L3 - Bleeding And Clotting Disorders

Question 1

What sx should make you suspect a platelet disorder until proven otherwise?

Answer 1

Mucosal bleeding (epistaxis, gingival bleeding)

Question 2

Which lab tests should be performed for bleeding disorders?

Answer 2

CBC 
Bleeding time or platelet function assay 
PT for extrinsic coagulation pathway 
PTT for intrinsic coagulation pathway 
Fibrinogen level

Question 3

Which factors are in the intrinsic pathway?

Answer 3

XII, XI, IX and VIII

Question 4

Which factors are in the extrinsic pathway?

Answer 4

Tissue factor

VII

Question 5

Which factors are in the common pathway?

Answer 5

X, II (thrombin), I (fibrinogen) and XIII (fibrin clot)

Question 6

Why is a genetic test for hemophilia A beneficial?

Answer 6

Can help predict disease severity (certain mutations are associated with more significant bleeding)
Eliminates other diseases in the differential

Question 7

What is the progression of hemophilic arthropathy?

Answer 7

Normal joint —> acute bleeding —> chronic synovitis —> early arthritis —> end stage arthritis

Question 8

Describe the evolution of hemophilia treatment

Answer 8

Fresh frozen plasma (too much volume and infection concern) —>
Cyroprecipitate (less volume but infection concern remains) —>
HIV/AIDs epidemic —>
Recombinant factor VIII

Question 9

What are some primary hemostasis disorders?

Answer 9

Drug induced platelet destruction/dysfunction
Aplastic anemia
Immune platelet destruction (ITP)
Mechanical platelet destruction (hypersplenism)

Question 10

List some secondary hemostasis disorders

Answer 10

VIII and V most common
Anti phospholipid Abs
Drug induced factor inhibition (heparin, warfarin)
Consumption of factors

Question 11

What are the expected lab results for VWD?

Answer 11

Normal PT
Normal to high PTT
High bleeding time
Normal platelets

Question 12

What are the expected lab results for hemophilia?

Answer 12

Normal PT, bleeding time and platelets

Increased PTT

Question 13

What are the expected lab results for ITP?

Answer 13

Normal PT and PTT
Increased bleeding time
Decreased platelets

Question 14

What are the expected lab results for DIC?

Answer 14

Increased PT, PTT, bleeding time

Decreased platelets

Question 15

What are the expected lab results for the effects of Warfarin?

Answer 15

Increased PT
Normal to increased PTT
Normal bleeding time and platelets

Question 16

What are the expected lab results for the effects of heparin?

Answer 16

Normal PT, bleeding time and platelets

Increased PTT

Question 17

What are the expected lab results for Glanzmann?

Answer 17

Normal PT, PTT and platelets
Increased bleeding time
(Same results for Bernard-Soulier)

Question 18

What are the components of Virchow’s triad?

Answer 18

Venous stasis, endothelial injury, hyper-coagulability

Question 19

What can cause venous stasis?

Answer 19

Intra operative period, post op period, travel

Question 20

What can cause endothelial injury?

Answer 20

Trauma
Implanted devices
Catheters

Question 21

What can cause hyper-coagulability?

Answer 21

Genetic mutations, nephrotic syndrome, hyper viscosity due to malignancy, auto immune/inflammatory dz, contraceptives, cigarette smoking

Question 22

What is a white thrombus?

Answer 22

Arterial 
Platelet rich 
Occur in high shear stress 
Atherosclerosis 
Coronary or cerebral arteries 
Common in older adults/elderly

Question 23

What is a red thrombus?

Answer 23

Venous
Red cell rich
Stasis
LE