EDAIC Coagulation and Transfusion Medicine 3 — Questions and Answers
Question 1: Which product should be given to a patient with hemophilia A who is bleeding acutely?
- Fresh frozen plasma
- Vitamin K
- Factor VIII concentrate (Correct answer)
- Cryoprecipitate alone
Correct answer: Factor VIII concentrate
Factor VIII concentrate is the preferred treatment for acute bleeding in hemophilia A.
Question 2: What is the target fibrinogen level in massive hemorrhage according to current guidelines?
- Above 0.5 g/L
- Above 1.0 g/L
- Above 1.5–2.0 g/L (Correct answer)
- Above 3.0 g/L
Correct answer: Above 1.5–2.0 g/L
Guidelines recommend maintaining fibrinogen above 1.5–2.0 g/L during active massive hemorrhage.
Question 3: Protamine sulfate is used to reverse heparin. What is the primary adverse effect of rapid protamine administration?
- Hyperkalemia
- Hypotension and bradycardia (Correct answer)
- Thromboembolism
- Anaphylaxis only in fish allergy
Correct answer: Hypotension and bradycardia
Rapid protamine infusion causes histamine release leading to hypotension and bradycardia.
Question 4: Which platelet count threshold generally triggers prophylactic platelet transfusion in a non-bleeding, non-surgical ICU patient?
- <100 × 10⁹/L
- <50 × 10⁹/L
- <20–10 × 10⁹/L (Correct answer)
- <5 × 10⁹/L
Correct answer: <20–10 × 10⁹/L
Prophylactic transfusion is typically indicated when platelets fall below 10–20 × 10⁹/L in stable patients.
Question 5: Tranexamic acid works by which mechanism?
- Inhibiting thrombin directly
- Blocking plasminogen activation and inhibiting fibrinolysis (Correct answer)
- Activating protein C
- Increasing von Willebrand factor release
Correct answer: Blocking plasminogen activation and inhibiting fibrinolysis
Tranexamic acid competitively inhibits plasminogen binding, preventing fibrinolysis.
Question 6: A post-cardiac surgery patient has increased bleeding. TEG shows shortened R time and elevated MA. What does this suggest?
- Fibrinolysis
- Hypercoagulable state (Correct answer)
- Heparin effect
- Thrombocytopenia
Correct answer: Hypercoagulable state
Shortened R time (fast clot initiation) and elevated MA (strong clot) indicate a hypercoagulable state.
Question 7: Which condition is associated with microangiopathic hemolytic anemia, thrombocytopenia, and renal failure forming the classic TTP triad?
- DIC
- Hemophilia A
- Thrombotic thrombocytopenic purpura (TTP) (Correct answer)
- Heparin-induced thrombocytopenia
Correct answer: Thrombotic thrombocytopenic purpura (TTP)
TTP classically presents with microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction due to ADAMTS13 deficiency.
EDAIC Coagulation and Transfusion Medicine 3
Which product should be given to a patient with hemophilia A who is bleeding acutely?