Hematology: Platelets and Bleeding

Question 1

Platelet plug is what stage of hemostasis

Answer 1

primary hemostasis

Question 2

Fibrin clot is what stage of hemostasis

Answer 2

secondary hemostasis

Question 3

If you have low platelet counts, which stage of hemostasis are you concerned about

Answer 3

primary

Question 4

If you have a deficiency in a coagulation factor, which stage of hemostasis are you concerned about

Answer 4

secondary hemostasis

Question 5

Primary hemostasis major sites of bleeding

Answer 5

Platelet dysfunction
mucocutaneous (mouth, nose, GI tract)

Question 6

Secondary hemostasis major sites of bleeding

Answer 6

clotting factor deficiencies
Deep tissue (joints, muscles, soft tissue)

Question 7

What are 4 simple steps to primary hemostasis

Answer 7

Adhesion (Platelet adheses to vWF)
Activation (Bind to vWF, platelet activates)
Aggregation (Platelets clump at site of injury)
Platelet plug formed

Question 8

What values do the coagulation labs give

Answer 8

PT/INR (extrensic pathway)
PTT (Intrensic pathway)
PT & PTT prolonged= common pathway (Hepatic dysfunction, DIC)
Fibrinogen, D-Dimer

Question 9

What are the vitamin K dependent factors

Answer 9

2, 7, 9, 10

Question 10

Management of platelet or bleeding disorders

Answer 10

• Avoid contact sports (boxing, rugby, football, martial arts)
• Avoid OTC platelet inhibitors (Vitamin E, Garlic, Gingko)
• Control of menses

Question 11

At which platelet count are you at an increased risk for spontaneous bleeding for platelet count

Answer 11

<20k
Only need around 50k to form a good clot

Question 12

Platelet life span

Answer 12

8-10 days

Question 13

What are the 4 etiologies of thrombocytopenia

Answer 13

1. Decreased production of bone marrow
2. Increased platelet distruction
3. Abnormal platelet distribution
4. Dilution of body fluids (Get saline)

Question 14

What are some of the drugs that induce thrombocytopenia

Answer 14

Chemotherapy drugs, Sulfa/Vancomycin antibiotics, Anticoagulants (Heparin)
GERD medications

Question 15

What is the most common cause of Isolated thrombocytopenia in children

Answer 15

ITP
Frequently follows 4-6 weeks after viral infection or live virus vaccine like MMR

Question 16

If a kid gets the MMR vaxcine and then develops thrombocytopenia, what is most likely the cause

Answer 16

ITP- frequently follows 4-6 weeks after viral infection or live virus vaccine like MMR

Question 17

If a patient has TMA, what is the correct discharge plan/ handoff? Where do you send them (i.e. home?)

Answer 17

*Admit to hospital- urgent- consult hematology. Urgent. Def not home.

Question 18

What lab peripheral smear finding do you see in TMA

Answer 18

Schistocytes

Question 19

Is there a negative or positive DAT/Coombs in TMA?

Answer 19

Negative- non-immune hemolysis

Question 20

Deficiency of ADAMSTS13 is associated with what

Answer 20

TTP

Question 21

The pentad of symptoms is associated with which bleeding disorder

Answer 21

TTP-
FAT RN- Fever, Anemia, Thrombocytopenia, Renal involvement, Neuro symptoms
VwF is not being cleaved, cause sheering of RBCs

Question 22

Fever, Anemia, Thrombocytopenia, Renal involvement, Neuro symptoms are associated with which disease

Answer 22

TTP

Question 23

TTP is accompanied by which symptoms

Answer 23

FAT RN- Fever, Anemia, Thrombocytopenia, Renal involvement, Neuro symptoms
VwF is not being cleaved, cause sheering of RBCs

Question 24

TTP vs HUS symptom differences

Answer 24

Uremia (kidney injury) with HUS
Triad with HUS and Pentad with TTP

Triad: Thrombocytopenia, Anemia, renal dysfunction (uremia) (ATR, 3 middle symptoms)

Pentad:
FAT RN- Fever, Anemia, Thrombocytopenia, Renal involvement, Neuro symptoms
VwF is not being cleaved, cause sheering of RBCs

Question 25

Shiga toxin predisposes you to which disorder

Answer 25

HUS

Question 26

exposure to e.coli predisposes you to which disorder

Answer 26

HUS

Question 27

Between HUS and TTP, which typically leads to AKI?

Answer 27

HUS has associated acute kidney injury

Question 28

Burns, sepsis, trauma, and cancer therapy leads to what coagulation disorder

Answer 28

DIC- life threatening disorder- clotting and bleeding at same time

Question 29

2 common drugs that result in acquired platelet dysfunction

Answer 29

Salicylates (asprin- irreversable inhibition of platelet cyclooxygenase) NSAIDS(ibuprofen- reversible inhibition of cyclooxygenase)