Blood Disorders (Exam III) Marcus's Cards

Question 1

What are the S/S of vWF disorder?

Answer 1

Easy bruising
epistaxis
menorrhagia

Question 2

What does vWF do?

Answer 2

Plays a role in PLT adhesion

Question 3

Which type of vWF disease is the most mild?

Answer 3

Type 1

Question 4

Which type of vWF disease is the most rare and severe?

Answer 4

Type 3

Question 5

What would lab values be for someone with vWF deficiency?

Answer 5

• Normal PT & aPTT
• Bleeding time is prolonged

Question 6

What are the treatments for vWF deficiency?

Answer 6

• Desmopressin
• Cryoprecipitate
• Factor VIII

Question 7

What is DDAVP/desmopressin?

Answer 7

Synthetic vasopressin

Question 8

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

Answer 8

Stimulates vWF release from endothelial cells

Question 9

What is the dose for DDAVP?

Answer 9

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

Question 10

What is the onset & duration of DDAVP?

Answer 10

• Onset: 30mins
• Duration: 6-8hrs

Question 11

What are side effects of DDAVP?

Answer 11

• HA
• Stupor
• hypotension
• tachycardia
• hyponatremia
• water intoxication (excessive water retention)

Question 12

What is the most major side effect of DDAVP?

Answer 12

Hyponatremia

Question 13

Someone that gets DDAVP needs to be on what?

Answer 13

Fluid restriction 4-6hrs before & after DDAVP

Question 14

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

Answer 14

Cryoprecipitate

Question 15

1 unit of Cryo raises the ____ level by ___?

Answer 15

Fibrinogen by 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.

Question 18

Does Factor VIII undergo viral attenuation?

Answer 18

Yes, there is a reduced risk of infection with Factor VIII

Question 19

What two things does Factor VIII contain?

Answer 19

• Factor VIII
• vWF

Question 20

When is Factor VIII given?

Answer 20

Preop or intraop

Question 21

When should DDAVP be given prior to surgery?

Answer 21

30-60mins before Sx

Question 22

What blood product poses an increase risk for infection? Why?

Answer 22

• Cryoprecipitate
• Not sent for viral attenuation

Question 23

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

Answer 23

• Hematoma
• Nerve compression

Question 24

What are the anesthesia considerations for someone with vWF deficiency?

Answer 24

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

Question 25

How does heparin work?

Answer 25

- Thrombin inhibition - Antithrombin III activation

Question 26

What labs are monitored with heparin?

Answer 26

PTT &/or ACT

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

6-8hrs

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

Question 32

How do tranexamic acid (TXA) and aminocaproic acid 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

Question 34

What will labs show for someone in DIC?

Answer 34

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

Question 35

When is antifibrinolytic therapy given to someone in DIC?

Answer 35

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

Question 36

What is factor V Leiden?

Answer 36

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

Question 37

What is Factor V Leiden deficiency?

Answer 37

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

Question 38

What does Activated Protein C do?

Answer 38

Inactivates factor V when enough fibrin has been made.

Question 39

Who is usually tested for Factor V Leiden?

Answer 39

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

Question 40

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

Answer 40

- Warfarin - LMWH & unfractionated heparin

Question 41

What is the hallmark sign of HIT?

Answer 41

Plt count <100,000 *thrombocytopenia*

Question 42

HIT results in ____ activation and potential____?

Answer 42

platelet; thrombosis

Question 43

What is heparin replaced with when HIT is diagnosed?

Answer 43

Agratroban or bivalirudin (direct-thrombin inhibitors)

Question 44

What is Fondaparinux & when is it used?

Answer 44

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