Exam #1: Coagulation Studies

Question 1

What involves splenomegaly → thrombocytopenia?

Answer 1

Splenic Sequestration

Question 2

In what way do the following conditions affect RBCs: ITP, DIC, HIT, TMA (TTP and HUS)?

Answer 2

Increased Destruction of RBCs

Question 3

What condition involves simultaneous clotting and bleeding?

Answer 3

Disseminated Intravascular Coagulation (DIC)

Question 4

What condition involves significantly low platelet count – consider meds, excessive bleeding/bruising?

Answer 4

Immune Thrombocytopenia (ITP)

Question 5

What condition involves acquired thrombocytopenia while on heparin therapy?

Answer 5

Heparin-Induced Thrombocytopenia (HIT)

Question 6

Why MUST platelets be monitored with Heparin use?

Answer 6

Can cause thrombocytopenia

- If thrombocytopenia presents, heparin must be stopped immediately and never restarted

Question 7

Which platelet disorder involves thrombosis in capillaries and arterioles due to endothelial injury?

Answer 7

Thrombotic Microangiopathies (TMA)

Question 8

Which condition is associated with ADAMTS-13?

Answer 8

Thrombotic Thrombocytopenic Purpura (TTP)

Question 9

Which platelet disorder is a medical emergency; more common in black females?

Answer 9

Thrombotic Thrombocytopenic Purpura (TTP)

Question 10

Which condition involves the pentad of microangiopathic hemolytic anemia, thrombocytopenia, AKI, neuro deficits, fever?

Answer 10

Thrombotic Thrombocytopenic Purpura (TTP)

Question 11

Which condition is associated with Shiga toxin-producing E. coli O157:H7?

Answer 11

Hemolytic-Uremic Syndrome (HUS)

Question 12

Which condition is mostly seen in children and MUST present with bloody stools?

Answer 12

Hemolytic-Uremic Syndrome (HUS)

Question 13

Which condition involves the triad of microangiopathic hemolytic anemia, thrombocytopenia, AKI?

Answer 13

Hemolytic-Uremic Syndrome (HUS)

Question 14

Which condition shows fragmented RBCs (schistocytes/helmet cells)?

Answer 14

Thrombotic Microangiopathies (TMA)
- Includes microangiopathic hemolytic anemia

Question 15

In what way do the following conditions affect RBCs: congenital vs. acquired bone marrow failure, chemotherapy/radiation, bone marrow infiltration (CA vs. infection), nutritional (vitamin B12/folate/iron deficiency, alcohol)?

Answer 15

Impaired Production of RBCs

Question 16

What lab test involves the intrinsic and common pathways?

Answer 16

PTT or aPTT

- You play “table tennis” (aka TT) “INside” (aka intrinsic)

Question 17

What lab test is used to monitor UFH?

Answer 17

PTT or aPTT

Question 18

What lab test involves the extrinsic and common pathways?

Answer 18

PT

- You play “tennis” (aka T) “outside” (aka external)

Question 19

What two lab tests are used to monitor Warfarin?

Answer 19

• INR
• PT

NOTE: for PT, it uses external pathway and you go to “war” (aka Warfarin) with “other/external” countries (external)

Question 20

Which three anticoagulants are often preferred for outpatient treatment (do not require IV)?

Answer 20

• Warfarin
• Xarelto (Direct Xa inhibitor)
• Eliquis (Direct Xa inhibitor)

Question 21

Direct Thrombin Inhibitors (Pradaxa) AND Direct Xa Inhibitors (Xarelto, Eliquis, Lixiana/Savaysa) are both examples of what?

Answer 21

Direct Oral Anticoagulants (DOACs)

Question 22

For patients with a DVT or PE WITHOUT CA, what anticoagulation treatment is recommended?

Answer 22

Direct Oral Anticoagulants (DOACs) so…

• Direct Thrombin Inhibitors (Pradaxa)
• Direct Xa Inhibitors (Xarelto, Eliquis, Lixiana/Savaysa)

Question 23

For patients with a DVT or PE WITH CA, what anticoagulation treatment is recommended?

Answer 23

LMWH

Question 24

What is the initial dosing of Warfarin? What should subsequent dose adjustments be based off of?

Answer 24

Initial dose of 5mg/day

- Adjust based on INR values

Question 25

What is the target INR value for Warfarin usually?

Answer 25

2.0-3.0

Question 26

What is the reversal agent used to treat Warfarin “overdose” aka supratherapeutic INR?

Answer 26

Vitamin K

Question 27

What is the reversal agent for UFH, LMWH?

Answer 27

Protamine

Question 28

What is the reversal agent for Xarelto, Eliquis?

Answer 28

Andexane

Question 29

Is acquired or congenital platelet dysfunction more common?

Answer 29

Acquired (i.e. drugs/chemo)

Question 30

What lab test is used to monitor UFH AND LMWH?

Answer 30

Anti-Factor Xa (anti-Xa)

Question 31

What lab test are these components of: antithrombin, Factor V-Leiden, Protein C, Protein S, prothrombin gene mutation, lupus anticoagulant (anti-phospholipid antibodies), MTHFR gene

Answer 31

Hypercoagulable Panel

Question 32

If starting a patient on UFH, which three labs should be ordered for baseline? Which two can be ordered for monitoring?

Answer 32

Baseline:

• aPTT
• PT/INR
• CBC

Monitoring:

• aPTT
• Factor Xa

Question 33

If starting a patient on LMWH, which four labs should be ordered for baseline? Are monitoring tests required?

Answer 33

Baseline:

• aPTT
• PT/INR
• CBC
• Creatinine

Monitoring: NOPE

Question 34

If starting a patient on a DOAC, which three labs should be ordered for baseline? Are monitoring tests required?

Answer 34

Baseline:

• PT/INR
• CBC
• Creatinine

Monitoring: NOPE

Question 35

If starting a patient on Warfarin, which five labs should be ordered for baseline? Which lab should be ordered for monitoring?

Answer 35

Baseline:

• aPTT
• PT/INR
• CBC
• Creatinine
• LFTs

Monitoring:
- PT/INR

Question 36

For how long should parenteral anticoagulation treatment (UFH/LMWH) overlap with Warfarin?

Answer 36

At least 5 days

- And until INR is therapeutic for 24 hours or 2 days

Question 37

What is the best option for decreasing INR if life-threatening situation?

Answer 37

PCC with Vitamin K (IV)