Lecture 10 - coagulation abnormalities

Question 1

__ disorders of coagulation are more common than congenital disorders of coagulation

Answer 1

aquired (DIC, hypercoagulable states, liver dz, vitamin K antagonism or deficiency, snake envenomation)

Question 2

What is the most common coagulation abnormality

Answer 2

von willebrand’s dz

Question 3

__ is seen in critically ill patients and is ALWAYS secondary to another dz

Answer 3

DIC (must treat BOTH primary dz and DIC)

Question 4

DIC is uncontrolled continued activation of __ and __

Answer 4

BOTH coagulation and fibrinolysis

Question 5

why does DIC lead to uncontrolled bleeding

Answer 5

depletes coagulation factors and platelets

Question 6

why does DIC lead to microvasculare obstruction

Answer 6

produces excess intravascular clots

Question 7

phase 1 of DIC

Answer 7

Hypercoagulable phase (organ dysfucntion due to lack of O2/perfusion)

Question 8

During the hypercoagulable phase death may occur before hemorrhage bc

Answer 8

multiple organ dysfunction (ischemia/low perfusion)

Question 9

outward clinical signs of DIC are limited an may go unrecognized with out doing __ test

Answer 9

coagulation

Question 10

hypercoagulable phase (phase 1 DIC) is characterized by __ leading to organ dysfunction

Answer 10

thromboses (many thrombi from primary site)

Question 11

Phase 2 DIC is the __ phase

Answer 11

consumptive phase

Question 12

Consumptive phase (Phase 2 DIC) is characterized by uncontrolled consumption of __ and __

Answer 12

platelets and coagulation factors

Question 13

What are the consequences of Phase 2 DIC

Answer 13

Bleeding

Question 14

What are the consequences of Phase 1 DIC

Answer 14

organ dysfunction

Question 15

Consumptive phase (phase 2) is a mixture of __ and __ bleeding

Answer 15

platelet type and coagulopathy type

Question 16

platelet type bleeding is characterized by

Answer 16

petichea and ecchymosis

Question 17

coagulopathy type bleeding is characterized by

Answer 17

bleeding into cavities (abdomen, thorax, joints)

Question 18

4 pathologies that can cause DIC

Answer 18

1. tissue factor and procoags released from dead or cancerous tissue
2. vasculitis
3. proteolytic enzymes activate coag factors (envenomation, pancreatitis)
4. stagnant blood flow

Question 19

severe tissue damage and inflammation can cause

Answer 19

DIC

Question 20

Be on the lookout early for DIC in __

Answer 20

ill patients (lots of causes for DIC)

Question 21

__ is a common blood film finding for DIC

Answer 21

Fragmentation hemolysis (microangiopathic hemolytic anemia) - schystocytes, keratocytes

Question 22

5 lab findings for DIC

Answer 22

1. Anemia
2. thrombocytopenia
3. acanthocytes
4. schistocytes (fragmentation)
5. prolonged coagulation factors (PT, PTT, ACT)
6. Decreased fibrinogen and AT3
7. increased FDPs and d-dimers

Question 23

Coagulation tests can be __ due to the dynamic nature of DIC

Answer 23

Variable (typically prolonged)

Question 24

will see increased ___ due to plasmin breaking down fibrin

Answer 24

FDPs

Question 25

__ is helpful in early recognition of DIC but is a send out test that is not readily available

Answer 25

thromboelastography

Question 26

__promotes clot formation by stimulating platelet aggregation

Answer 26

thrombin

Question 27

__ activates multiple coagulation factors (1, 5, 8, 11, 13)

Answer 27

thrombin

Question 28

thrombin promotes clot persistence via __ and also decreases clot formation via __ activation.

Answer 28

TAFI (thrombin-activatable fibrinolysis inhbitor), activates protein C and TFPI

Question 29

Check and balance coagulation factor is __

Answer 29

antithrombin 3 (anticoagulant factor, if lose this can become hypercoagulable)

Question 30

In protein losing nephropathy proteins leak out of kidneys, lose __ causing hypercoagulability (prone to forming clots)

Answer 30

antithrombin 3 (small protein, anticoagulation factor)

Question 31

petechiation and mucosal hemorrhages are __ type bleeding

Answer 31

platelet

Question 32

coagulation factors are made in the __ so need to screen for coagulation abnormalities prior to biopsy or surgery with dz

Answer 32

liver

Question 33

vitamin K deficiency causes coagulopathy (clotting issues) due to decreased production of __. What is a good test to screen for this?

Answer 33

vitamin k dependent factors 2, 7, 9, 10. TP (7 has shortest half life)

Question 34

5 Causes of vitamin K def or antagonism

Answer 34

1. anticoagulant rodenticide intoxication 2. moldy sweet clover 3. gut sterilization 4. fat malabsorption or maldigestion (bile obstruction) 5. dietary def (rare)

Question 35

vitamin K def will see __ coagulation tests

Answer 35

prolonged (PT first)

Question 36

coagulopathic patients with vitamin K def will need __ and __ STAT and __ if severe hemorrhagic anemia. If bleeding into cavities may need __. Avoid __. Will need to be put on __ for at least a month

Answer 36

fresh frozen plasma and fresh whole blood. O2 cage. thoracocentesis traumatic things and drugs that inhibit platelet function vitamin K replacements

Question 37

__ is a very large, multimeric protein important to platelet adhesion and aggregation (primary hemostasis)

Answer 37

von Willebrand factor

Question 38

von willebrand dz is the most common hereditary bleeding disorder effecting

Answer 38

primary hemostasis/platelet function = bleeding tendency

Question 39

vWD have various types that relate to degree of bleeding. Name some predisposed breeds

Answer 39

dobermans, german pointers, scottish terriers, shelties

Question 40

a __ state has vWF concentration around 30-70%

Answer 40

vWD carrier

Question 41

a __ state has a vWF concentration less than 35%

Answer 41

vWD symptomatic

Question 42

vWD clincal signs

Answer 42

petechiae and mucosal bleeding cutaneous bruising prolonged hemorrhage and BMBT

Question 43

Test of choice for vWD is

Answer 43

BMBT (if BMBT is normal can send out for vWF test)