4.6 F) Haematological Disorders Of Haemostasis And Coagulation

Front 1

Treatment options for Haemophilia A with

bleeding?

Back 1

1. DDAVP [Desmopressin]
2. Factor VIII replacement

3. Factor VIIa [ for high titre inhibitor levels]

Front 2

Treatment options for Haemophilia B and

bleeding?

Back 2

1. Factor IX replacement

2. factor VIIa [for high titre inhibitor levels]

Front 3

Von Willebrand Disease forms?

Back 3

1. Type I : partial decrease in vWF
2. Type II : dysfunctional vWF
3. Type III : no vWF

Front 4

Treatment options for Von Willebrand

Disease?

Back 4

1. DDAVP [Desmopressin] Type I

2. Factor VIII / vWF concentrates
- Type II and III
- for all cases of serious bleeding

3. *** Cryoprecipitate***
- contains vWF
[use only if factor VIII/vWF concentrate

unavailable]

Front 5

What doe DDAVP do?

Back 5

Stimulates release of Factor VIII and vWF from endothelial cells

2. Indicated for Mx bleeding in :
a. Von Willebrand Disease [Type I]
b. Haemophilia A

Front 6

Complications of Sickle cell Disease ?

Back 6

1. Vaso-occlusive crisis -Pain
2. Acute chest syndrome **
3. Splenic sequestration crisis **
4. Aplastic crisis
5. Stroke **
6. Leg ulcers
7. Infections
- functional asplenia
- increased susceptibility to encapsulated

organisms { H. influenzae ; S. pneumoniae }
8. Cholelthiasis [ bilirubin stones]
9. Osteonecrosis [ femoral / humeral heads]
10. Priapism **

** = Indications for exchange transfusion

Front 7

What are the indications for an IVC filter in Thromboembolic Disease ( VTE)?

Back 7

1. Acute VTE and Contraindications for

anticoagulation
2. Acute VTE while appropriately anti

coagulated
3. Critically ill and at risk of recurrent

embolism

( where embolism likely to be fatal).

Front 8

Which is incorrect regarding PE in Pregnancy?
A. PE is 5 times more common in pregnancy.
B. 70% of pregnant PE patients will have a positive Ultrasound.
C. 20% of VQ scans performed in suspected PE in pregnancy will be

"Indeterminate" and will require CTPA.
D. CTPA has a radiation risk that is 25% greater than VQ.

Back 8

D. 13%

Front 9

Which is correct regarding PE in pregnancy?
A. PE occurs in 1: 10,000 pregnancies.
B. The CTPA has a radiation dose of 5 mGy.
C. VQ scan has a radiation dose of < 1 mGy to the Maternal breast.
D. The radiation dose required for harm to the fetus is 10 mGy

Back 9

C.

A = PE in 1: 1000 - 1:2000 pregnancies
B. CTPA : 10-60 mGy radiation dose to breasts
D. Fetal radiation dose harm when > 50mGy

Front 10

Which is correct regarding PE in pregnancy?
A. Heparin is generally not safe in pregnancy
B. Warfarin is safe in pregnancy
C. LMWH is safe in pregnancy and lactation
D. Warfarin is not safe in lactation.

Back 10

C.
A = Heparin is the mainstay of therapy
B. Warfarin is not safe to be used in

pregnancy
D. Warfarin is safe in breastfeeding

Front 11

Which of the following is considered a minor risk factor for venous thromboemblism?
A. Post partum period ( up to 42 days )
B. Factor V Leiden Thrombophilia
C. Immobilisation : Bed rest > 3 days
D. Recent Surgery, within 4 weeks.

Back 11

B.

Front 12

What is the relative risk of Patients having a

major risk factor for VTE?

Back 12

Relative risk = 5-20

Front 13

what are the Major Risk Factors for VTE? ( 6)

Back 13

Major Risk Factors for VTE:

1. Recent Surgery (< 4 weeks)
2. Immobilisation (bed rest > 3 days)
3. Pregnancy ( 3rd > 2nd > 1st )
4. Postpartum ( up to 42 days -6 weeks )
5. Malignancy
6. History of VTE

Front 14

What is the relative Risk for VTE in a patient with minor risk factors ?

Back 14

2-4

Front 15

What 4 Clinical Symptoms / signs are present in 97% of patients diagnosed with PE?

Back 15

1. Breathlessness
2. Chest pain
3. Tachypnoea
4. Tachycardia

Front 16

Which of the following VTE percentages is

incorrect?
A. 50% of patients with DVT have concomitant PE.
B. A moderate probability of PE for the Wells Criteria = 20% likelihood of PE
C. A moderate pre-test probability for DVT for the Wells criteria = 25% likelihood
D. 60-70 % of VQ scans are read as Indeterminate n the non-pregnant population.

Back 16

C. 17%

Low = 3% [ < 1 point ]
moderate = 17% [ 1-2 points ]
High = 75% [ > 3 points ]

Front 17

Which VTE percentage is incorrect?
A. 20% of VQ scans in pregnancy are read as "Indeterminate".
B. A high pre-test probability in the Wells Criteria for PE = 50%
C. A low pre-test probability in the Wells Scores for DVT and PE = 3% and 2% respectively.
D. In patients with a low Gestalt Clinical suspicion for PE and a negative PERC rule, they have a 5% risk of PE.

Back 17

D. 2%

Front 18

Which one of the following is not a 1.5 point score in the Wells Criteria for PE?
A. Heart rate > 100 bpm
B. Haemoptysis
C. Previous DVT / PE
D. Surgery / Immobilisation within 4 weeks.

Back 18

B. Haemoptysis = 1 point

Front 19

What are the 3 point scores in the Wells

Criteria for PE?

Back 19

1. Clinical evidence for DVT
2. An alternative Diagnosis being LESS LIKELY than PE.