Blood Disorders (Exam II)

Question 1

What are the S/S of vWF disorder?

Answer 1

• Easy bruising
• Epistaxis
• Menorrhagia

Question 2

What would lab values be for someone with vWF deficiency?

Answer 2

• Normal PT & aPTT
• Bleeding time is prolonged

Question 3

What are the treatments for vWF deficiency?

Answer 3

• Desmopressin (DDAVP)
• Cryoprecipitate
• Factor VIII

Question 4

What is the best diagnostic lab value in vWD?

Answer 4

ACT
PT/aPTT are often normal

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)

Max effect in 30min, lasts 6-8hrs

Question 7

What is the onset & duration of DDAVP?

Answer 7

• Onset: 30mins
• Duration: 6-8hrs

Question 8

What are side effects of DDAVP?

Answer 8

• HA
• Stupor
• Hypotension
• Tachycardia
• Hyponatremia
• Water intoxication (excessive water retention)

Question 9

What is the most major side effect of DDAVP?

Answer 9

Hyponatremia

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

What S/S would you expect with Na+ of 120?

Answer 12

Confusion, restlessness, widened QRS

Question 13

What S/S would you expect with Na+ of 115?

Answer 13

Somnolence, nausea, elevated ST, widened QRS

Question 14

What S/S would you expect with Na+ of 110?

Answer 14

Siezures, coma, vtach/vfib

Give hypertonic saline 3% as bolus until seizing stops

Question 15

1 unit of Cryo raises the ____ level by ___?

Answer 15

fibrinogen, 50 mg/dL

Question 16

What is a potential risk factor with cryoprecipitate?

Answer 16

Increased risk of infection (not submitted to viral attenuation)

Question 17

What is Factor VIII concentrate made of?

Answer 17

Pool of plasma from a large number of donors, does undergo viral attenuation
Contains F VIII and vWF

Question 18

When is Factor VIII given?

Answer 18

Preop or intraop

Question 19

When should DDAVP be given prior to surgery?

Answer 19

60mins before SX

Question 20

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

Answer 20

• Hematoma
• Nerve compression

Question 21

What are the anesthesia considerations for someone with vWF deficiency?

Answer 21

• Avoid trauma (particularly airway)
• Avoid IM/SQ sticks
• Avoid arterial lines (if feasible)
• Avoid spinals

Question 22

Medications that can cause aquired bleeding

Answer 22

• Heparin
• Warfarin
• Fibrinolytic
• Antiplatelets

Question 23

How does heparin work?

Answer 23

• Thrombin inhibition
• Antithrombin III activation

Heparin won’t work on patients with antithrombin III deficiency

Question 24

What does thrombin do?

Answer 24

Converts fibrinogen to fibrin

Question 25

What labs are monitored with heparin?

Answer 25

PTT & ACT

Question 26

Reversal for Heparin

Answer 26

Protamine

Question 27

What is the mechanism of action of Coumadin?

Answer 27

Inhibition of vitamin K-dependent factors

Question 28

Which factors are vitamin-K dependent?

Answer 28

II, VII, IX & X

Question 29

What is the onset for Vitamin K administration?

Answer 29

6-8 hrs

Question 30

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

Answer 30

- Prothrombin complex concentrates - Factor VIIa - FFP

Question 31

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

Answer 31

**Convert plasminogen to plasmin**, which cleaves fibrin causing clot dissolution

Question 32

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

Answer 32

**Inhibit conversion of plasminogen to plasmin**

Question 33

What is the **best** way to treat DIC?

Answer 33

Treat the underlying cause | ...can also replete coag factors and platelets

Question 34

What is systematic activation of the coagulation system that simultaneously leads to thrombus formation and exhaustion of platelets and coagulation factors?

Answer 34

DIC

Question 35

What will labs show for someone in DIC?

Answer 35

- ↓Platelet count - Prolonged PT, PTT & TT. - ↑ fibrin degradation products

Question 36

When is antifibrinolytic therapy given to someone in DIC?

Answer 36

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

Question 37

What is factor V Leiden?

Answer 37

- Protein for normal clotting *Activated protein C inactivates factor V thus stopping clot growth*.

Question 38

What is Factor V Leiden deficiency?

Answer 38

Genetic mutation where activated protein C cannot stop factor V Leiden, thus excessive fibrin

Question 39

What does activated protein C do?

Answer 39

Inactivates factor V when enough fibrin has been made.

Question 40

Anesthesia implication for Factor V Leiden

Answer 40

↑ risk of DVT/PE Pt will probably be on anticoagulants

Question 41

Who is usually tested for Factor V Leiden?

Answer 41

**Pregnant women.** Especially ones with unexplained late stage abortions

Question 42

What anticoagulant medications could someone with Factor V Leiden be put on?

Answer 42

- Warfarin - LMWH & unfractionated heparin

Question 43

What is the hallmark sign of HIT?

Answer 43

Plt count <100,000 *thrombocytopenia*

Question 44

HIT results in ____ activation and potential for____?

Answer 44

platelet; thrombosis

Question 45

What is heparin replaced with when HIT is diagnosed?

Answer 45

Agratroban, lepirudin, bivalirudin (direct-thrombin inhibitors)

Question 46

What is Fondaparinux & when is it used?

Answer 46

- A synthetic Factor Xa inhibitor - Used to treat VTE in HIT

Question 47

What is the most common hereditary bleeding disorder?

Answer 47

vWF

Question 48

What is the most common reason for epistaxis?

Answer 48

Hypertension | ...per Dr. C in class

Question 49

Which classification of vWF requires factor concentrates?

Answer 49

Type 3