Detection, Diagnosis, and Management of Bleeding and Clotting Disorders Flashcards
How can von Willebrand disease present in a clinical history?
1) Frequent epistaxis
2) Easy bruising
3) Menorrhagia
What lab tests can help clue you in for suspected von Willebrand disease?
1) vWF Antigen and activity
2) aPTT
3) Factor VIII
What is used to treat vWD type 1?
What is its MOA?
1) Desmopressin
2) Helps release of vWF from endothelial cells/platelets
How can Hemophilia A present in a clinical history?
1) Oral bleeding after a dental procedure
2) Easy bruising
3) Joint pain
What lab tests can help clue you in for suspected Hemophilia A?
1) aPTT
2) Factor VIII levels
3) Genetic tests
If only the time for aPTT is abnormal then what factors associated with the bleeding are defected?
1) VIII
2) IX
3) XI
If only the time for PT is abnormal then what factors associated with the bleeding are defected?
VII
Genetic testing for hemophilia A is essential because?
1) Help determine disease severity
2) Eliminate vWD in differential
What is the genetic inheritance of Hemophilia A?
How may an unaffected carrier mom pass the gene to her daughter and son?
1) X-linked recessive
2) Son can become affected while daughter can be unaffected carrier
The most standard therapy for Hemophilia A is?
Recombinant FVIII
What is a debilitating consequence of chronic hemophilia?
Hemophilic arthropathy
How can acquired hemophilia present in a clinical history?
1) Menorrhagia, Epistaxis, Ecchymoses
2) Mucosal pallor
3) Hypotensive
4) Family history of autoimmune disease
What lab tests can help clue you in for suspected acquired hemophila?
1) Prolonged PTT
2) Mixing study for PTT did not correct
If a mixing study for PTT fails to correct than what is most likely the cause?
Presence of an Factor VIII inhibitory antibody
If a patient tests positive for factor VIII inhibitor what is their most likely diagnosis?
Acquired Hemophilia A
How do you treat Acquired hemophilia A?
1) Give factors VIII and VIIa
2) Immunosuppression
While acquired hemophilia A is often seen in older adults, what can cause it to happen in a younger patient?
Occur during postpartum
What conditions are acquired hemophilia A most associated with?
1) RA
2) SLE
What painful, cramping sensation typically originates in the calf and can easily be confused with muscle strain?
Deep Vein Thrombosis
If a DVT is not caught what complication can arise?
Thromboembolism
As an embolic mass lodges in pulmonary circulation what may ensue?
Acute hypoxia and right heart failure
What are questions to ask if you suspect thromboembolism?
What are questions to ask if you suspect a pulmonary embolus?
What is a general question to ask for any form of embolus?
1) Had a PE/DVT before?
2) Cancer patient?
3) Recent hospitalization, surgery, fracture?
1) Any hemoptysis?
2) Tachycardia?
1) Are you older than 65?
What lab test can be performed to diagnose a thromboembolism?
Why is this test used?
1) D-Dimer
2) Great exclusion test for thromboembolism
What radiography can be performed to diagnose a thromboembolism?
1) Ultrasound for DVT
2) CT angiogram for PE
What are D-dimers?
Degradation product of cross-linked fibrin
How is a compression ultrasound used for DVT?
Normally, you can compress a vein lumen but if there is a DVT, the lumen is not going to compress because of the space-occupying clot
What can cause bowel infarction due to mesenteric vein thrombosis?
Protein C deficiency
How can protein C deficiency present in a clinical history?
1) Abdominal pain
2) Multiple miscarriages
3) Parent death from stroke
What type of thrombosis occurs commonly in coronary/cerebral arteries, is platelet-rich and occurs via high shear stress?
What type of thrombosis occurs in veins, is rich with RBCs and involves the lower extremities?
1) White thrombus
2) Red thrombus
White thrombosis is mostly related to?
Red thrombosis is mostly related to?
1) Atherosclerosis
2) Stasis
What is a paradoxical embolism?
This is caused by what embryo phenomenon?
1) Passage of an embolus from the venous circulation to the arterial circulation
2) Patent foramen ovale
What daily medication can cause a DVT/PE?
Oral contraceptives (more estrogen the more likely)
How long should you be on anticoagulants if you had a thromboembolism with no underlying conditions or enduring risk factors?
3-6 months
What can be used as a non-pharmacologic option for thromboembolisms?
Inferior Vena Cava Filter
