Secondary Hemostasis and Related Disorders

Question 1

Factors in intrinsic arm

Answer 1

XII
XI
IX
VIII
X

Question 2

Factors in extrinsic arm

Answer 2

VII

X

Question 3

Function of 2˚ hemostasis

Answer 3

stabilize platelet plug formed in 1˚ hemostasis

Question 4

Fibrin serves to bind what together

Answer 4

adjacent platelets

via GPIIb/IIIa

Question 5

Factor bleeding results in bleeding where

Answer 5

deep tissue bleeding

muscles and joints

Question 6

PTT measures what

Answer 6

intrinsic coag arm

Question 7

PT measures what

Answer 7

extrinsic coag arm

*used to monitor bleeding due to liver dysfunction b/c monitoring VII, which has shortest t1/2

Question 8

Hemophilia A defect and inheritance

Answer 8

VIII

X-linked recessive (often de novo)

Question 9

Hemophilia B defect and inheritance

Answer 9

IX

X-linked recessive (often de novo)

Question 10

Hemophilia C defect and inheritance

Answer 10

XI

autosomal recessive

Question 11

Tx of
hemophilia A
hemophilia B
hemophilia C

Answer 11

A: VIII + desmopressin
B: IX
C: XI concentrate

Question 12

How to remember which hemophilia is which

Answer 12

intrinsic arm is descending numbers
so are the letters
C: XI
B: IX
C: VIII (also hemophilia 8 instead of hemophilia A)

Question 13

Coagulation factor inhibitor
most common type
labs

Answer 13

Factor VIII

PTT does not correct with mixing study

Question 14

If there is low VIII and the PTT does not correct with mixing study? what if it does correct?

Answer 14

no correction: coagulation factor inhibitor

corrects: hemophilia A

Question 15

Von Willebrand Disease
defect
inheritance
Tx

Answer 15

genetic vWF deficiency
dominant!
Tx: desmopressin (vWF release from Weibel-Palade bodies)

Question 16

Labs in von Willebrand disease

Answer 16

increased bleeding times (bad platelet adhesion)
high PTT, b/c vWF stabilizes factor VIII
abnormal ristocetin test

Question 17

Ristocetin test

Answer 17

ristocetin induces platlet agglutination by causing vWF to bind platelet GpIb
if no vWF then impaired agglutination
+ test if no agglutination in von Willebrand disease

Question 18

Where is vit K reduced in liver

Answer 18

epoxide reductase

Question 19

Vit K-dependent factors

Answer 19

II, VII, IX, X, proteins C and S

Question 20

Vit K deficiency causes

Answer 20

newborn: no gut bacteria
malabsorption: K is fat soluble
long term Abx: flora

Question 21

How to track coag problems in liver failure

Answer 21

VII

has shortest t1/2 of factors

Question 22

Large volume transfusions

secondary hemostasis disorder

Answer 22

dilutes coag factors