Exam 3 Blood Disorders

Question 1

What are the S/S of vWF disorder?

Answer 1

Easy bruising
epistaxis
menorrhagia

Question 2

What would lab values be for someone with vWF deficiency?

Answer 2

• Normal PT & aPTT
• Bleeding time is prolonged

Question 3

What is the treatment for vWF deficiency?

Answer 3

• Desmopressin
• Cryoprecipitate
• Factor VIII

Question 4

How does DDAVP work?

Answer 4

Stimulates vWF release from endothelial cells

Question 5

What is the dose for DDAVP?

Answer 5

0.3 mcg/kg in 50 mL over 15-20 mins (Do not bolus)

Question 6

What is the onset & duration of DDAVP?

Answer 6

• Onset in 30mins
• duration is 6-8hrs

Question 7

What are side effects of DDAVP?

Answer 7

• HA
• hypotension
• tachycardia
• hyponatremia
• water intoxication(excessive water retention)

Question 8

Someone that gets DDAVP needs to be on what?

Answer 8

Fluid restriction 4-6hrs before & after DDAVP

Question 9

1 unit of Cryo raises the ____ level by ___?

Answer 9

Fibrinogen by 50 mg/dL

Question 10

What is a potential risk factor with cryoprecipitate?

Answer 10

Increased risk of infection (not submitted to viral attenuation)

Question 11

What is Factor VIII concentrate made of?

Answer 11

Pool of plasma from a large number of donors.

Question 12

When is Factor VIII given?

Answer 12

Preop or intraop

Question 13

When should DDAVP be given?

Answer 13

30-60mins before Sx

Question 14

Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?

Answer 14

• Hematoma &
• compression of neurological structures

Question 15

What are the anesthesia considerations for someone with vWF deficiency?

Answer 15

• Avoid trauma
• avoid IM sticks
• avoid arterial lines (if feasible)
• avoid spinals,

Question 16

How does heparin work?

Answer 16

• It inhibits thrombin
• activates antithrombin III

Question 17

What labs are monitored with heparin?

Answer 17

PTT &/or ACT

Question 18

What factors are affected by Coumadin?

Answer 18

Vitamin K-dependent factors II, VII, IX & X

Question 19

What is the onset for Vitamin K?

Answer 19

6-8hrs

Question 20

What can be given to reverse coumadin faster than Vit K?

Answer 20

• Prothrombin complex concentrates
• Factor VIIa
• FFP

Question 21

How do UK, streptokinase & tPA act?

Answer 21

Convert plasminogen to plasmin, which cleaves fibrin

Question 22

How do TXA, aminocaproic acid & aprotinin work?

Answer 22

Inhibit conversion of plasminogen to plasmin

Question 23

What will labs show for someone in DIC?

Answer 23

• Reduced Plt.
• Prolonged PT, PTT & TT.
• Elevated fibrin degradation products

Question 24

When is antifibrinolytic therapy given to someone in DIC?

Answer 24

It shouldn’t, it can lead to catastrophic thrombotic complications

Question 25

What is Factor V Leiden?

Answer 25

• Genetic mutation that leads to increased fibrin production.
• Activated protein C cannot stop factor V

Question 26

What does Activated Protein C do?

Answer 26

Inactivates factor V when enough fibrin has been made.

Question 27

Who is usually tested for Factor V Leiden?

Answer 27

Pregnant women. Especially ones with unexplained late stage abortions

Question 28

What anticoags could someone with Factor V Leiden be put on?

Answer 28

• Warfarin
• LMWH & unfractionated heparin

Question 29

What is the hallmark sign of HIT?

Answer 29

Plt count <100,000

Question 30

HIT results in ____ activation and potential____?

Answer 30

• Platelet activation
• venous & arterial thrombosis

Question 31

What is heparin replaced with when HIT is identified?

Answer 31

Agratroban or bivalirudin

Question 32

What is Fonaparinaux & when is it used?

Answer 32

• A synthetic Factor Xa inhibitor
• used to treat VTE in HIT