Chapter 105 Bleeding disorders

Question 1

T/F The R value on TEG represents the primary hemostasis

Answer 1

False. It represents the secondary hemostasis

Question 2

T/F The MA value on TEG is more dependent on platelet number and function than on fibrinogen.

Answer 2

True. MA represents both but the value is more dependent on platelets than on fibrinogen

Question 3

T/F Mild hypofibrinogenemia will cause prolonged PT/PTT?

Answer 3

False. Hypofibrinogenemia usually does not cause prolonged PT/PTT until it is under 50-100mg/dl.

Question 4

What are two limitations to TEG and ROTEM?

Answer 4

Inability to detect vWD and are insensitive to anti-platelet drugs

Question 5

What are some reasons for acquired hypofibrinogenemia?

Answer 5

Hemodilution
Massive transfusion
Hepatic dysfunction
DIC
Sepsis
Thrombolytic therapy

Question 6

Why can it be difficult to detect hypothermia-induced coagulopathy with conventional coagulation tests?

Answer 6

Because the coagulation is reversible and conventional tests are performed at 37 degrees Celcius.

Question 7

Is academia induced coagulopathy reversible or irreversible if pH is corrected with buffer administration?

Answer 7

Irreversible

Question 8

The half-life of D dimer is short and elevation indicates recent or ongoing fibrinolysis. What is the half-life?

Answer 8

5 hours.

Question 9

These two breeds have reported non-pathologic thrombocytopenia?

Answer 9

Cavalier King Charles Spaniel and Greyhound

Question 10

What criteria are used to diagnose DIC?

Answer 10

Underlying condition (sepsis or SIRS) plus three or more of the following:

• Prolonged PT/PTT
• Thrombocytopenia
• Hypofibrinogenemia
• Increased D-dimer
• Reduces antithrombin
• Schistocytes on blood smear.

Question 11

Describe what trauma-induced coagulopathy is (ACoTS and RAC).

Answer 11

• ACoTS = Acute coagulopathy of trauma and shock. Coagulopathy that developer minutes after the traumatic event. Caused by tissue trauma, shock and sympathoadrenal activation and inflammation.
• RAC = Resuscitation-associated coagulopathy. Develops later and is secondary to hemodilution, worsening acidosis, and hypothermia.