Spring 2024 (Exam II) Blood Disorders

Question 1

What is the number 1 most common hereditary bleeding disorder?

Answer 1

vWF disorder (platelet adhesion dysfunction)

Question 2

What are the S/S of vWF disorder?

Answer 2

• Easy bruising
• epistaxis
• menorrhagia (menstrual bleeding)

Question 3

What would lab values be for someone with vWF deficiency?

Answer 3

• Normal PT & aPTT
• Bleeding time is prolonged

Question 4

What are the treatments for vWF deficiency?

Answer 4

• Desmopressin
• Cryoprecipitate
• Factor VIII

Question 5

How does DDAVP work in regards to treatment of von Willebrand deficiency??

Answer 5

Stimulates vWF release from endothelial cells

Question 6

What is the dose for DDAVP?

Answer 6

0.3 mcg/kg in 50 mL over 15-20 mins (Do not bolus)

Question 7

What is the onset & duration of DDAVP?

Answer 7

• Onset: 30mins (max effect)
• Duration: 6-8hrs

Don’t bolus DDAVP; drip slowly.

Question 8

What are the side effects of DDAVP?

Answer 8

• HA
• Stupor
• hypotension (if given quickly)
• tachycardia
• hyponatremia (d/t retention of water, pt needs to be on fluid restriction)
• water intoxication(excessive water retention)
• • restict water PO/ IV

Question 9

What is the major side effect of DDAVP?

Answer 9

Hyponatremia

Na+ 120: Confusion, restlessness, wide QRS
Na+ 115: Somnolence, nausea, elevated ST, wide QRS
Na+ 110 Seizure, coma, V-tach, V-fib

Question 10

Someone that gets DDAVP needs to be on what?

Answer 10

Fluid restriction 4-6hrs before & after DDAVP

Question 11

What blood product can be utilized for vWF disease if the patient is unresponsive to DDAVP?

Answer 11

Cryoprecipitate

Question 12

1 unit of Cryo raises the ____ level by ___?

Answer 12

Fibrinogen by 50 mg/dL

Question 13

What is a potential risk factor with cryoprecipitate?

Answer 13

Increased risk of infection (not submitted to viral attenuation/ multi-pool donors)

Question 14

What is Factor VIII concentrate made of?

Answer 14

Pool of plasma from a large number of donors.
Contains Factor VIII and vWF

Question 15

When is Factor VIII concentrate given?

Answer 15

Preop or intraop
* contains F VIII and vWF

Question 16

Between Cryo and F VIII concentrate, which has a higher risk for infection? Why?

Answer 16

• Cryo
• multi-pool donors with no viral attenuation
• F VIII concentrate does undergo viral attenuation

Question 17

Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?

Answer 17

• Hematoma
• Nerve compression

Question 18

What are the anesthesia considerations for someone with vWF deficiency?

Answer 18

• Avoid trauma (Get the best intubator performing DL)
• Laryngeal trauma during tracheal intubaton may cause hematoma= postop obstruction of airway
• avoid IM sticks (Will cause localized tissue trauma)
• avoid arterial lines (if feasible)
• avoid spinals

Question 19

How does heparin work?

Answer 19

• Heparin inhibits thrombin by activating antithrombin III
• AT-III will inhibit thrombin

Question 20

What labs are monitored with heparin?

Answer 20

PTT &/or ACT

Question 21

Use and benefits of LMWHs

Answer 21

• VTE prophylaxis
• more predictable pharmacokinetic response
• fewer effects on plt function
• reduced risk for HIT
• no labs monitoring

Question 22

What is the mechanism of action of Coumadin?

Answer 22

Inhibition of vitamin K-dependent factors

Question 23

Which factors are vitamin-K dependent?

Answer 23

II, VII, IX & X

Question 24

What is the onset for Vitamin K?

Answer 24

6-8hrs

Question 25

What drugs/products can be given to reverse coumadin faster than Vit K?

Answer 25

• Prothrombin complex concentrates
• Factor VIIa
• FFP

Question 26

What is the mechanism of action for fibrinolytics (UK, streptokinase & tPA)?

Answer 26

Convert plasminogen to plasmin, which cleaves fibrin

Question 27

How do tranexamic acid (TXA) and aminocaproic acid work?

Answer 27

Inhibit conversion of plasminogen to plasmin

Question 28

What is the best way to treat DIC?

Answer 28

Treat the underlying cause

Question 29

What will labs show for someone in DIC?

Answer 29

• ↓PLTs
• Prolonged PT, PTT & thrombin time
• ↑ fibrin degradation products

Question 30

When is antifibrinolytic therapy given to someone in DIC?

Answer 30

Trick question, it shouldn’t. Can lead to catastrophic thrombotic complications

Question 31

What is factor V Leiden?

Answer 31

• Protein for clotting.

Activated protein C inactivates factor V thus stopping clot growth (negative feedback).

Question 32

What is Factor V Leiden deficiency?

Answer 32

Genetic mutation where Activated protein C cannot stop factor V Leiden thus excessive fibrin.

Question 33

What does Activated Protein C do?

Answer 33

Inactivates factor V when enough fibrin has been made.

Question 34

Factor V Leiden increases risk of ?

Answer 34

DVT w/ wo PE

Question 35

Who is usually tested for Factor V Leiden?

Answer 35

Pregnant women. Especially ones with unexplained late stage miscarriages

Question 36

What anticoagulant medications could a pregnant woman with Factor V Leiden be put on?

Answer 36

• LMWH
• For individuals with severe Factor V, they will be placed on Coumadin

Question 37

What is the hallmark sign of HIT?

Answer 37

Plt count <100,000

Thrombocytopenia occurs 5-14 days after initial heparin therapy and affects 5% of patients exposed to unfractionated heparin and rare cases LMWH.

Question 38

HIT results in ____ activation and potential____?

Answer 38

platelet; thrombosis

Question 39

What is heparin replaced with when HIT is diagnosed?

Answer 39

Agratroban or bivalirudin, lepirudin, argatroban (direct-thrombin inhibitors)

Question 40

What is Fonaparinaux & when is it used?

Answer 40

• A synthetic Factor Xa inhibitor
• used to treat VTE in HIT