Hypercoagulable State Clinical

  1. T/F: Primary hemostasis is the coagulation activation
    False; coagulation activation is the secondary hemostasis
  2. Coagulation activation (secondary hemostasis) begins with ____ activation, followed by the amplification phase which involves _______, _____, _____ and then the propagation phase which is aka ____ that finally leads to ____formation and a definitive hemostatic plug
    • Thrombin
    • Platelets, V , VIII
    • Thrombin explosion
    • fibrin clot
  3. What is the virchow’s triad:
    • venous stasis
    • vascular injury
    • hypercoagulability
  4. What can indicate inherited thrombophilia?
    • Less than 50 years of age
    • First degree relative with blood clots
    • Recurrent thrombotic episodes
    • Odd location of clots
  5. For inherited thrombophilia, deficiencies for which factor/ protein could be the cause?
    • Factor V Leiden (6% white people)
    • Prothrombin G2021A (3% white people)
    • Antithrombin deficiency
    • Protein C deficiency
    • Protein S deficiency
  6. History of past surgery/ trauma, long plane rides, cancer and medication such as OCP use is indicative for which type of thrombophilia?
  7. Recent trauma or surgery suggest _____ thrombophilia due to ______
    Acquired thrombophilia due to vascular injury
  8. Long plane, train, bus or car ride suggest ____ thrombophilia due to _____
    • Acquired
    • Venous stasis
  9. Cancer can be indicative of ____ thrombophilia due to ___
    • Acquired
    • Hypercoagulability
  10. Medications such as oral contraceptive can be suggestive of _____ thromnophilia due to _____
    • Acquired
    • Hypercoagulability
  11. Non-iatrogenic acquired thrombophilia consists of ___ vs _____. While iatrogenic acquired thrombophilia consists of _____ vs ______
    • Malignant
    • Non-malignant
    • Surgical
    • Pharmacologic
  12. Surgery, especially of orth or pelvic nature, along with forced immobility are _____ cause of acquired iatrogenic thrombophilia
  13. oral contraceptive, self-medication, EPO use and hormone replacement therapy are ____ Cause of acquired iatrogenic thrombophilia
  14. cancer is considered as _____ acquired thrombophilia
  15. T/F: patient with cancer often have DVT that they don’t even know of
    True; malignancy would be an non-iatrogenic acquired thrombophilia
  16. What are non-malignant non-iatrogenic etiologies of thrombophilia
    • Antiphospholipid antibody syndrome
    • DIC
    • Polycythemia rubra very
    • Pregnancy
    • Post-partum state
  17. Which imaging workup is useful in accessing a possible lower extremity DVT?
    Venous compression US
  18. An echogenic thrombus on venous US will be found in a ________ venous lumen
  19. T/F: D-dimers are sensitive and specific for intravascular thrombosis
    False; they are sensitive but not specific, so a negative assay may be helpful in ruling out a DVT but a positive test does NOT indicate that the patient HAS a clot
  20. A negative D-dimer _____ clot. A positive D-dimer _____ clot
    • Can rule out
    • cannot be indicative of a (though have suspicions)
  21. What is the next step when D-dimer comes back positive?
    Use CT-angio with IV contrast to evaluate for possible Pulmonary embolus. Because a positive does not indicate that there IS a blood clot
  22. Wells criteria for DVT, most finding is worth ______ point(s). What is special about this one?
    • Each finding is worth 1 point
    • However, an alternative explanation for leg symptoms such as due to infections or cellulitis, you TAKE AWAY 2 points
  23. If 0-1 point on DVT Well’s criteria, it is _______, so you would do. While >1 point is _______, and you would ______.
    • 0-1 point, DVT is unlikely, and you would just check D-dimer to rule out DVT
    • 1+ points, DVT is likely so order a Doppler ultrasound to evaluate for DVT
  24. T/F: if you have more than one points on the Well’s criteria for DVT, you would go ahead and order a D-dimer to rule out a DVT
    False; if you have more than one point, then you would skip D-dimer and get a doppler ultrasound to evaluate for DVT. You would only order D-dimer when it is 0 to 1 point.
  25. How is Well’s criteria for PE scored? ______ gets 3 points, ________ gets 1.5 points and ______ get 1 point
    • Clinical signs and sxs of DVT / PE is the most likely diagnosis : each get 3 points
    • Bedridden for > 3 days / History of DVT or PE gets: 1.5 points each
    • Hemoptysis / active cancer: gets 1 point each
  26. Scores of Well’s criteria for PE:
    • Less than 4 points = unlike PE, check D-dimer
    • 4-6 points = moderate possibility of PE – do CTA to assess for PE
    • Greater than 6 points = high probability of PE – do CTA to assess
  27. After a clot has resolved, what are some serologic markers that you would want to check?
    • Activated protein C resistance
    • Factor V Leiden
    • Prothrombin G20210A gene mutation
    • Antiphospholipid antibodies
    • Antithrombin deficiency
    • Protein C and S deficiency
Card Set
Hypercoagulable State Clinical
HemeOnc Final