module 4 disorders of hemostasis

Question 1

Coagulopathy s/s (5)

Answer 1

prolonged pt/ptt
joint bleeding
tissue hematoma
large, spontaneous, centrally located ecchymosis
bleeding delayed

Question 2

Thrombocytopenia

Answer 2

mucosal bleeding
bleed immediately
petechiae maybe

Question 3

adequate plt count
rarely develop purpura even w trauma
asymptomatic, risk for excessive bleed w trauma
spontaneous bleeds, maybe petechiae

Answer 3

> 50,000
30,000-50,000
10,000-30,000
<10,000

Question 4

causes of thrombocytopenia (5)

Answer 4

hemodilution (esp Post-op)
splenomegaly (ca/cirrhosis)
HIV, BM failure
Hemolysis
Medications

Question 5

Medications causing thrombocytopenia

Answer 5

Heparin
sulfa, vanc, piperacillin, PCN, rifampin
quinine
linezolid
valproic acid, carbamazapine, phenytoin

Question 6

Idiopathic Thrombocytic Purpura

mostly in ______
Primary
Secondary

Answer 6

mostly in women
Primary: acquired d/t destruction of plts
secondary: d/t SLE, CML, antiphospholipid, meds

Question 7

Acute vs chronic Idiopathic thombocytic pupura

Answer 7

acute w kids 1-2 months d/t viral infections, sle, drug allergies

chronic- idiopathic (primary) and progessive

Question 8

Platelet destruction in Idiopathic thrombocytic pupura starts w
___ by ___ who ___ to ____=____
___ binds to ____=destroyed plt

Answer 8

phagocytosis by macrophages who present digested plt peptides to CD4 cells-> = immune response
IgG bind to glycoproteins ->plt destroyed

Question 9

Neonatal thrombocytopenia is when
can be 2 reasons
Risk of

Answer 9

Moms IgG’s cross over to fetus’ plts=destroyed
Can be bc mom has Idiopathic thrombocytic pupura or just an alloimmune response
intracranial hemorrhage risk when plt <20,000

Question 10

Idiopathic thrombocytic pupura symptoms

Answer 10

petechiae, purpura, bruising
GI/GU, nose bleeds
intracranial hemorrhage
older adults more severe bleeds bc of comorbidities (htn)

Question 11

How can Thrombotic Thrombocytopenic purpura cause platelet consumption and organ ischemia

Answer 11

thrombocytic microangiopathy caused when platelets aggregate and occlude the microcirculation
=plt consumption/organ ischemia in brain, heart, kidneys

Question 12

Acquired vs Familial Thrombotic Thrombocytopenic purpura

Answer 12

familial- affects children, appears chronic, recurring episodes q3wks, responsive to treatment
acquired- acute/severe, females 30+

Question 13

Thrombotic Thrombocytopenic purpura causes

Answer 13

autoimmune, family, HIV, CA, post-op, meds (antiplt, quinine, mitomcyin, cisplatin, bleomycin)

Question 14

Patho of Thrombotic thrombocytopenic purpura
gene mutation causing _______=________ ->_____ = _____ in _____ = organ death

^_______

Answer 14

vADAMS13 (d/t mutation in gene making adams13)=^Von willebrand factor
=hypercoaguable =microthrombi in organs

^plasminogen activator inhibitor

Question 15

Thrombocytic Thrombocytopenic purpura

s/s

Answer 15

may have neuro symptoms (seziure, hemiplegia, ams)
fatigue w anemia (microangiopathic d/t rbc lysis)
petechiae, pallor, jaundice
fever
dark urine from hemoglobinurua
n/v/d abd pain, GI symptoms common
CP, HF, shock ,death
thrombocytopenia, NORMAL pt/ptt, fibrinogen
^cr, BUN, LDH, bili
blood smear=shistocytes

Question 16

Hemophilia sites of bleeding

Answer 16

knees, elbows, ankles
GI
Spontaneous=severe disease

Question 17

Hemophilia diagnostic testing

Answer 17

normal platelets
normal pt
prolonged ptt

Question 18

Hemophilia children diagnosed when _

will see__

Answer 18

diag in children when they start crawling/standing

Bruising, swelling, joint redness, mouth bleeding

Question 19

Disseminated intravascular coagulation

activation of ____ and ___ d/t ___

Answer 19

activation of coagulation cascade and fibrinolytic cascade d/t underlying disease

Question 20

Disseminated intravascular coagulation triggered by

Answer 20

CA, sepsis, obstetrical complications, trauma/surguries

ards, rabdo, bites, acidemeia, transfusion rxcn

Question 21

Patho of Disseminated intravacular coagulation
____= exposed ____= ______
______ broken down->______ prevents adhesion =_____
may cause ____ d/t ______

Answer 21

endothelial damage=exposed TF=coagulation cascade
widespread fibrin deposition broken down-> products adhere to plts, prevent adhesion=bleeding
may cause organ failure d/t micro thrombi

Question 22

Disseminated intravascular coagulation

s/s

Answer 22

bleeding from wounds, venipuncture
stroke, PE, necrotic skin lesions
hemorrhaging into closed compartments
multisystem failure= neuro, oligura, hematuria, hypotension, cyanosis of toes/fingers

Question 23

Disseminated intravasular coagulation 
pt/ptt
fibrinogen
d diner
plt

Answer 23

prolonged pt/ptt
low fibrinogen
^d-dimer
plt <100,000

Question 24

arterial vs venous thrombus

main complication w either

Answer 24

arterial: high blood flow, fibrin/plts (stroke)
venous: low blood flow, rbcs/fibrin few plts (PE)

Question 25

virchows triad (dvt) 3:

Answer 25

injury to blood vessel (atherosclerosis, htn, smoking)
abnormalities in blood flow (turbulent w sickle cell, ^viscocity)
hypercoagulable states (chf, MI, bed rest)

Question 26

Unusual sites for thombus (4)

Answer 26

mesenteric vein, renal vein, hepatic, cerebral

Question 27

arterial thrombosis associated w 3 deficiencies and ___

Answer 27

protein c
protein s
antithrombin

lupus anticoagulants

Question 28

Factor 5 Leidan Mutation (hereditary hypercoagulable)
common cause of ___
causes factor ____ to be resistant to _______= _______ by APC= ^_________

Answer 28

common cause of thrombophilia in caucasians

factor Va resistant to activated protein c (APC)
= factor Va not broken down=^thrombin

=thrombophilic state

Question 29

Protein S deficiency (hereditary hypercoagulable)

activates ____ which inactivates ___ and ____

why does inflammation=risk for clots

Answer 29

activates protein C which inactivates Va and VIIIa

some attaches to complement
during inflammation=vProtein S=^coagulable

Question 30

Protein C deficiency (hereditary hypercoagulable)

what kind of mutation causes this

Answer 30

activated by protein S to form activated protein c
APC inactivates Va and VIIIa

autosomal dominant mutation in PROC gene