Hemostasis 2

Question 1

types of hemophilia

Answer 1

hemophilia a: factor 8
hemophilia b: factor 9

clinically indistinguishable

Question 2

t/f in males, just having 1 x chromosome will make the patient express the trait

Answer 2

true

Question 3

if the father has hemophilia and the mother is not a carrier

Answer 3

all sons are normal

all daughters are obligatory carriers

Question 4

if the father does not have hemophilia and the mother is a carrier

Answer 4

all sons have a 50% chance of being affected

all daughters have a 50% change of being carriers

Question 5

symptoms of hemophilia

Answer 5

hemarthrosis

sites of bleeding: knees, iliopsoas, gluteal area, soft tissue, intracranial bleed

Question 6

mild bleeding severity for hemophilia

Answer 6

5-<40% of normal clotting factor level

episodes: spontaneous bleeding with major trauma or surgery, rare spontaneous bleeding

Question 7

moderate bleeding severity for hemophilia

Answer 7

1-5% of normal CFL

occasional spontaneous bleeding, prolonged bleeding with minor trauma or injury

Question 8

severe bleeding severity for hemophilia

Answer 8

<1% of normal CFL

spontaneous bleeding without hemostatic challenge

Question 9

treatment for hemophilia

Answer 9

factor replacement
antifibrinolytic therapy (txa)
rehabilitation

Question 10

types of factor replacement for hemophilia

Answer 10

factor 8 (for a)
factor 9 (for b)
cryoprecipitates (a) and cryosupernates (b)

cryoprecipitEIGHTS
cryosuBernates

Question 11

principle of rehabilitation for hemophilia

Answer 11

patients develop target joints –> always swollen –> joints will be destroyed

Question 12

characteristics of dic

Answer 12

• uncontrolled generation of thrombin due to tissue factor being activated
• widespread intravascular fibrin formation due to excess blood protease activity

Question 13

pathophysio of dic

Answer 13

• high fibrin + thrombin -> ischemic damage -> multiple organ failure
• rbc damage and hemolysis due to fibrin clots
• excess fibrin -> secondary fibrinolysis -> fdp production d-dimer

Question 14

most sensitive test/marker for dic

Answer 14

fdp d-dimer

Question 15

common causes of dic

Answer 15

sepsis (cocci)
immunologic disorders
trauma and tissue injury
drugs
vascular disorders
envenomation (snake/insects)
OB complications
liver disease
cancer (APL) 
misc

Question 16

symptoms of dic

Answer 16

thrombocytopenia

prolonged pt and ptt (consumed coagulation factors both in intrinsic and extrinsic pathway)

Question 17

diagnosis of dic

Answer 17

low platelet count
low fibrinogen level
prolonged ptt
increased d-dimer or fibrin degradation products

Question 18

differential diagnosis for dic

Answer 18

itp = labs are normal
ttp = closer to dic labs

Question 19

treatment for dic

Answer 19

treat underlying cause
transfusion
- fresh frozen plasma
- cryoprecipitates
- platelet concentrates
heparin

Question 20

arterial vs venous thrombosis

Answer 20

arterial: atherosclerosis
venous: due to immobility, surgery, or underlying medical condition

Question 21

what is unprovoked thrombosis

Answer 21

not caused by immobility, drugs, surgery, or underlying conditions
strongest predictor in recurrence

treated with anticoagulant indefinitely

Question 22

virchow’s triad

Answer 22

blood: hypercoagulable
vessel: vascular damage
flow: circulatory stasis

Question 23

risk factors for thrombosis

Answer 23

history: provoked/unprovoked?
age and gender
family history (factor v leiden)
malignancy

Question 24

inherited venous risk factors for thrombosis

Answer 24

factor v leiden
protein c deficiency
protein s deficiency
elevated factor 8

Question 25

acquired venous and arterial risk factors for thrombosis

Answer 25

malignancy (should be given anticoagulants)

Question 26

acquired venous risk factors for thrombosis

Answer 26

previous thrombosis
immobilization
major surgery
obesity