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Diagnosis and Management of Bleeding/Clotting Disorders Flashcards

1
Q

What are key findings in the patient history that may point towards a platelet disorder?

A

Mucosal bleeding = nose bleeds and gingival bleeds

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2
Q

What is a key finding in an adult woman’s history that may point towards a bleeding disorder?

A

Very heavy menstrual bleeding

ex. change pad/tampon every hour

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3
Q

What is a key finding in the patient history that may point towards a coagulation disorder?

A

Spontaneous hemarthroses

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4
Q

Primary disorders

A

Platelets

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5
Q

Secondary disorders

A

Coagulation cascade proteins/factors

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6
Q

What 3 things do you want to measure if Von Willebrand Disease is suspected?

A

vWF antigen
vWF cofactor
Factor VIII

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7
Q

What type of vWF Disease has decreased vWF and normal factor VIII?

A

Type 1

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8
Q

How are Types 1, 2A and 2B Von Willebrand Disease inherited?

A

Autosomal DOMINANT

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9
Q

What type of vWF Disease has severely decreased vWF and decreased factor VIII?

A

Type 3

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10
Q

What is the treatment for minor bleeding associated with Von Willebrand Disease?

A

Desmopressin - allows release of vWF

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11
Q

Desmopressin treats mild Von Willebrand Disease. What are its side effects?

A

Hyponatremia
Flushing
Hypotension

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12
Q

What does Desmopressin treat and how?

A

Mild bleeding due to Von Willebrand Disease

- Allows release of vWF

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13
Q

What is the treatment for major bleeding associated with Von Willebrand Disease?

A

Plasma derived or recombinant vWF

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14
Q

Disorders of secondary hemostasis have a ____ PT and/or PTT

A

PROLONGED

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15
Q

Hemophilia A

A

Decrease in Factor VIII

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16
Q

How is Hemophilia A inherited?

A

X-linked Recessive

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17
Q

Hemophilia B

A

Decrease in Factor IX

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18
Q

What type of testing with Hemophilias is important to predict disease severity and eliminate other diseases as options?

A

Genetic testing

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19
Q

What is the standard therapy for Hemophilia A?

A

Recombinant Factor VIII

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20
Q

Why is Recombinant Factor VIII a better treatment option than plasma with the coagulation proteins in it?

A

Plasma is at a higher risk of containing an infection

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21
Q

What is a possible MSK complication that can occur with Hemophilias?

A

Hemophilic Arthropathy

- Bleeds in the joints slowly creates arthritis

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22
Q

The overall goal of treatment for Hemophilias is to?

A

Increase factor activity to limit bleeding

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23
Q

Emicizumab is a very expensive treatment for Hemophilia. What does it do?

A

Binds to factor IXa and X

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24
Q

Describe a mixing study

A
  • Combine a patients plasma that has a prolonged PTT with a normal PTT
  • Normal: Corrected PTT
  • Abnormal: Failed to correct PTT
    == Inhibitor antibodies present if abnormal results
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25
Q

In a mixing study using a factor deficient plasma, even ____ of normal factor levels will correct the PTT

A

50%

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26
Q

In a mixing study that fails to correct, the patient’s plasma contains?

A

Surplus of inhibitor antibodies

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27
Q

What do inhibitor antibodies do?

A

Bind to coagulation factors and inactivate them which causes the persistent prolongation time (PTT)

28
Q

What can bind to coagulation factors and inactivate them to cause a prolonged PTT during a mixing study?

A

Inhibitor antibodies

29
Q

Patients that are (+) for Factor VIII inhibitors are said to have?

A

ACQUIRED Hemophilia A

30
Q

What is the treatment for acquired Hemophilia A?

A

Immunosuppression

31
Q

What are the demographics for those that get Acquired Hemophilia A?

A
  • Usually older adults in post-partum

- Associated with autoimmune diseases

32
Q

Patients with congenital Hemophilia, can they produce antibodies to factors eventually?

A

Yes it is possible

33
Q

Deep Vein Thrombosis (DVT) is the same as?

A

(VTE) Venous Thromboembolism

34
Q

Virchow’s Triad

A
  • Increased risk for thrombosis
    1. Endothelial Injury
    2. Venous Stasis
    3. Hypercoagulable
35
Q

Where do DVTs usually originate?

A

Lower extremity veins

  • Above knee = iliac or femoral
  • Below knee = NOT popliteal
36
Q

Symptoms of a DVT?

A

Unilateral pain, cramping sensation in the leg

37
Q

What can (PE) Pulmonary Embolisms cause?

A

Hypoxia and Right-sided Heart Failure

38
Q

What criteria can aid an index of suspicion for a VTE?

A

Wells, Geneva criteria

39
Q

What are common risk factors for VTE?

A 
Prior DVT
Surgery/hospitalization
Immobilization
Smoking
Birth control
Increasing age
Malignancy
40
Q

If suspicions are towards the lower end for a DVT, what is a good lab test to do?

41
Q

What is a D-dimer?

A

Degradation product of cross-linked fibrin

42
Q

If D-dimer is (-), what does that tell you?

A

There is NO thromboembolic event occurring

43
Q

NO thromboembolic event occurring D-dimer result?

44
Q

A compression ultrasound can diagnose?

45
Q

If a DVT is not present, what will the compression ultrasound show?

A

Compression of the venous lumen

46
Q

If a DVT IS present, what will the compression ultrasound show?

A

NO compression of the vein due to the clot

47
Q

A CT angiogram can diagnose?

48
Q

If a PE is not present, what will the CT angiogram show?

A

White contrast in the vessels

49
Q

If a PE IS present, what will the CT angiogram show?

A

Not white contrast in the vessels

50
Q

Describe the ventilation/perfusion (V/Q) scan

A
  • Inhale radiotracer dye
  • Inject radiotracer dye
  • Compare scans
    = SHOULD BE EQUAL
51
Q

If the V/Q scans show a mismatch, that could indicate?

52
Q

Normally the ____ produces protein C and S

53
Q

Normally, what does Protein C and S do?

A

Block sites at VIII and X to STOP clotting cascade

54
Q

Normally, what does Protein C and S do?

A

Block sites at VIII and X to STOP clotting cascade

55
Q

Deficiency in Protein C and S will cause?

A

Thrombophilia - will not be able to stop clotting

56
Q

What is a paradoxical embolism?

A

Passage of an embolus from venous circulation into arterial circulation through a patent foramen ovale

57
Q

What anatomical abnormality is common in those under the age of 55 who experience a stroke?

A

Patent foramen ovale

58
Q

Diagnosis for a paradoxical embolism?

A

Transesophageal Echocardiography with bubble study (TEE)

59
Q

Passage of embolus from venous circulation into arterial circulation through a patent foramen ovale

A

Paradoxical Embolism

60
Q

Best treatment and how it works for thrombophilia?

A

Rivaroxaban and Apixaban

- (-) factor Xa

61
Q

ex. of drugs that inhibit factor Xa to treat thrombophilia?

A

Rivaroxaban and Apixaban

62
Q

What factors does Heparin inhibit?

A

2, 9, 10, 11

63
Q

What factors does Warfarin inhibit?

A

Vitamin K dependent factors 2, 7, 9 , 10

64
Q

What is a non-pharmacologic option to treat thrombophilia?

A

Inferior Vena Cava filter

65
Q

What is the duration of treatment for a provoked thromboembolism?

A

3-6 months

SBL (48 decks)

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