Hemorrhagic & Hypercoagulable D/Os

Question 1

Splenomegaly (from portal HTN results in sequestering of what? Leading to what?

Answer 1

platelets
thrombocytopenia (rarely <50,000)

Question 2

Usually the most sensitive indicator of liver function is what?

Answer 2

prolonged PT

Question 3

What are the most effective therapies for preventing hemorrhagic complications of invasive procedures or treating active bleeding?

Answer 3

FFP & Platelet transfusions

Question 4

What may at least partially reverse coagulation abnormalities but not likely in advanced liver disease?

Answer 4

Vitamin K

Question 5

Vitamin K dependent factors are?

Answer 5

II, VII, IX, X & anticoagulant factors protein C & S

Question 6

PT is more sensitive than PTT in detecting vitamin K deficiency b/c why?

Answer 6

factor VII (in extrinsic pathway) is most labile

Question 7

How to treat vitamin K deficiency?

Answer 7

PO supplementation (or SQ if malabsorption)

Question 8

Primary Hypercoagulable States
Deficiency of antithrombotic factors include what d/o’s

Answer 8

antithrombin III deficiency
Protein C deficiency
Protein S deficiency

Question 9

Primary Hypercoagulable States
Increased prothrombotic factors include what d/o’s?

Answer 9

factor Va (activated protein C resistance; factor V Leiden)
prothrombin
factor IX paduda
Factor CII, XI, IX, VIII; vWF; fibrinogen

Question 10

Antithrombin III deficiency:
Major inhibitor of?
Deficiency results in?
ONly deteceted in ~what % of those with VTE but ~ what % in those with recurrent thrombosis or thrombosis @ younger age (< 45y/o)?

Answer 10

thrombin & other activated coagulation factors
unregu8lated protease activity & fibrin formation/accumulation
1-2%; 2.5%

Question 11

Protein C Deficiency:
results in unregulated what?
detected in what % of those with VTE?

Answer 11

fibrin generation d/t impaired inactivation of factors VIIIa & Va
~2-5%

Question 12

Protein S Deficiency:
similar to what?; loss of regulation of what?
detected in what % of those with VTE?

Answer 12

protein C deficiency; fibring generation by impaired inactivation of factors VIIIa & Va
~1-3%

Question 13

Factor V Leiden (activated protein C resistance)
occurs in what % of whites?
Detected in what % of those with VTE?

Answer 13

~3-7%
~10-64%

Question 14

Clinical Manifestations of Primary Hypercoagulable States include?

Answer 14

DVT of LE & PE (most frequent)
Venous thrombosis of mesenteric & cerebral vasculature
typically occurs in early adulthood
usually have family h/o thrombosis

Question 15

Management of Primary Hypercoagulable States
No cancer use what medication?
Cancer use what?
gaol INR is what for VKA?
in those with >/= 2 events, need what?

Answer 15

DOACs over VKA, VKA over LMWH
LMWH over VKA & DOACs
2-3
lifelong therapy with warfarin

Question 16

How does Malignancy lead to thrombin generation?

Answer 16

Tissue Factor (TF) & a procoagulant are expressed by tumor cells. In living cells, TF is dormant but activated during cellular apoptosis –> initiation of coagulation cascade –> thrombin generation

Question 17

Pregnancy and thrombosis
Progressive state of what?
placenta is source of increased what?
increased platelet what?
Fibrinolytic system is what?

Answer 17

DIC
thrombin
activation/turnover
blunted

Question 18

Oral Contraceptives lead to thrombosis how?

Answer 18

increase procoagulant effects/decreased anticoagulant effects

Question 19

HRT
increased risk of VTE by what a factor of what @ least in first year?

Answer 19

2-3.5x