CCS Hemostasis and Coagulation Management 2 — Questions and Answers
Question 1: Which blood product is most appropriate to correct dilutional thrombocytopenia causing microvascular bleeding after cardiopulmonary bypass?
- Fresh frozen plasma
- Cryoprecipitate
- Platelet transfusion (Correct answer)
- Packed red blood cells
Correct answer: Platelet transfusion
Platelet transfusion addresses thrombocytopenia and platelet dysfunction that commonly occur after CPB due to hemodilution and platelet activation by the bypass circuit.
Question 2: Cryoprecipitate is the preferred product for replacing which coagulation factor in a cardiac surgery patient with significant bleeding?
- Factor VIII and fibrinogen (Correct answer)
- Factor IX and protein C
- Factor VII and protein S
- Factors II, VII, IX, and X
Correct answer: Factor VIII and fibrinogen
Cryoprecipitate is rich in fibrinogen (factor I), factor VIII, vWF, and factor XIII, making it the preferred product when fibrinogen replacement is specifically needed.
Question 3: What minimum platelet count is generally recommended before performing cardiac surgery to reduce perioperative bleeding risk?
- 20,000/µL
- 50,000/µL
- 100,000/µL (Correct answer)
- 150,000/µL
Correct answer: 100,000/µL
A platelet count of at least 100,000/µL is generally recommended before cardiac surgery to minimize bleeding risk during and after the procedure.
Question 4: Which antifibrinolytic agent is most commonly used in cardiac surgery to reduce perioperative blood loss?
- Aminocaproic acid
- Tranexamic acid (Correct answer)
- Aprotinin
- Desmopressin (DDAVP)
Correct answer: Tranexamic acid
Tranexamic acid is the most widely used antifibrinolytic in cardiac surgery; it inhibits plasminogen activation and reduces fibrinolysis, thereby decreasing perioperative blood loss.
Question 5: A patient develops excessive bleeding after protamine reversal of heparin following CPB, with a normal ACT. Thromboelastography shows decreased clot amplitude. Which intervention is most appropriate?
- Administer additional protamine
- Transfuse fresh frozen plasma
- Administer platelet transfusion (Correct answer)
- Give recombinant factor VIIa
Correct answer: Administer platelet transfusion
Decreased clot amplitude on TEG indicates platelet dysfunction or thrombocytopenia; platelet transfusion addresses this defect in platelet-mediated clot strength.
Question 6: Which laboratory finding is most consistent with disseminated intravascular coagulation (DIC) in a post-cardiac surgery patient?
- Elevated fibrinogen, prolonged PT, thrombocytopenia
- Low fibrinogen, prolonged PT/aPTT, elevated D-dimer, thrombocytopenia (Correct answer)
- Normal PT, elevated fibrinogen, thrombocytosis
- Low D-dimer, normal PT, elevated fibrinogen
Correct answer: Low fibrinogen, prolonged PT/aPTT, elevated D-dimer, thrombocytopenia
DIC is characterized by simultaneous clotting and fibrinolysis, resulting in low fibrinogen (consumed), prolonged PT/aPTT, elevated D-dimer (fibrin degradation), and thrombocytopenia.
Question 7: Desmopressin (DDAVP) is used perioperatively in cardiac surgery primarily to treat bleeding associated with which condition?
- Heparin overdose
- Warfarin toxicity
- Platelet dysfunction due to aspirin or uremia (Correct answer)
- Factor VIII deficiency (hemophilia A)
Correct answer: Platelet dysfunction due to aspirin or uremia
DDAVP releases stored vWF and factor VIII from endothelial cells, improving platelet adhesion in patients with aspirin-induced or uremia-induced platelet dysfunction.
CCS Hemostasis and Coagulation Management 2
Which blood product is most appropriate to correct dilutional thrombocytopenia causing microvascular bleeding after cardiopulmonary bypass?