Detection, Diagnosis, and Management of Bleeding and Clotting Disorders

Question 1

How can von Willebrand disease present in a clinical history?

Answer 1

1) Frequent epistaxis
2) Easy bruising
3) Menorrhagia

Question 2

What lab tests can help clue you in for suspected von Willebrand disease?

Answer 2

1) vWF Antigen and activity
2) aPTT
3) Factor VIII

Question 3

What is used to treat vWD type 1?

What is its MOA?

Answer 3

1) Desmopressin

2) Helps release of vWF from endothelial cells/platelets

Question 4

How can Hemophilia A present in a clinical history?

Answer 4

1) Oral bleeding after a dental procedure
2) Easy bruising
3) Joint pain

Question 5

What lab tests can help clue you in for suspected Hemophilia A?

Answer 5

1) aPTT
2) Factor VIII levels
3) Genetic tests

Question 6

If only the time for aPTT is abnormal then what factors associated with the bleeding are defected?

Answer 6

1) VIII
2) IX
3) XI

Question 7

If only the time for PT is abnormal then what factors associated with the bleeding are defected?

Answer 7

VII

Question 8

Genetic testing for hemophilia A is essential because?

Answer 8

1) Help determine disease severity

2) Eliminate vWD in differential

Question 9

What is the genetic inheritance of Hemophilia A?

How may an unaffected carrier mom pass the gene to her daughter and son?

Answer 9

1) X-linked recessive

2) Son can become affected while daughter can be unaffected carrier

Question 10

The most standard therapy for Hemophilia A is?

Answer 10

Recombinant FVIII

Question 11

What is a debilitating consequence of chronic hemophilia?

Answer 11

Hemophilic arthropathy

Question 12

How can acquired hemophilia present in a clinical history?

Answer 12

1) Menorrhagia, Epistaxis, Ecchymoses
2) Mucosal pallor
3) Hypotensive
4) Family history of autoimmune disease

Question 13

What lab tests can help clue you in for suspected acquired hemophila?

Answer 13

1) Prolonged PTT

2) Mixing study for PTT did not correct

Question 14

If a mixing study for PTT fails to correct than what is most likely the cause?

Answer 14

Presence of an Factor VIII inhibitory antibody

Question 15

If a patient tests positive for factor VIII inhibitor what is their most likely diagnosis?

Answer 15

Acquired Hemophilia A

Question 16

How do you treat Acquired hemophilia A?

Answer 16

1) Give factors VIII and VIIa

2) Immunosuppression

Question 17

While acquired hemophilia A is often seen in older adults, what can cause it to happen in a younger patient?

Answer 17

Occur during postpartum

Question 18

What conditions are acquired hemophilia A most associated with?

Answer 18

1) RA

2) SLE

Question 19

What painful, cramping sensation typically originates in the calf and can easily be confused with muscle strain?

Answer 19

Deep Vein Thrombosis

Question 20

If a DVT is not caught what complication can arise?

Answer 20

Thromboembolism

Question 21

As an embolic mass lodges in pulmonary circulation what may ensue?

Answer 21

Acute hypoxia and right heart failure

Question 22

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?

Answer 22

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?

Question 23

What lab test can be performed to diagnose a thromboembolism?

Why is this test used?

Answer 23

1) D-Dimer

2) Great exclusion test for thromboembolism

Question 24

What radiography can be performed to diagnose a thromboembolism?

Answer 24

1) Ultrasound for DVT

2) CT angiogram for PE

Question 25

What are D-dimers?

Answer 25

Degradation product of cross-linked fibrin

Question 26

How is a compression ultrasound used for DVT?

Answer 26

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

Question 27

What can cause bowel infarction due to mesenteric vein thrombosis?

Answer 27

Protein C deficiency

Question 28

How can protein C deficiency present in a clinical history?

Answer 28

1) Abdominal pain
2) Multiple miscarriages
3) Parent death from stroke

Question 29

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?

Answer 29

1) White thrombus

2) Red thrombus

Question 30

White thrombosis is mostly related to?

Red thrombosis is mostly related to?

Answer 30

1) Atherosclerosis

2) Stasis

Question 31

What is a paradoxical embolism?

This is caused by what embryo phenomenon?

Answer 31

1) Passage of an embolus from the venous circulation to the arterial circulation
2) Patent foramen ovale

Question 32

What daily medication can cause a DVT/PE?

Answer 32

Oral contraceptives (more estrogen the more likely)

Question 33

How long should you be on anticoagulants if you had a thromboembolism with no underlying conditions or enduring risk factors?

Answer 33

3-6 months

Question 34

What can be used as a non-pharmacologic option for thromboembolisms?

Answer 34

Inferior Vena Cava Filter