Coagulation 7

Question 1

Which coagulopathies present with a prolonged PTT and normal PT? (select 2)
a. hemophilia A
b. hemophilia B
c. factor 10 deficiency
d. factor 2 deficiency

Answer 1

a & b

Question 2

Hemophilia A is

Answer 2

factor 8 deficiency

Question 3

Hemophilia A is most common in

Answer 3

males

Question 4

Severe hemophilia A is associated with

Answer 4

spontaneous bleeding in the joints, muscles, and vital organs

Question 5

________ is prolonged with hemophilia A

Answer 5

PTT

Question 6

Treatment options for hemophilia A include

Answer 6

factor 8 concentrate, FFP, cryo, and DDAVP

Question 7

Hemophilia _ is usually more severe than hemophilia _

Answer 7

A; B

Question 8

Hemophilia B is a _______ deficiency

Answer 8

factor 9

Question 9

Anesthetic considerations for hemophilia B are

Answer 9

the same as with hemophilia A

Question 10

________ is prolonged with hemophilia B

Answer 10

PTT

Question 11

_____________ can be used to replace factor 9 in hemophilia B

Answer 11

factor 9 prothrombin complex

Question 12

Factor-9 prothrombin complex concentrate is associated with

Answer 12

thromboembolic complications

Question 13

____________ is a treatment option for hemophilia A & B

Answer 13

recombinant factor 7

Question 14

Risks for recombinant factor 7 include

Answer 14

MI
embolic stroke
PE
DVT

Question 15

Recombinant factor 7 is used as a

Answer 15

last ditch tx. for bleeding without an identifiable cause

Question 16

The dose of recombinant factor 7 is

Answer 16

20-40 mcg/kg

Question 17

Hemophilia A is a __________ chromosomal disorder

Answer 17

X linked

Question 18

Mild disease of hemophilia A

Answer 18

does not cause spontaneous bleeding but is associated with increased surgical bleeding

Question 19

The half-life of factor 8 is

Answer 19

8-12 hours so redosing may be required

Question 20

All of the following can be used to reduce bleeding in the hemophilia A patient

Answer 20

factor 8
FFP
cryo
DDAVP (mild-moderate dx.)
antifibrinolytics

Question 21

Factor 9 has a half-life of

Answer 21

18-24 hours

Question 22

The dose of recombinant factor 7 for hemophilia patients is

Answer 22

90-120 mcg/kg

Question 23

For a patient with severe form of hemophilia, what should always be performed before surgery?

Answer 23

Type and cross

Question 24

A septic patient undergoing exlap has developed bleeding from the wound and around his IV sites. He has a platelet count of 40,000, fibrinogen of 95, and an elevated D-dimer. What is the BEST treatment for this patient?
a. heparin infusion
b. tranexamic acid
c. FFP
d. albumin

Answer 24

c. FFP

Question 25

DIC is characterized by

Answer 25

disorganized clotting and fibrinolysis that leads to the simultaneous occurrence of hemorrhage and systemic thrombosis

Question 26

Conditions with the highest risk of developing DIC include

Answer 26

sepsis obstetric complications malignancy

Question 27

the definitive treatment for DIC is

Answer 27

reversing the underlying cause supportive- treat hypovolemia with fluids, replaced consumed blood products with FFP, platelets, and Cryo, and consider IV heparin or LMWH for severe microvascular thrombosis

Question 28

Signs of DIC include

Answer 28

ecchymosis, petechiae, mucosal bleeding, bleeding at IV puncture sites, prolonged PT & PTT, increased D-dimer and fibrin split products

Question 29

Lab values for patients with DIC will include

Answer 29

increased PT/PTT increased D-dimer decreased platelets decreased fibrinogen

Question 30

The highest risk of sepsis related DIC is

Answer 30

gram-negative bacilli

Question 31

The highest risk of obstetric related DIC is

Answer 31

preeclampsia

Question 32

Highest risk of malignancy related DIC is

Answer 32

adenocarcinoma

Question 33

A patient with a history of type 2 heparin-induced thrombocytopenia requires anticoagulation for cardiopulmonary bypass. What is the BEST treatment? a. enoxaparin b. heparin test dose c. warfarin d. bivalirudin

Answer 33

d. bivalirudin

Question 34

Thrombotic disorders include

Answer 34

antithrombin deficiency heparin-induced thrombocytopenia protein C & S deficiency Factor 5 Leiden mutation

Question 35

Antithrombin inactivates factors

Answer 35

9a, 10a, 11a, and 12a which ultimately leads to thrombin factor 2a inhibition

Question 36

Patients with antithrombin deficiency are unresponsive to

Answer 36

heparin

Question 37

Treatment for antithrombin deficiency includes

Answer 37

AT concentrate & FFP

Question 38

Heparin-induced thrombocytopenia causes

Answer 38

clot formation throughout the body

Question 39

How many types if HIT are there?

Answer 39

2 types

Question 40

Type 1 HIT resolves

Answer 40

spontaneously

Question 41

Type 2 HIT causes

Answer 41

a hypercoaguable state

Question 42

Complications of type 2 HIT include

Answer 42

amputation and death

Question 43

Protein C and S work as a team to

Answer 43

inhibit factors 5a and 8a

Question 44

A deficiency of protein C or S can produce

Answer 44

a hypercoaguable state, increasing the risk of thrombosis

Question 45

For the patient with protein C and S deficiency, thromboembolism is treated with

Answer 45

heparin and the patient is transitioned to warfarin

Question 46

Factor 5 Leiden causes a

Answer 46

resistance to the anticoagulant effect of protein C

Question 47

____________________ is unwarranted with Factor 5 Leiden mutation unless

Answer 47

lifelong anticoagulation; the patient experiences recurrent thrombotic events