CLINICAL COAGULATION CASES:
QUESTIONS:
1. Described the three distinct phases used to form an effective hemostatic plug that prevents blood loss?
2. How do you measure the first phase of hemostasis: a) by clinical examination and by history? b) and in the laboratory?
3. During the second phase of hemostasis what happens?
4. How is thrombin generated during coagulation lab testing using the prothrombin time, activated partial thromboplastin time assays ?
5. What is the final phase of hemostasis and how is it measured?
6. What clinical disorders are associated with the final phase of blood coagulation?
7. What tests are used to diagnose von Willebrand’s disease? Which one is most important?
8. What is the major difference between Type I and Type II von Willebrand’s Disease?
9. Does DDAVP help treat Type III von Willebrand’s Disease? Why?
10. What coagulation factors are present in cryoprecipitate?
11. What factors are present in plasma but are missing in serum and why?
12. What factor(s) trigger the formation of thrombin in vivo?
13. To form a fibrin gel what has to happen to the fibrinogen molecule?
14. Will blood clotted in a test tube dissolve? Why?
15. Name 3 “invisible” clotting factors that cause severe bleeding disorders but do not have any defect in PT or aPTT? How do you measure them?
16. What are the clinical problem(s) associated with DIC Syndrome?
17. How is DIC Syndrome defined?
18. What is a better term for DIC Syndrome?
19. How does the D-dimer antigen form?
20. What is the major use for D-dimer in a) the hospital and b) the outpatient setting?
21. An isolated PT prolongation is most likely due to a deficiency of what factor?
22. To actually define the cause for a prolonged PT and aPTT one needs to order what tests?
23. How can you distinguish between DIC Syndrome from Liver Disease?
24. Does bleeding time predict for bleeding? Does bleeding time have any use?
25. What is the best predictor of bleeding?
26. How common is von Willebrand’s disease?
27. Is DDAVP ever contraindicated in von Willebrand’s Disease?
28. When is Amicar used clinically? How does it work? When is a contraindicated?
29. What does a euglobulin lysis time measure?
30. What should you order to treat a bleeding hemophiliac in the emergency room?
31. Can the lupus anticoagulant patient bleed? Why or Why not?
32. A patient with Amyloid has a prolonged PT and PTT normal fibrinogen level and needs to have gallbladder surgery. Is it safe? What tests must be ordered?
33. Name 2 things that platelets do during hemostasis?
34. What converts prothrombin to thrombin and where does this occur.
35. A 60 year old man with possible hepatoma is admitted for a biopsy of a liver mass. PT is elevated 5 secs, PTT is elevated 10 secs, and fibrinogen is 80mg%. Is it safe to biopsy? Do factors need replacement? Why, why not, or what more needs to be done?
36. An asymptomatic man is admitted from NYC to get biliary sugery at MUSC. PT is normal aPTT is prolonged 5 sec what should you do?
37. A 23 year old nurse is admitted for gall bladder surgery. No bleeding history, PT-normal, aPTT prolonged 20 secs now what? What test or tests? Should patient get replacement therapy why or why not tests should be done? How do you decide?
38. A 65 year old preacher develops pain and swelling in right knee and had arthrocentesis in the emergency room. Blood was detected in the fluid. PT normal aPTT prolonged by 20 secs. What is the most likely diagnosis?
39. A 16 year old boy presents with bloody nose, petechiae and elevated white cell count. What comes to mind as a possible cause for this set of findings?
40. How can myeloma protein cause a abnormalities in a) coagulation lab tests and b) in clinical hemostasis?
41. A 42 year old woman presents with hematomas, GI bleeding, bruising, nose bleeds and PT 60sec aPTT 170sec fibrogen 280mg91% platelets normal, blood smear normal. Her factor VII level is 2% factor II level 10% what is likely diagnosis?
42. If a patient has easy bruising and nose bleeds what is the most likely diagnosis? Does a blood smear help? Why?
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