Bleeding And Thrombosis 10/6

Question 1

What is the term for bleeding into joints?

What usually causes it?

Answer 1

Hemarthrosis

Usually caused by coagulation factor deficiency.

Question 2

What do injured BVs release that attracts platelets?

Answer 2

ADP

Question 3

What Coag test asses the extrinsic pathway?

Answer 3

PT: prothrombin time

Measures time to form fibrin clot. Normal: 10-12 s

Monitored in pt’s on warfarin

Question 4

What Coag test asses the intrinsic pathway?

Answer 4

PTT: partial thromboplastin time

Uses neg charged particles, calcium; time to form fibrin clot.

Used to measure response to HEPARIN

Question 5

What is the cause if ONLY the PT is prolonged?

Answer 5

Defect in factor 7

Question 6

What is the differential (3) if patient presents with petechia and purpura but the PT and PTT are both normal?

Answer 6

Vessel wall abnormalities:

1. Scurvy
2. Infection
3. Drugs

Question 7

What is the cause if ONLY the PTT is prolonged?

Answer 7

Defects of factors 12, 11, 9, 8

Question 8

How do you test whether or not there is a clotting factor deficiency?

Answer 8

Mixing study.

Patient’s plasma mixed with normal plasma.

Clotting factor deficiency: correction after mix

Inhibitor: no correction after mix

Question 9

How are hemophilia A and B genetically inherited?

Answer 9

X-linked recessive.

Only males.

Question 10

Symptoms of hemophilia: (4)

Answer 10

1. Spontaneous/traumatic subcutaneous bleeding
2. Blood in urine
3. Bleeding in mouth, lips, tongue
4. Bleeding into joints, cns, GI tract

Question 11

What will Coag test findings indicate with Von willebrand’s disease?

Answer 11

Prolonged PTT

VWF stabilizes factor 8.

defect w/ factor 8 - long PTT

Question 12

What are the quantitative values for thrombocytopenia and thrombocytosis?

Answer 12

Thrombocytopenia: <100k

Thrombocytosis: >400k

Question 13

Hallmarks of thrombocytopenia (3)

Answer 13

Immediate post-surgical bleeding, petechia, ecchymosis, menorrhagia

Reddish-purple blotchy rash

Spontaneous bleeding from minor trauma

Question 14

Causes of thrombocytopenia? (3)

Answer 14

1. Decreased production from bone marrow (toxins, radiation, infx, leukemia)
2. Increased destruction (autoimmune)
3. Increased platelet consumption (DIC)
4. Spleen sequestration
5. Spurious- clumping of platelets. BAD!!

Question 15

What demographic usually presents with thrombotic thrombocytopenia purpura (ttp)

Answer 15

Adults, 30’s, mostly women, after virus.

Question 16

What is the Pentad (5) symptoms of TTP?

Answer 16

1. Fever
2. Thrombocytopenia w/ purpura
3. MHA (micro angiopathic hemolytic anemia)
4. Neurological deficit
5. Renal failure

Question 17

What enzyme is deficient in TTP?

Answer 17

ADAMST-13

Can’t degrade multimeters of VWF

Question 18

What is the treatment for TTP?

Answer 18

Therapeutic plasma exchange with FFP: removed multimers and adds VWF

Question 19

What will peripheral blood smear for MHA show?

Answer 19

Schistocytes

Large platelets

Question 20

What demographic most commonly gets HUS (hemolytic uremic syndrome)?

Answer 20

Children 1-4 y.o

Presents with bloody diarrhea

Question 21

What is the triad of symptoms for HUS?

Answer 21

1. Thrombocytopenia
2. MHA
3. Renal dysfunction (hematuria, proteinuria, uremia)

Question 22

What demographic most commonly presents with ITO (immune thrombocytopenic purpura)?

Answer 22

Young women

Question 23

What causes ITP?

Answer 23

Autoantibody mediated destruction of platelets. Platelets are opsonized and removed by spleen.

Question 24

What are the four symptoms of ITP?

Answer 24

Petechia
Menorrhagia
Hematuria
Melena

Question 25

What is a defect of platelet adhesion?

Answer 25

Bernard-Soulier

Question 26

What is defective formation of platelet aggregation?

Answer 26

Glanzman thrombasthenia

Question 27

Disseminated intravascular coagulopathy (DIC) is a thrombohemorrhagic disorder with: (3)

Answer 27

1. Excessive coagulation activation 2. Consumption of platelets, fibrin, and coagulation factors: hemorrhage 3. Activation of fibrinolysis: formation of thrombi in microvasculature

Question 28

5 diagnostic findings of DIC:

Answer 28

1. Thrombocytopenia 2. MHA - schistocytes 3. Prolonged pt/PTT 4. Increased fibrin split products (fsp) & d-dimers 5. Decreased fibrinogen and coagulation favored (5 & 8)

Question 29

What 2 enzymes promote plasminogen conversion to plasmin?

Answer 29

T-PA UPA

Question 30

What enzyme inhibits plasminogen conversion to plasmin?

Answer 30

PAI-1 Released from endothelial cells **PAI-1 deficiency can cause thrombus formation

Question 31

What inactivates plasmin?

Answer 31

Alpha 2-antiplasmin

Question 32

What 2 coagulation factors does protein c inhibit to inhibit thrombin's ability to activate CF's and platelets?

Answer 32

5 & 8

Question 33

What Coag cofactors are vitamin k dependent?

Answer 33

2, 7, 9, 10 Protein c and s

Question 34

What are the 2 genetic causes of hypercoagulable states?

Answer 34

1. Factor 5 Leiden point mutation (reduced activity of pC) 2. Mutant form of factor 5 (insensitive to pC) 3. Prothrombin gene point mutation (elevated prothrombin)

Question 35

What are the 4 acquired causes of hypercoagulable states?

Answer 35

1. BC 2. Cancer 3. HIT (heparin induced thrombocytopenia) 4. Anti phospholipid syndrome

Question 36

What is a likely outcome of protein C or S deficiency?

Answer 36

Deep vein thrombosis

Question 37

What is the syndrome of thrombosis associated with a visceral malignancy, such as adenocarcinoma of the pancreas?

Answer 37

Trousseau's syndrome