Exam 3 - Blood Disorders

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
• Cryoprecipitate
• Factor VIII

Question 4

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

Answer 4

Stimulates vWF release from endothelial cells; synthetic analouge of vasopressin

Question 5

What is the dose for DDAVP?

Answer 5

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

Question 6

What is the onset & duration of DDAVP?

Answer 6

• Onset: 30 mins
• Duration: 6-8 hrs

Question 7

What are side effects of DDAVP?

Answer 7

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

Question 8

What is the most major side effect of DDAVP?

Answer 8

Hyponatremia

From dilution

Question 9

Someone that gets DDAVP needs to be on what?

Answer 9

Fluid restriction 4-6hrs before & after DDAVP

Causes thirst which can lead to water intoxication and hyponatremia

Question 10

At what serum Na+ do you see confusion, restlessness, and widening of QRS?

Answer 10

120 mEq/L

Question 11

What CNS and EKG changes are seen at a serum Na+ of 115 mEq/L?

Answer 11

• CNS: Somnolence and nausea
• EKG: Elevated ST, widened QRS

Question 12

What serum Na+ can seizures, coma, and Vtach/Vfib be seen?

Answer 12

110 mEq/L

Question 13

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

Answer 13

• Cryoprecipitate
• Infection risk, not submitted to viral attenuation

Question 14

1 unit of Cryo raises the ____ level by ___?

Answer 14

Fibrinogen by 50 mg/dL

Question 15

What is Factor VIII concentrate made of?

Answer 15

• Pool of plasma from a large number of donors
• Contains factor VIII and vWF

Question 16

When is Factor VIII given?

Answer 16

Preop or intraop

Question 17

When should DDAVP be given prior to surgery?

Answer 17

30-60mins before Sx

Question 18

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

Answer 18

• Hematoma
• Nerve compression

Question 19

What are the anesthesia considerations for someone with vWF deficiency?

Answer 19

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

Question 20

How does heparin work?

Answer 20

• Thrombin inhibition
• Antithrombin III activation

ATIII inhibits thromin and factors IX and X

Question 21

What labs are monitored with heparin?

Answer 21

PTT and ACT (activated clotting time)

Question 22

What is the mechanism of action of Coumadin?

Answer 22

Inhibition of vitamin K-dependent factors (II, VII, IX, X)

Question 23

What is the onset for Vitamin K administration?

Answer 23

6-8hrs

Question 24

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

Answer 24

• Prothrombin complex concentrates
• Factor VIIa
• FFP

Question 25

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

Answer 25

**Convert plasminogen to plasmin**, which cleaves fibrin

Question 26

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

Answer 26

**Inhibit conversion of plasminogen to plasmin**

Question 27

Treatment for antiplatelet reversal?

Answer 27

- D/C drugs on time - Platelet transfusion

Question 28

Some causes of DIC?

Answer 28

- Trauma - Amniotic fluid embolus - Malignancy - Sepsis - Incompatible blood transfusions

Question 29

Patho of DIC?

Answer 29

Question 30

What will labs show for someone in DIC?

Answer 30

- ↓Platelet count - Prolonged PT, PTT & TT (thrombin time). - ↑ fibrin degradation products

Question 31

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

Answer 31

* Treat the underlying cause * Blood component transfusions

Question 32

When is antifibrinolytic therapy given to someone in DIC?

Answer 32

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

Question 33

What is Factor V Leiden deficiency?

Answer 33

* Genetic mutation of factor V that is resistant to activated protein C * Leads to factor V leiden making excess fibrin ## Footnote Activated Protein C usually inhinits favtor V activity

Question 34

What the symptom for TXA toxicity?

Answer 34

Loss of color vision

Question 35

What does Activated Protein C do?

Answer 35

Inactivates factor V when enough fibrin has been made.

Question 36

Who is usually tested for Factor V Leiden?

Answer 36

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

Question 37

What anticoagulant medications could someone with Factor V Leiden be put on? Why is this good for pregnant woemen?

Answer 37

- Warfarin - LMWH & unfractionated heparin - Prevents placental thrombosis and leads to better outcomes

Question 38

What is the hallmark sign of HIT?

Answer 38

Plt count < 100,000, usually 5-14 days after initial therapy *thrombocytopenia*

Question 39

HIT results in ____ activation and potential ____ ?

Answer 39

platelet; thrombosis

Question 40

What causes HIT?

Answer 40

- Creation of immune complexes (IgG antibody, platelet factor 4, and heparin)

Question 41

What is heparin replaced with when HIT is diagnosed?

Answer 41

Argatroban, lepirudin, bivalirudin (direct-thrombin inhibitors)

Question 42

What is Fondaparinux & when is it used?

Answer 42

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

Question 43

When do HIT immune complexes clear from the circulation?

Answer 43

Typically, within 3 months - should still avoid future heparin exposure