Coagulation Quick Case Studies
Coagulation Quick Case Studies
Quick Case #1
A 4‐year‐old was seen in the pediatrician’s office for vomiting and coughing for the past 2 days. He
showed extensive bruising on his extremities and was lethargic and dehydrated. A viral illness had been
spreading through the day care center he attends.
WBC = 25 x109/L
RBC = 3.4 x 1012/L
Hct = 34%
Plt = 50 x 109/L
1. Which of these blood results demands the most immediate attention?
a. WBC
b. Platelet count
c. RBC
d. Hct
2. What condition is associated with viral illness and low platelets in children?
e. DIT
f. HIT
g. TTP
h. ITP
3. What is the mechanism of platelet destruction in this patient?
i. Antibody coating of platelets leading to sequestration
j. Immune destruction of platelets
k. Missing vWF
l. Improper mixing of sample
Quick Case Study #2
A 6‐year‐old girl presented to the pediatric dentist with a severe toothache. After examination it was
determined that the tooth had a cavity. Because it was a baby tooth, it was decided to extract the tooth.
The tooth extraction was accompanied by a prolonged episode of severe bleeding. The patient
mentioned that she “bruised easy like my sister.”
Plt = 100 x 109/L
Blood smear revealed large platelets
1. Platelet count and morphology indicate which condition?
a. Bernard‐Soulier
b. Glanzmann’s thrombathesenia
c. vWD
d. HUS
2. Platelet aggregation studies would show what pattern?
a. No aggregation except with ristocetin
b. Aggregation with all agonists except ristocetin
3. What Is the pathophysiology of this disorder?
a. Absence of vWF
b. Absence of GP IIb/IIIa
c. Absence of GP Ib/IX
d. Absence of platelets
4. What is the treatment of choice for bleeding patients with this disorder?
a. FFP
b. Packed cells
c. Platelet transfusions
d. Cryoprecipitate
Quick Case Study #3
A 63‐year‐old woman is an in‐patient for sepsis. She develops severe hematuria, ecchymosis, epistaxis,
and bruising. Laboratory results are as follows:
Platelet count = 107 x 109/L
PT = 22.9 secs
APTT = 58.2 secs
Fibrinogen = 42 mg/dL (normal = 200-400)
FSP = >40 mg
D‐dimer = elevated
Radiographic studies show several large aortic aneurysms in the abdominal aorta.
1. Hemostasis studies indicate which condition?
a. DIC
b. HUS
c. TTP
d. ITP
2. What is fibrinogen’s role in hemostasis?
3. Appropriate levels of fibrinogen are needed (200-400 mg/dL) for normal hemostasis. Most
often, patients lack fibrinogen because of inherited or acquired disorders?
4. How can acquired disorders be distinguished from inherited disorders?
5. What is unique about DIC in relation to the classic hemostatic symptoms of either bleeding or thrombosis?
6. Why would patients with DIC have low fibrinogen?
7. What is thrombin’s role in hemostasis?
8. In patients with DIC, thrombin is often increased or decreased?
9. What is plasmin’s role in hemostasis?
10. Plasmin is activated in DIC which causes what to happen?
11. Using Box 18.2, what could have triggered this patient’s DIC state?
12. Explain why the patient’s hemostasis testing is abnormal.
13. The patient’s D‐dimer and FSP results indicate bleeding or thrombosis?
14. What is the treatment of choice for bleeding patients in DIC?
a. Find and correct the cause
b. Keep giving packed red blood cells
c. Hope the patient doesn’t bleed
d. Cryoprecipitate
Quick Case Study #4
A 52‐year‐old male complains of pain in his left leg. When he goes to his physician, his examination
reveals edema in his leg up to his thigh and redness. He also states that starting this morning he was
feeling pain in his chest. He is diagnosed with a thrombophlebitis and recently developed pulmonary
embolism. He is put on anticoagulant therapy, then investigated for the cause of thrombophlebitis and
embolism.
1. What is a thrombosis?
2. What is the term for an inherited or acquired condition that predisposes individuals to
thrombosis?
3. What changes in hemostatic components (vascular system, platelets, coagulation, fibrinolysis can cause thrombosis?
BOX 18.2 Pathologic Events Triggering Disseminated Intravascular Coagulation Infections . Gram-negative bacteria . Gram-positive bacteria . Malaria Tissue Injury . Crush injury . Burns . Massive head injury Malignancy . Acute promyelocytec leukemia Acute monoblastic or myeloblastic leukemia . Microangiopathic disorders . Thrombotic thrombocytopenia purpura Gastrointestinal Disorders . Acute hepatitis Obstetric Complications . Maternal toxemia . Abruptio placentae . Hemolytic disease of the newborn . Group B streptococcusnfection . Retained dead fetus Other . Snake bites Heparin-induced thrombosis . Septic shock . Hemolytic transfusion reaction . Graft-versus-host disease . Heatstroke
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