 9

Factor V Leiden

Question 10

mutation of guanine to adenine at 20210 position on prothrombin gene (CF 2) → ↑ prothrombin production → ↑ coagulation

Answer 10

prothrombin gene mutation

Question 11

unable to inactivate thrombin (2a)→↑ coagulation

may be resistant to heparin: accelerates activity of antithrombin (may need to give higher dose)

Answer 11

antithrombin deficiency

Question 12

unable to inactivate CF 5 + 8 →↑ coagulation

Answer 12

protein C deficiency

Question 13

if hx of recurrent DVT or DVT with no known cause, consider

Answer 13

hypercoaguable state