Untitled Deck

Question 1

What are the main antifibrinolytic agents used in coagulation support?

Answer 1

Tranexamic acid.

Question 2

How is warfarin reversal achieved?

Answer 2

With vitamin K or Octaplex (factors II, VII, IX, X).

Question 3

What is used in patients with inhibitors during bleeding?

Answer 3

Factor VIIa or increased doses of factor VIII to overpower antibodies. FEIBA or Octaplex can also be used.

Question 4

What is disseminated intravascular coagulation (DIC)?

Answer 4

An acquired thrombophilia where widespread clotting and bleeding occur.

Question 5

Why do many elderly patients not switch from warfarin to DOACs?

Answer 5

Warfarin is cheaper but requires complex management, whereas DOACs are simpler but more expensive.

Question 6

What is haemarthrosis?

Answer 6

Bleeding into joints, often seen in untreated haemophiliacs, leading to joint fixation.

Question 7

How much factor level is required to maintain hemostasis?

Answer 7

At least 25% of factor levels, but up to 100% is targeted before surgery to reduce transfusion needs.

Question 8

What is desmopressin (DDAVP) and how does it work?

Answer 8

Desmopressin increases von Willebrand factor (vWF) and factor VIII levels by 2-6 times. It is cheap, safe, and widely available.

Question 9

What is the half-life of desmopressin (DDAVP) and its implication in surgery?

Answer 9

12 hours. If surgery is delayed beyond 24 hours, factor levels return to baseline.

Question 10

What is the role of tranexamic acid in coagulation?

Answer 10

It is an antifibrinolytic that prevents clot breakdown by inhibiting the conversion of plasminogen to plasmin.

Question 11

How are patients with von Willebrand disease (vWD) treated?

Answer 11

Type 1: Desmopressin or tranexamic acid mouthwash.

Type 2: Treated with vWF concentrates like Willate.

Type 3: Requires vWF concentrates; DDAVP is ineffective.

Question 12

What is the preferred method for managing warfarin reversal in severe cases (INR > 20)?

Answer 12

Octaplex is preferred over plasma to avoid adding fuel to the fire.

Question 13

What factors are included in Octaplex?

Answer 13

Factors II, VII, IX, X, as well as proteins C and S.

Question 14

Why is Hepatitis B considered particularly resilient?

Answer 14

It is highly durable and survives in various conditions.

Question 15

What led to significant HIV and Hepatitis C transmission in haemophiliacs in the past?

Answer 15

Contaminated plasma-derived products before the advent of viral inactivation methods.

Question 16

How are plasma-derived products inactivated to ensure safety?

Answer 16

Through methods such as solvent detergent treatment, dry heat, and pasteurization.

Question 17

What is the Ristocetin cofactor assay used for?

Answer 17

To test if vWF is effectively binding platelets.

Question 18

How is cryoprecipitate discovered and what does it contain?

Answer 18

Discovered accidentally; it contains fibrinogen, vWF, and factor VIII.

Question 19

What are the advantages of recombinant factors over plasma-derived products?

Answer 19

Recombinant factors are safer, with no risk of viral transmission, although human-derived products are cheaper.

Question 20

What is the role of FEIBA in haemophilia management?

Answer 20

It is used to bypass inhibitors by providing activated clotting factors.

Question 21

How is tranexamic acid used in dental procedures for coagulation disorders?

Answer 21

It can be applied as a mouthwash every 6 hours or incorporated into tissue packs to control bleeding.

Question 22

What makes vWF a ‘sticky’ protein?

Answer 22

It binds platelets and factor VIII, playing a key role in clot formation.

Question 23

Why are human-derived products still used in some countries?

Answer 23

They are cheaper, although they are now viral-inactivated to ensure safety.

Question 24

What cells are used to produce recombinant factor VIII?

Answer 24

Chinese hamster ovary cells, as they allow proper glycosylation required for function.

Question 25

What is the treatment of choice for haemophiliacs with intracranial hemorrhage?

Answer 25

Rapid infusion of factor concentrates to restore adequate clotting factor levels.

Question 26

What is the role of monoclonal antibody columns in coagulation product preparation?

Answer 26

They are used to purify specific clotting factors, such as factor VIII, enhancing product safety and efficacy.

Question 27

Why is factor VIII often administered with von Willebrand factor (vWF)?

Answer 27

vWF stabilizes factor VIII in circulation, enhancing its half-life and efficacy in preventing bleeds.

Question 28

What is the effect of prosthetic joints on haemophilia treatment?

Answer 28

Prosthetic joints can improve mobility for haemophiliacs with chronic joint damage caused by repeated bleeds.

Question 29

What is the primary cause of haemarthrosis in children with haemophilia?

Answer 29

Repeated bleeding into joints due to low clotting factor levels.

Question 30

What happens if surgery for a haemophiliac is delayed beyond 24 hours?

Answer 30

Factor levels, increased by treatments like DDAVP, return to baseline, necessitating repeated dosing.

Question 31

How is haemophilia treatment different for ‘low responders’ with inhibitors?

Answer 31

Increased doses of factor VIII can be used to overpower antibodies, or alternative agents like FEIBA are employed.

Question 32

What is the primary advantage of recombinant products over plasma-derived products?

Answer 32

They eliminate the risk of viral contamination.

Question 33

What is the impact of delayed recognition of moderate haemophilia?

Answer 33

Patients may only be diagnosed during events like dental extractions, leading to unanticipated bleeding complications.

Question 34

Why is octaplex used in Ireland for coagulation support?

Answer 34

It is a cost-effective option that provides multiple clotting factors along with proteins C and S.

Question 35

How do antifibrinolytics support haemostasis?

Answer 35

By preventing the breakdown of clots, thus stabilizing formed thrombi in bleeding patients.