Heme/Onc- Coagulation Disorders

Question 1

S&S hemophilia

Answer 1

Severity based on degree of factor activity:

Delayed/ prolonged bleeding 
Hemarthrosis
IM hematomas 
GI bleeds 
Intracranial bleeds 
Prolonged bleeding after dental procedure 
Hemophilic Arthropathy

Question 2

Management of hemophilic arthoropathy caused by hemophilia

Answer 2

early prophylaxis with fact concentrates.

Question 3

Management of heparin induced thrombocytopenia

Answer 3

Discontinue all heparin products and start anticoagulation with a non heparin medication (also not warfarin)

Transfusions are not needed unless active bleeding

Question 4

Heparin induced thrombocytopenia

Answer 4

Antibody mediated mmild/ moderate thrombocytopenia.

Minimal bleeding risk , significant thrombotic risk

Question 5

Most common causes of secondary immune thrombocytopenia

Answer 5

HIV and Hep C

Question 6

Lab findings Immune thrombocytopenia

Answer 6

Normal: Leukocyte, erythrocyte and coat studies
Normal Platelet morphology (normal and large size due to turn over)
Platelets < 100k

Question 7

Use of hemoglobin electrophoreses

Answer 7

Diagnosis thalassemia

Question 8

Pmechanism of platelet dysfunction in CKD

Answer 8

rising urea–> up regulation of nitric oxide–> ↓vWF ↓ADP& thromboxane A2, ↓ GP2b3a –> ↓ platelet adhesion, activation & aggregation

Question 9

TX platelet disfunction in CKD

Answer 9

Desmopressing (↑vWF secretion) only if symptomatic or procedure prophylaxis