Hemophilia A and B Quiz
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Questions and Answers

Which of the following is NOT a clinical feature of Hemophilia A in infants?

  • Excessive bruising
  • Dental eruption (correct)
  • Joint and soft tissues bleeds
  • Spontaneous bleeding into deep tissues
  • What is the main characteristic that differentiates Hemophilia A from Hemophilia B?

  • The genetic inheritance pattern
  • The type of bleeding
  • The specific clotting factor deficiency (correct)
  • The age at which symptoms develop
  • The severity of bleeding
  • Which of the following statements about Hemophilia A is INCORRECT?

  • The severity of bleeding is related to the level of FVIII in the blood.
  • The defect is an absence or low level of plasma factor VIII.
  • Females are generally affected more severely than males. (correct)
  • It is a recessive X-linked inherited disorder.
  • What is the most serious complication that can result from recurrent hemarthrosis in Hemophilia A?

    <p>Joint deformity and disability (D)</p> Signup and view all the answers

    Which of the following laboratory tests is NOT typically included in the initial assessment of Hemophilia A?

    <p>Bleeding time (BT) (B)</p> Signup and view all the answers

    Why is Hemophilia often referred to as "love of bleeding"?

    <p>Because it can be difficult to control the bleeding. (D)</p> Signup and view all the answers

    Which of the following is a TRUE statement about Hemophilia B?

    <p>It is caused by a deficiency of factor IX (E)</p> Signup and view all the answers

    The term "Hemophilic pseudo tumor" refers to:

    <p>A rare complication of Hemophilia characterized by a progressive swelling of muscle and/or bone due to repeated bleeding. (C)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the inheritance pattern of Hemophilia B?

    <p>It can occur due to spontaneous mutation. (C)</p> Signup and view all the answers

    A patient presents with prolonged bleeding time, low FVIII, prolonged aPTT, and low vWF. Which of the following is the MOST likely diagnosis?

    <p>Von Willebrand Disease Type 3 (C)</p> Signup and view all the answers

    What is the primary function of Von Willebrand factor (vWF)?

    <p>Promoting platelet adhesion to damaged endothelium and platelet aggregation (A)</p> Signup and view all the answers

    Why is FVIII level reduced in Von Willebrand Disease?

    <p>vWF is unable to protect FVIII from premature degradation. (C)</p> Signup and view all the answers

    Which type of Von Willebrand Disease is characterized by abnormally high affinity of vWF for platelets?

    <p>Type 2B (D)</p> Signup and view all the answers

    What is the most common cause of Hemophilia B?

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

    Which laboratory test is used to assess the concentration of vWF protein in plasma?

    <p>VWF:Ag (A)</p> Signup and view all the answers

    Which of the following is NOT a typical characteristic of Von Willebrand Disease?

    <p>Elevated platelet count (C)</p> Signup and view all the answers

    Identify the most likely underlying cause of acquired dysfibrinogenemia in a patient with liver disease.

    <p>Functional abnormality of fibrinogen biosynthesis (B)</p> Signup and view all the answers

    Which of the following conditions can contribute to both thrombocytopenia and disseminated intravascular coagulation (DIC) in a patient with liver disease?

    <p>All of the above (D)</p> Signup and view all the answers

    A patient with severe liver disease presents with prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). What is the most likely cause of the prolonged clotting times?

    <p>Decreased synthesis of coagulation factors (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic laboratory finding typically associated with disseminated intravascular coagulation (DIC)?

    <p>Increased serum levels of antithrombin (D)</p> Signup and view all the answers

    Which of the following is a potential trigger for disseminated intravascular coagulation (DIC) in a patient with liver disease?

    <p>All of the above (D)</p> Signup and view all the answers

    A patient with liver disease presents with hemolytic anemia and red blood cell fragmentation. What is the most likely explanation for this finding?

    <p>Obstruction of small vessels by fibrin strands (C)</p> Signup and view all the answers

    What is the primary mechanism by which oral vitamin K administration helps in treating coagulation factor deficiencies associated with liver disease?

    <p>Promoting the synthesis of vitamin K-dependent coagulation factors in the liver (C)</p> Signup and view all the answers

    Which of the following explains why fresh frozen plasma (FFP) is a potential treatment for disseminated intravascular coagulation (DIC)?

    <p>FFP replenishes depleted coagulation factors and platelets (C)</p> Signup and view all the answers

    In a mixing study, if the PTT normalized after the addition of normal plasma, what does this indicate?

    <p>The patient has a deficiency in Factor VIII or IX (C)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding acquired hemophilia A?

    <p>It can be associated with autoimmune disorders (B)</p> Signup and view all the answers

    Which of the following tests is NOT used for carrier detection and antenatal diagnosis of Hemophilia A?

    <p>Umbilical cord blood analysis for factor IX levels (A)</p> Signup and view all the answers

    Why is it important to consider that factor IX levels can be low at birth?

    <p>This can lead to a misdiagnosis of Hemophilia B in newborns. (A)</p> Signup and view all the answers

    Which of the following treatments is NOT used for hemophilia A?

    <p>Factor IX replacement therapy (D)</p> Signup and view all the answers

    A patient presents with prolonged PTT, normal PT and BT. A mixing study normalizes the PTT. What is the most likely diagnosis?

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

    What is the significance of the fact that the gene for FIX is close to the gene for FVIII?

    <p>It explains why Hemophilia A and Hemophilia B are often inherited together. (C)</p> Signup and view all the answers

    Why is prophylactic treatment with stored FVIII recommended for patients with Hemophilia A?

    <p>It can significantly reduce the frequency of bleeds and improve quality of life. (C)</p> Signup and view all the answers

    Which of the following is a type of acquired coagulation disorder that can be treated with Vitamin K?

    <p>Hemorrhagic disease of the newborn (A)</p> Signup and view all the answers

    What is the primary reason for the bleeding symptoms associated with Von Willebrand's disease?

    <p>The lack of von Willebrand factor prevents platelets from clumping together at the site of injury, leading to prolonged bleeding. (D)</p> Signup and view all the answers

    Which of the following statements accurately describes a characteristic difference between Hemophilia A and Von Willebrand's disease?

    <p>Hemophilia A usually presents with deep tissue bleeding, while Von Willebrand's disease commonly causes mucosal bleeding. (C)</p> Signup and view all the answers

    Which of the following laboratory findings would be most likely observed in a patient with Vitamin K deficiency?

    <p>Prolonged PT and aPTT, normal platelet count, and normal fibrinogen levels. (A)</p> Signup and view all the answers

    How does the drug warfarin (Vitamin K antagonist) affect the clotting process?

    <p>Warfarin inhibits the synthesis of certain clotting factors, including II, VII, IX, and X, thereby reducing the clotting ability of the blood. (D)</p> Signup and view all the answers

    What is the primary mechanism by which the antibiotic ristocetin promotes platelet aggregation?

    <p>Ristocetin causes the von Willebrand factor to bind to platelets, initiating the formation of platelet clumps. (B)</p> Signup and view all the answers

    Which of the following conditions is NOT associated with an increased risk of bleeding due to a clotting factor deficiency?

    <p>Von Willebrand's disease (D)</p> Signup and view all the answers

    Which statement regarding Hemorrhagic disease of the newborn (HDN) is TRUE?

    <p>HDN is characterized by an inability to absorb Vitamin K due to immature liver cells in newborns. (C)</p> Signup and view all the answers

    Flashcards

    Hemophilia A

    A hereditary bleeding disorder caused by deficiency of Factor VIII.

    Hemophilia B

    A hereditary bleeding disorder caused by deficiency of Factor IX.

    von Willebrand's disease

    An inherited bleeding disorder characterized by lack of von Willebrand factor (vWf).

    Recessive X-Linked Inheritance

    The inheritance pattern for Hemophilia; primarily affects males.

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    Spontaneous bleeding

    Unpredictable bleeding without apparent cause, common in hemophilia.

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    Hemarthrosis

    Joint bleeding common in hemophilia, leading to pain and swelling.

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    Severity of Hemophilia

    Dependent on the blood level of Factor VIII; lower levels lead to worse bleeding.

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    Laboratory tests for Hemophilia

    Include blood count, PT, PTT, and bleeding time to detect bleeding disorders.

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    PTT Prolongation

    Prolonged partial thromboplastin time indicating intrinsic pathway disruption in hemophilia A and B.

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    Mixing Study

    A test done after prolonged PTT to check for factor deficiency by mixing patient's plasma with normal plasma.

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    Factor VIII Activity

    Diagnosis of hemophilia is confirmed if factor VIII activity is less than 40% of normal.

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    Antenatal Diagnosis

    Detection of FVIII levels in fetal blood during 16-20 weeks gestation using ultrasound-guided needle aspiration.

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    Desmopressin

    Synthetic vasopressin that stimulates release of FVIII and vWF from endothelial cells, boosting plasma levels.

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    Hemophilia B treatments

    Infusion of FIX, which has a longer half-life than FVIII and requires less frequent infusions.

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    Acquired Hemophilia A

    Non-genetic form of hemophilia A caused by autoantibodies against factor VIII, often associated with autoimmune disorders.

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    Laboratory findings in Hemophilia B

    Prolonged aPTT and reduced FIX clotting assay; normal bleeding time and PT.

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    Von Willebrand's Disease (vWD)

    A disorder caused by reduced levels or abnormal function of von Willebrand factor (vWF).

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    Factor IX Deficiency

    Also known as hemophilia B, characterized by low levels of factor IX, tested through umbilical cord blood.

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    Types of Von Willebrand's Disease

    Three types: Type 1 (mild), Type 2 (abnormal vWF), Type 3 (severe deficiency).

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    Carrier Detection

    Use of DNA probes to detect mutations in carriers of hemophilia genes.

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    Function of vWF

    Promotes platelet adhesion to damaged endothelium and protects factor VIII from degradation.

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    Laboratory findings in vWD

    Prolonged bleeding time, low FVIII, prolonged aPTT, low vWF, defective platelet aggregation.

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    VWF:Ag assay

    An immunoassay measuring the concentration of vWF protein in plasma.

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    Ristocetin

    An antibiotic that causes platelet clumping by binding von Willebrand factor (VWF) to platelets.

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    Von Willebrand’s Disease (vWD)

    A bleeding disorder characterized by deficiency or dysfunction of VWF, affecting blood clotting.

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    Bleeding Symptoms in VWD

    VWD typically causes mucosal bleeding, such as nosebleeds and gum bleeds.

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    Vitamin K deficiency

    A condition caused by inadequate intake or absorption of vitamin K, leading to bleeding issues.

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    Hemorrhagic Disease of the Newborn

    A condition in newborns due to vitamin K deficiency, causing severe bleeding.

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    Laboratory findings in Vitamin K deficiency

    Prolonged PT and aPTT with normal platelet count and fibrinogen levels.

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    Prophylaxis in liver disease

    Use of oral vitamin K to prevent bleeding in liver dysfunction.

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    Vitamin K absorption and liver

    Biliary obstruction impairs vitamin K absorption and coagulation factor synthesis.

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    Thrombocytopenia causes

    Decreased thrombopoietin production from liver leads to low platelet counts.

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    Disseminated Intravascular Coagulation (DIC)

    Widespread clotting and consumption of clotting factors & platelets due to disorders.

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    DIC pathogenesis triggers

    Procoagulant materials released due to conditions like liver disease and infections.

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    Laboratory findings of DIC

    Characteristics include low platelet count and increased D-dimers.

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    Thromboplastin secretion in liver disease

    Damaged liver cells release thromboplastin leading to DIC complications.

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    DIC treatment options

    Use of fresh frozen plasma or RBC transfusion to treat DIC.

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    Study Notes

    Coagulation Disorders

    • Coagulation disorders are conditions affecting the body's ability to form blood clots.
    • Inherited disorders include Hemophilia A and B, von Willebrand's Disease.
    • Acquired disorders are more common than inherited ones.

    Inherited Coagulation Disorders: Overview

    • Hemophilia A: Deficiency in Factor VIII (FVIII)
    • Hemophilia B: Deficiency in Factor IX (FIX)
    • von Willebrand's Disease: Deficiency or abnormality in von Willebrand Factor (vWF).

    Hemophilia

    • Also known as "love of bleeding"
    • Bleeding symptoms of both types (A & B) are the same
    • Some infants are asymptomatic until they experience minor trauma
    • Symptoms include easy bruising, spontaneous bleeding into deep tissues (joints, muscles, soft tissues), life-threatening bleeding after injury or surgery
    • Results in lifelong bleeding problems.

    Hemophilia A

    • Bleeding due to a deficiency of FVIII coagulant activity
    • Severity is related to FVIII level in blood
    • Low FVIII (< 1 IU/dL) levels cause significant bleeding
    • Transmission is recessive X-linked
    • Males are affected, females are carriers
    • Gene mutation causes a lack/low level of plasma factor VIII

    X-linked Recessive Inheritance

    • The inheritance pattern for bleeding disorders, such as hemophilia,
    • Unaffected father has no affected sons
    • Unaffected mother will have unaffected sons
    • Carrier mother has affected sons
    • Affected father has no affected daughters
    • Carrier mother can have affected daughters

    Clinical Features of Hemophilia A

    • Infants can develop joint and soft tissue bleeding and excessive bruising
    • Bleeding after dental extractions can be prolonged
    • Hemarthrosis (bleeding into joints) is common and can cause joint deformities and disabilities
    • Hemophilic pseudo tumors are a rare complication (cystic swellings in muscles or bones)
    • Hematuria (blood in urine)
    • Gastrointestinal bleeding

    Recurrent Hemarthrosis

    • Repeated bleeding into joints causes joint deformities and disabilities.

    Severity of Hemophilia A Based on Factor VIII Levels

    • Severe: Factor level 0-1 IU/dL, spontaneous bleeds, serious bleeding
    • Moderate: Factor level 2-5 IU/dL, few bleeds, primarily traumatic
    • Mild: Factor level 5-30 IU/dL, post-traumatic bleeds, few episodes

    Coagulation Pathway

    • Illustration of the complex cascade of proteins involved in blood clotting
    • Intrinsic pathway (activated by damage inside the vessel) uses aPTT test
    • Extrinsic pathway (initiated by tissue damage) uses PT test
    • Many clotting factors are involved in the cascade

    Laboratory Investigations for Hemophilia

    • Complete blood count (CBC)
    • Prothrombin time (PT)
    • Partial thromboplastin time (PTT)
    • Bleeding time (BT)
    • The PTT test will be prolonged
    • The PT test and BT will be normal

    Other Laboratory Investigation for Carrier Detection and Antenatal Diagnosis

    • Measuring factor VIII plasma levels
    • DNA probes to detect mutations in carriers
    • Fetal biopsies from 8-10 weeks gestation
    • Fetal DNA analysis for factor VIII at 16–20 weeks gestation using UV-guided ultrasound

    Treatments for Hemophilia

    • Factor VIII replacement therapy (recombinant factor or frozen concentrate) used to replace the missing or deficient clotting factor
    • Desmopressin (synthetic vasopressin analogue) stimulates FVIII and vWF release from endothelial cells, thereby increasing levels in the plasma
    • Prophylactic treatments — storing and administering FVIII — can reduce bleeding and improve patient quality of life
    • Social and physiological care plays a critical supporting role

    Non-Genetic Form of Hemophilia A

    • Caused by autoantibodies against factor VIII, called acquired haemophilia A
    • Associated with cancers, immune issues, after childbirth responses to treatment

    Hemophilia B

    • Also known as Christmas disease
    • Primarily involves a deficiency in factor IX
    • Clinical features are virtually identical to Hemophilia A
    • Distinguished using coagulation assays
    • Incidence approximately 1/5 of Hemophilia A cases
    • Factor IX levels can be low at birth; umbilical cord blood testing is more accurate
    • Treatments involve factor IX infusions

    Laboratory Findings in Hemophilia B

    • Prolonged aPTT assay
    • Reduced FIX clotting assay
    • Normal bleeding time
    • Normal PT

    Additional Information on Hemophilia

    • Hemophilia is a hereditary condition, but not always associated with family history
    • Can result from spontaneous mutations in genes controlling clotting factor proteins F8 or F9
    • There are over a thousand mutations in F8, F9, causing factor VIII and IX deficiency

    Von Willebrand's Disease

    • Abnormalities either from reduced level or abnormal function of vWF
    • vWF is a large protein forming multimers
    • Inheritance is autosomal dominant
    • Symptoms include typical mucosal bleeding (nose, gum), bleeding after dental work, and post-traumatic hemorrhaging
    • Severity depends on the type of VWD

    vWF (von Willebrand Factor) and Function

    • vWF is a multi-functional protein
    • Promotes platelet adhesion to damaged endothelium and subsequent platelet aggregation.
    • Acts as a carrier molecule for factor VIII protecting it from premature destruction.

    Von Willebrand's Disease Types

    • VWD type 1: Reduced vWF quantity
    • VWD type 2: Abnormal vWF structure or function
    • VWD type 3: Little or no vWF present

    Type 2 Subtypes

    • Type 2A, loss of high molecular weight (HMW) multimers, affects platelet aggregation
    • Type 2B, very high affinity for platelets (abnormal attachment), causing platelet removal (thrombocytopenia)

    Laboratory Findings in Von Willebrand's Disease

    • Prolonged bleeding time
    • Low FVIII
    • Prolonged aPTT
    • Decreased vWF levels
    • Defective platelet aggregation
    • Platelets are usually normal except in type 2B

    Specialized Lab Investigations for Von Willebrand's Disease

    • VWF:Ag (immunoassay) measures concentration of vWF in plasma
    • VWF:RCo (ristocetin cofactor activity) —assesses the ability of vWF to interact with platelets
    • Factor VIII coagulant assay

    Treatments for Von Willebrand's Disease

    • Antifibrinolytic agents — for type 2B
    • Desmopressin — for type 1
    • FVIII and vWF infusions— for patients with very low vWF

    Hemophilia A vs Von Willebrand's disease

    • Gender: Hemophilia A — mainly males, Von Willebrand's Disease — both genders are affected
    • Bleeding Symptoms: Hemophilia A— deep tissues, musculoskeletal, internal organs; Von Willebrand's disease — mucosal (nosebleeds, gum bleeds)

    Acquired Coagulation Disorders

    • More common than inherited types
    • Often involve multiple clotting factor deficiencies

    Vitamin K Deficiency

    • Caused by inadequate diet, malabsorption of vitamin K, or by drugs inhibiting vitamin K
    • Deficiency affects factors II, VII, IX, X as well as protein C&S
    • Has a hemorrhagic form in newborns

    Hemorrhagic Disease of the Newborn

    • Vitamin K deficiency in newborns, often due to inadequate absorption or lack of gut bacteria for vitamin K synthesis
    • Prolonged PT, aPTT; normal platelet count and fibrinogen
    • Treatment— oral vitamin K

    Vitamin K Deficiency in Liver Disease

    • Due to obstructive jaundice, pancreatic or small bowel disease
    • Prolonged PT, APTT; normal platelet count and fibrinogen
    • Deficiency of factors II, VII, IX, X

    Hemostasis Disorders in Liver Disease

    • Impaired vitamin K absorption
    • Reduced synthesis of coagulation factors
    • Reduced fibrinogen synthesis
    • Thrombocytopenia
    • Increased levels of coagulation inhibitors leading to DIC

    Disseminated Intravascular Coagulation (DIC)

    • Widespread intravascular fibrin deposition; causes depletion of coagulation factors and platelets
    • Often due to many disorders releasing procoagulants
    • Causes extensive endothelial damage leading to activation of the coagulation pathway

    DIC Pathogenesis

    • Procoagulant substances enter circulation, triggering massive clotting and consumption of clotting factors and platelets.
    • Causes include amniotic fluid embolism, liver disease, placental separation, cancer cells, snake bites, infections, endothelial damage & severe burns

    DIC Laboratory Findings

    • Low platelet count
    • Prolonged PT, aPTT, and Thrombin Time (TT)
    • Elevated D-dimers or fibrin degradation products
    • Hemolytic anemia and red blood cell fragmentation

    DIC Treatments

    • Fresh frozen plasma or plasma concentrate
    • Red blood cell transfusion
    • Antithrombin and protein C to inhibit coagulation

    Coagulation Deficiency Caused by Antibodies

    • Alloantibodies against factor VIII may occur in 5-10% of hemophilia cases
    • SLE autoimmune disease may lead to lupus anticoagulants interfering with coagulation
    • Treatments include immunosuppression or factor replacement

    Massive Transfusion Syndrome

    • Further decreased platelets and coagulation factors due to large volume blood transfusion
    • Extended storage of blood (24 hrs at 4°C) affects platelet function and clotting factors
    • Some patients may have underlying bleeding disorders

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    Description

    Test your knowledge on the clinical features and complications of Hemophilia A and B. This quiz covers inheritance patterns, laboratory assessments, and specific characteristics distinguishing the two types of Hemophilia. Perfect for medical students and professionals looking to refresh their understanding of this condition.

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