Coagulation Disorders and Antithrombin III

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Questions and Answers

What condition is characterized by the prolonged bleeding and hemarthrosis due to a deficiency in a particular factor?

  • Hypercoagulability
  • Cushing disease
  • Antithrombin III deficiency (correct)
  • Diabetes insipidus

Which lab findings would suggest Antithrombin III deficiency?

  • Decreased platelet count
  • Prolonged PT/PTT (correct)
  • Elevated protein C levels
  • Normal TSH levels

What is the primary treatment for a severe deficiency in Antithrombin III?

  • Surgery
  • Factor replacement therapy (correct)
  • Blood transfusion
  • Anticoagulation therapy

What would be an expected symptom of a coagulation disorder related to factor dysfunction?

<p>Prolonged bleeding (C)</p> Signup and view all the answers

Which of the following conditions is NOT a coagulation disorder?

<p>Hypothyroidism (B)</p> Signup and view all the answers

What would be an indicator of inherited or acquired Antithrombin III deficiency?

<p>Increased instances of DVTs or PEs (A)</p> Signup and view all the answers

Aside from Antithrombin III deficiency, what could cause prolonged PT/PTT?

<p>Vitamin K deficiency (D)</p> Signup and view all the answers

What is a common treatment approach for coagulation disorders?

<p>Anticoagulation therapy (C)</p> Signup and view all the answers

What is the most common inherited bleeding disorder?

<p>Von Willebrand Disease (B)</p> Signup and view all the answers

What are the typical symptoms of Hemophilia?

<p>Spontaneous bleeding and hemarthrosis (D)</p> Signup and view all the answers

Which diagnostic test is associated with Antiphospholipid Syndrome (APS)?

<p>Positive lupus anticoagulant (C)</p> Signup and view all the answers

Which treatment is commonly used for Hemophilia A?

<p>Desmopressin (A)</p> Signup and view all the answers

What is a characteristic symptom of Thrombocytopenia?

<p>Petechiae and purpura (D)</p> Signup and view all the answers

What is the main genetic cause of Factor V Leiden mutation?

<p>Mutation causing resistance to activated protein C (A)</p> Signup and view all the answers

Which condition is associated with recurrent miscarriages and thrombosis?

<p>Antiphospholipid Syndrome (A)</p> Signup and view all the answers

What is a common treatment for Immune Thrombocytopenic Purpura (ITP)?

<p>Steroids (B)</p> Signup and view all the answers

What underlying condition is typically treated in patients with thrombocytosis?

<p>Underlying condition causing the elevated platelet count (B)</p> Signup and view all the answers

Which of the following is a classic symptom of heparin-induced thrombocytopenia (HIT)?

<p>Skin necrosis at heparin injection sites (C)</p> Signup and view all the answers

What diagnostic test is used to confirm G6PD deficiency?

<p>G6PD activity assay (B)</p> Signup and view all the answers

Which treatment is appropriate for a patient with hemochromatosis?

<p>Phlebotomy (D)</p> Signup and view all the answers

What is the main characteristic of sickle cell disease?

<p>Vaso-occlusion due to abnormal hemoglobin (B)</p> Signup and view all the answers

Which symptom is commonly associated with thalassemia?

<p>Microcytic anemia (D)</p> Signup and view all the answers

What treatment option is NOT typically recommended for patients with sickle cell disease during pain crises?

<p>Benzodiazepines (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of chronic lymphocytic leukemia (CLL)?

<p>Megaloblastic anemia (C)</p> Signup and view all the answers

Flashcards

Hemophilia

Genetic disorder causing bleeding problems due to deficient clotting factors.

Antiphospholipid Syndrome (APS)

Autoimmune disorder causing hypercoagulability due to antiphospholipid antibodies.

Von Willebrand Disease

Inherited bleeding disorder due to deficient/defective von Willebrand factor (vWF).

Thrombocytopenias

Low platelet count, leading to bleeding problems.

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Factor V Leiden Mutation

Genetic mutation causing resistance to activated protein C, increasing clotting risk.

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Immune Thrombocytopenic Purpura (ITP)

Immune disorder causing low platelet count through immune attack.

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Antithrombin Activity Assay

Test measuring the effectiveness of antithrombin (a protein that prevents clotting).

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Prolonged aPTT

Abnormal activated partial thromboplastin time (aPTT), suggesting potential clotting factor deficiency.

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Acromegaly/Gigantism

Excess growth hormone (GH); gigantism if it starts before the growth plates close. It's characterized by enlarged hands/feet, and coarse facial features.

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Cushing Disease

A pituitary tumor secreting too much ACTH, leading to the same symptoms as Cushing syndrome.

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Diabetes Insipidus

A condition caused by ADH deficiency or resistance, resulting in excessive urination and thirst.

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Hyperthyroidism

A condition resulting from excess thyroid hormone, causing symptoms like weight loss and heat intolerance.

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Hypothyroidism

A condition resulting from low thyroid hormone, leading to symptoms like fatigue and cold intolerance.

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Goiter

An enlarged thyroid gland, often causing neck swelling.

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Thyroid Nodules

Solitary or multiple growths on the thyroid, possibly benign or malignant.

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Antithrombin III Deficiency

A condition causing hypercoagulability due to a lack of antithrombin III, characterized by recurrent blood clots.

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Thrombocytosis Symptoms

Bleeding at multiple sites (e.g., IV lines, gums), petechiae, organ dysfunction. Sometimes asymptomatic or with thrombotic events.

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Heparin-Induced Thrombocytopenia (HIT)

Immune reaction to heparin causing platelet activation and blood clots.

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G6PD Deficiency Symptoms

Hemolysis (red blood cell breakdown) causing symptoms like jaundice, dark urine, and anemia after oxidative stress.

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Hemochromatosis

Genetic iron overload in the body, leading to various symptoms.

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Sickle Cell Disease

Blood disorder causing abnormal hemoglobin leading to vaso-occlusion (blockage).

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Thalassemia Symptoms

Genetic defect causing reduced globin chain causing microcytic anemia, fatigue, pallor.

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Thrombocytosis Diagnosis

Elevated platelet count assessed through tests like CBC.

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Diagnosis of G6PD Deficiency

The diagnosis of G6PD deficiency is determined using a G6PD activity assay test.

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Study Notes

Cardiovascular System

  • Cardiomyopathy (Dilated): reduced contraction strength and dilated ventricles, systolic dysfunction, common in 30-40yo, idiopathic, viral, or toxic causes. Symptoms include dyspnea, S3 gallop. Diagnosis with echocardiography showing LV dilation, thin ventricular walls. Treatment with ACE inhibitors, beta-blockers, and diuretics.

  • Cardiomyopathy (Hypertrophic Obstructive): autosomal dominant genetic disorder leading to LVH (Left Ventricular Hypertrophy), RVH (Right Ventricular Hypertrophy), diastolic dysfunction. Common in young athletes. Symptoms: dyspnea, syncope, harsh systolic murmurs, increased with valsalva, decreased with squatting. Diagnosis with echocardiography, showing LV hypertrophy, thickened septum; avoiding nitrates, diuretics, ACE inhibitors, and ARBs (Angiotensin Receptor Blockers), digoxin.

  • Cardiomyopathy (Restrictive): non-dilated but stiff heart, reduced compliance, diastolic dysfunction. Amyloidosis, sarcoidosis, or hemochromatosis. Presenting symptoms: peripheral edema, jugular venous distension (JVD), ascites, and hepatomegaly. Diagnosis with echocardiography showing atrial dilation. Avoiding nitrates, diuretics, ACE inhibitors, ARBs, and digoxin.

Conduction Disorders/Dysrhythmias

  • Sinus Arrhythmia: variation in heart rate during the respiratory cycle.

  • Sinus Node Dysfunction: abnormal SA node function, presenting with symptoms of exercise intolerance, fatigue, dizziness, chest pain, difficulties breathing. Medications, infiltrative diseases, inflammatory conditions may cause it. Diagnosis with ECG showing abnormal SA node action potential. Tx: symptomatic or unstable (atropine, pacing).

  • AV Blocks: delayed conduction through the AV node. First-degree AV block: prolonged PR interval. Second-degree AV block: Mobitz I (progressive PR lengthening) or Mobitz II (fixed PR). Third-degree AV block = complete atrioventricular dissociation. Tx: unstable (atropine); Stable (pacemaker or observing); avoid nitrates/diuretics, ACE inhibitors, ARBs, or digoxin.

  • Bundle Branch Block: delayed conduction in bundle branches, presenting with widened QRS complexes. Tx: symptomatic (pacemaker), asymptomatic (observing).

  • Atrial Fibrillation: irregular atrial activity, loss of atrial contraction. Risk factors: age, high blood pressure (HTN), coronary artery disease (CAD), congestive heart failure (CHF), valvular heart disease, hyperthyroidism. Irregularly irregular rhythm; no distinct P waves. Tx: rate control (beta-blockers, CCBs — Calcium Channel Blockers), anticoagulation (DOACs, or warfarin), rhythm control (cardioversion, antiarrhythmics).

  • Atrial Flutter: macro-reentrant circuit in the atria. risk factors: COPD, CHF, or valvular heart disease. "Sawtooth" flutter waves, regular ventricular rate. Tx: rate control (beta-blockers, CCBs), rhythm control (cardioversion), and anticoagulation.

Other Cardiovascular Topics

  • Atrial Tachycardia: rapid atrial rates, presence of P waves preceding each QRS complex. Dx: ECG showing narrow complex tachycardia. Tx: beta-blockers, CCBs, antiarrhythmics, catheter ablation.
  • Bradycardia: heart rate less than 60bpm. caused by vagal stimulation, drugs, hypothyroidism. Sxs: fatigue, dizziness, syncope. Tx: symptomatic (no Tx), unstable (atropine, pacing).
  • Idioventricular Rhythm: slow ventricular rhythm (20-40bpm). Wide QRS, no P-waves. Tx: pacing (if unstable), address underlying cause.
  • Junctional Rhythms: rhythms originating at the AV junction. (40-60 bpm) ECG: narrow QRS, inverted or absent P waves. Tx: if unstable, pacing; otherwise, monitor.
  • Premature Contractions: Premature depolarization in the atria or ventricles (PACs or PVCs). Tx: asymptomatic (no Tx); symptomatic (beta blockers).
  • QT Prolongation: prolonged ventricular repolarization. causes: drugs (antiarrhythmics, macrolides, antipsychotics), electrolyte abnormalities, congenital. Can increase risk of torsades de pointes. Tx: stop offending agents; magnesium sulfate for torsades; pacing (if recurrent).
  • Torsades de Pointes: polymorphic ventricular tachycardia. Caused by prolonged QT interval. Tx: stop offending agents; magnesium sulfate; pacing.

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