bleeding disorders

Question 1

what happens in the common pathway?

Answer 1

10 converted to thrombin (2) using 5

Question 2

extrinsic pathway involves

Answer 2

10 - 10a in the presence of factor 7 and TF

Question 3

the intrinsic/propagation pathway involves

Answer 3

12-11-9-10 with the help of 8

Question 4

what 2 factors help activate factor 12

Answer 4

prekallikrein and HMWK

Question 5

Do you need PK and HMWK or factor 12 to control bleeding?

Answer 5

NO

Question 6

PTT assesses

Answer 6

intrinsic (inside) and common pathway (have to get to the end)

Question 7

PT assesses

Answer 7

extrinsic and common

Question 8

Protein C and S (cofactor)

antithrombin

Answer 8

degrade 5 and 8

preferentially neutralizes 10 and 10a

Question 9

INR is

Answer 9

PT in sec/ geo mean in sec

Question 10

non-enzymatic co factors include

Answer 10

5, 8, TF

Question 11

which factors are NOT made in the liver

Answer 11

• tPA
• VWF
• thrombomodulin
• factor 8 made by endoth as well

Question 12

Factors with the shortest half life

Answer 12

7

5 and 8

Question 13

VWF is synthesized by

Answer 13

endothelial cells and megs

Question 14

VWF extends the half life of

Answer 14

factor 8

Question 15

Primary hemostatic disease is

Answer 15

VWF disease

can impact secondary hemostasis because less factor 8 around

Question 16

3 clinical components of VWF disease

Answer 16

1 - mucocutaneous bleed
2- autosomal inheritance
3- CBC INR/PTT often normal

Question 17

how do we treat mild VWF disease

Answer 17

• DDAVP - desmopressin- increase hemostasis - due to stress

-

Question 18

more moderate severe VWF - how do you treat

Answer 18

• give VWF/Factor 8 concentrate
• humate - wilate
• OCP

Question 19

In Hemophilia A and B which lab finding is commonly found

Answer 19

Prolonged PTT -

intrinsic pathway is delayed

Question 20

treating hemophilia –>

Answer 20

TREAT IMMEDIATED

then scan

Question 21

Severe hemophilia how do you treat?

Answer 21

• factor 8 or 9 concentrate can be given
  or
  DDAVP if moderate- mild

Question 22

in patients with liver disease most commonly present with

Answer 22

• esophageal/GI varices
  gastritis
  ulcers
  risk for bleeding and clotting

Question 23

Clues that a patient has liver disease from lab tests include

Answer 23

• Thrombocytopenia
• prolngation of INR and PTT
• decreased factors except factor 8

Question 24

treating coagulopathy of liver disease -

Answer 24

treat liver disease
vitamin K not effective
DDAVP
anti fibrinolytics

Question 25

Features of DIC

Answer 25

- prolonged INR PTT - Thrombocytopenia - Low fibrinogen

Question 26

Uncontrolled generation of what 2 factors results in DIC

Answer 26

- thrombin | - plasmin

Question 27

with DIC you can get excessive release of what factor

Answer 27

tissue factor release

Question 28

how do you treat DIC

Answer 28

treat the underlying cause - | protein C and antithrombin may help

Question 29

what are some causes of a vitamin K deficiency

Answer 29

- nutritional deficiency - warfarin - Antibiotics - Biliary obstruction/malabsorption - hemorrhagic disease of newborn

Question 30

what lab tests will you find with a vitamin K deficiency?

Answer 30

- prolonged PT/INR - PTT prolonged in more severe cases reduced factors 2,7,9,10

Question 31

INR/PTT for following diseases ``` VWF Factor 8 or 9 or 12 deficiency Drug induced heparin, thrombin inhibitor Inherited/acquired factor 7 deficiency vitamin k deficiency/early liver disease Severe vitamin K deficiency Severe liver disease ```

Answer 31

``` INR/PTT often normal Isolated PTT deficiency normal INR Isolated PTT deficiency normal INR prolonged INR/normal PTT prolonged INR/normal PTT Prolonged INR and PTT Prolonged INR and PTT ```