CABS Coagulopathies

Question 1

CBC indices give information on what clinically?

Answer 1

Information about size, weight, hemoglobin concentration of the RBC’s - assists with classifying anemia

Question 2

When do you transfuse a patient?

Answer 2

7

Question 3

When do you transfuse someone with a cardiac condition?

Answer 3

8

Question 4

What can cause thrombocytopenia?

Answer 4

Can result from severe infection and increased destruction or disseminated intravascular coagulation (DIC)

Question 5

At what level of platelets will spontaneous bleeding occur?

Answer 5

< 15,000 (<15)

Question 6

How long does it take for a clot to form via the extrinsic and common pathway when exposed to tissue factor?

Answer 6

Normally 11-13 seconds

Question 7

What is international normalized ratio (INR) measuring?

Answer 7

Ratio of the prothrombin time measured and a control prothrombin time

INR = (Patient PT/ Control PT)

Question 8

What is INR typically used for?

Answer 8

Monitoring Warfarin

Question 9

What are the PT and INR uses?

Answer 9

Unusual bleeding
Concern for DIC
Baseline prior to starting anticoagulation
Monitoring Warfarin
Monitoring liver function

Question 10

What are the uses of PTT?

Answer 10

Unexplained bleeding
DIC
Baseline before coagulation
Monitoring unfractionated heparin

Question 11

What are the uses of D-Dimer?

Answer 11

Deep vein thrombosis
Pulmonary embolism
Disseminated intravascular coagulation
Tracking progress throughout a disease course (COVID)

Not specific

Question 12

What is Virchow’s Triad?

Answer 12

Stasis, Hypercoagubility, and endothelial triad

Question 13

What is a provoked clot?

Answer 13

You know WHY the clot happened!

One of the corners of Virchow’s triad - trauma, recent surgery, immobilization, cancer, estrogen use

Question 14

What is an unprovoked clot?

Answer 14

We don’t know the source of clot, these patients need to go to hematology

Question 15

What is the presentation of deep vein thrombosis (DVT)?

Answer 15

Increased swelling, distended (varicose) veins, pain, skin hyperpigmentation

Question 16

What is Phlegmasia alba dolens?

Answer 16

White swollen leg associated with proximal DVT, concern for limb loss due to increased compartment pressures (compartment syndrome)

Question 17

What is Phlegmasia cerulea dolens?

Answer 17

Dusky or blue leg associated with proximal DVT, concern for limb loss due to increased compartment pressures (compartment syndrome)

Question 18

Who gets arterial thrombotic events?

Answer 18

Sick people- Diabetics, CHF, aFib, coronary heart disease

Question 19

What is the pathophysiology (cause) of a pulmonary embolism?

Answer 19

Virchow’s triad causes clot.

Clot becomes loose and travels through the circulation to lodge in the pulmonary vasculature.

Question 20

What conditions increases the risk of bleeding?

Answer 20

Von Willebrand Disease
Hemophilia
Platelet Disorders

Question 21

Hemophilia A is a deficiency in what factor?

Answer 21

VIII

Question 22

Hemophilia B is a deficiency in what factor?

Answer 22

IX

Question 23

What does the deficiency in Hemophilia A and B going to cause?

Answer 23

Deficiency in these factors will decrease the ability to form the fibrin mesh over the platelet plug

Question 24

What lab is going to be ordered to diagnose Hemophilia?

Answer 24

PTT

Question 25

Viral illness in kids is most commonly associated with what bleeding disorder?

Answer 25

Immune Thrombocytopenia Purpura (ITP)

Question 26

What does Immune Thrombocytopenia Purpura (ITP) normally present with?

Answer 26

Bleeding (mucosal) Purpura, petechia

Question 27

In a shocked state like hemorrhagic shock what is the cause of shock?

Answer 27

Loss of oxygen, ischemia

Question 28

What is the pathophysiology of Heparin Induced Thrombocytopenia (HIT)?

Answer 28

IgG mediated response to Heparin resulting in platelet activation, platelet consumption​

Question 29

How does estrogen increase platelet aggregation?

Answer 29

Increases circulating fibrinogen, increases factors X, VII

Question 30

What is Protein C dependent on?

Answer 30

Vitamin K

Question 31

What factors does Protein C degrade?

Answer 31

Va and VIIa

Question 32

The effects of Protein C Deficiency are pronounced on Warfarin, what is the common presenting symptom in this case?

Answer 32

Skin necrosis

Question 33

How do you diagnose Hemophilia A and B?

Answer 33

aPTT (prolonged)

Question 34

What type of genetic disorder is protein C and S deficiency?

Answer 34

Autosomal Dominant