PATH: 10-12 Bleeding Pt

Question 1

Menorrhagia

Answer 1

More than 80 ml of blood/cycle

Question 2

A: [aPTT and PT/INR Test] will pick up BOTH _____ and ______ defects, but CAN’T differentiate between the two

B: What does an [Elevated Thrombocytosis] + [low HgB] likely suggest?

Answer 2

A: [aPTT and PT/INR Test] Will pick up BOTH qualitative and quantitative defects, but CAN’T differentiate

B: Anemia (since Erythropoietin in the presence of low iron) —-> Stimulating Thrombocytogenesis

Question 3

Common causes of Thrombocyto_penia_ (9)

Answer 3

“The DMMV GILDS awards causes Thrombocytopenia”

1. ITP (Idiopathic Thrombocytopenic Purpura)
2. Gestational (Genetic: Fanconi’s anemia / May Hegglin)
3. Drug-induced (Quinidine/Sulfonadmides/[Heparin-HIT])
4. Viral (HIV / Rubella / EBV)
5. Splenomegaly
6. Marrow infiltration by neoplasia (CLL)
7. Microangiopathic (HUS / TTP)
8. DIC
9. Lupus (Acquired abnormal hematopoiesis: B12 Deficiency or pre-leukemia)

Question 4

Bernard-Soulier Disease

Answer 4

inherited deficiency of the platelet membrane glycoprotein – [GP1B/2a] – So – the platelets can’t bind to the VWF exposed by the collegen underbelly – can initiate primary hemostasis

Question 5

Glanzmann’s Thrombasthenia

Answer 5

– platelets fail to aggregate in the presence of ADP, collagen or [Thrombin Factor 2A] because there are no [Gp2B/3a receptors,] so the fibrinogen can’t bind the platelets to one another –—->, a problem in the primary platelet plug

Question 6

A: This Disorder is an Inherited Disorder of Platelet Activation

B: Primary Hemostasis

C: [Tissue Factor ____] is constitutively expressed by [Perivascular _______ and _______cells]. It normally is not exposed to circulating blood

Answer 6

A: Von Willebrand’s Disorder

B: aggregation of platelets and formation of the hemostatic plug

C: [Tissue Factor Thromboplastin] is constitutively expressed by [Perivascular Fibroblast and Smooth muscle cells]. It normally is not exposed to circulating blood

Question 7

What test can you order to assess the following questions regarding

[Von Willebrand factor]

A: Does the pt have any VWF?

B: Does that VWF work?

C: What is the structure of VWF

Answer 7

A: Use [VWF8 - Von Willebrand Factor 8 antigen]

B: Determine [Von Willebrand Factor-Ristocetin Cofactor] activity

C: Examine Von Willebrand Multimers. Follow up test. Not done initially.

Question 8

A: Common Causes of Prolonged PT/INR (4)

B: Common Causes of Prolonged aPTT (3)

Answer 8

• Liver Dz (can cause both to prolong)
• Warfarin
• [Early stage DIC]
• Factor 7 Deficiency

B: INC apTT causes:

• Heparin
• Factor Deficiency
• Lupus Anticoagulant

Question 9

A: Conditions that cause BOTH aPTT and PT/INR to prolong (5)

B: How do you differentiate between Factor Deficiency from Factor Inhibition

Answer 9

1. Heparin OR Warfarin
2. Dilution
3. Vit K Deficiency
4. Liver Dz
5. Paraproteins

B: MIXING STUDY with a donors plasma

Question 10

First 3 questions you should ask when a pt presents with possible Bleeding Diathesis

Answer 10

1. Mucosal (indicates Platelet problem) vs. Deep (coagulation problem)
2. Immediate vs. Delayed
3. What’s the CBC / differential show

Question 11

ITP (Idiopathic Thrombocytopenic Purpura) is a cause of _________. How do you treat it? (2)

Answer 11

ITP (Idiopathic Thrombocytopenic Purpura) is a cause of THROMBOCYTOPENIA.

Tx= [Steroid Pulse 1st] and [Rituximab 2nd]