EDAIC Coagulation and Transfusion Medicine 2 — Questions and Answers
Question 1: A trauma patient receives 10 units of packed red blood cells. Which electrolyte abnormality is most expected from massive transfusion?
- Hypercalcemia
- Hyperkalemia (Correct answer)
- Hyponatremia
- Hypermagnesemia
Correct answer: Hyperkalemia
Stored red blood cells release potassium over time, leading to hyperkalemia with massive transfusion.
Question 2: Which test best reflects the extrinsic coagulation pathway?
- Activated partial thromboplastin time (aPTT)
- Prothrombin time (PT) (Correct answer)
- Thrombin time (TT)
- Bleeding time
Correct answer: Prothrombin time (PT)
Prothrombin time (PT) measures the extrinsic pathway (tissue factor/Factor VII) and common pathway.
Question 3: A patient on warfarin requires emergency reversal. Which agent provides the most rapid and complete reversal?
- Vitamin K IV
- Fresh frozen plasma
- 4-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
- Protamine sulfate
Correct answer: 4-factor prothrombin complex concentrate (4F-PCC)
4-factor PCC provides immediate reversal of vitamin K antagonists with a smaller volume and faster effect than FFP.
Question 4: In heparin-induced thrombocytopenia (HIT), which anticoagulant is preferred for ongoing anticoagulation?
- Low molecular weight heparin
- Warfarin alone
- Argatroban (Correct answer)
- Protamine sulfate
Correct answer: Argatroban
Argatroban is a direct thrombin inhibitor not derived from heparin and is safe to use in HIT.
Question 5: Which component of the massive transfusion protocol is primarily given to replace fibrinogen?
- Packed red blood cells
- Cryoprecipitate (Correct answer)
- Fresh frozen plasma
- Platelet concentrate
Correct answer: Cryoprecipitate
Cryoprecipitate is rich in fibrinogen, Factor VIII, von Willebrand factor, and Factor XIII.
Question 6: A patient with renal failure develops prolonged bleeding time with normal PT and aPTT. What is the most likely mechanism?
- Thrombocytopenia
- Factor VII deficiency
- Platelet dysfunction due to uremic toxins (Correct answer)
- Warfarin effect
Correct answer: Platelet dysfunction due to uremic toxins
Uremia impairs platelet adhesion and aggregation by interfering with GPIb-von Willebrand factor interaction.
Question 7: Which viscoelastic test parameter represents clot formation rate?
- R time (TEG) / CT (ROTEM)
- K time (TEG) / CFT (ROTEM)
- Alpha angle (TEG/ROTEM) (Correct answer)
- MA (TEG) / MCF (ROTEM)
Correct answer: Alpha angle (TEG/ROTEM)
The alpha angle reflects the rate of clot formation and fibrin cross-linking in both TEG and ROTEM.
EDAIC Coagulation and Transfusion Medicine 2
A trauma patient receives 10 units of packed red blood cells.
Which electrolyte abnormality is most expected from massive transfusion?