EDAIC Coagulation and Transfusion Medicine 4 — Questions and Answers
Question 1: During liver transplantation, which coagulation abnormality is most expected during the anhepatic phase?
- Hypercoagulability due to protein C excess
- Fibrinolysis due to decreased clearance of tPA (Correct answer)
- Elevated Factor VIII levels
- Normal coagulation due to synthetic function preservation
Correct answer: Fibrinolysis due to decreased clearance of tPA
During the anhepatic phase, tissue plasminogen activator (tPA) is not cleared, leading to hyperfibrinolysis.
Question 2: Which blood group antigen system is most clinically significant for transfusion reactions after ABO?
- Lewis system
- Rhesus (Rh) system (Correct answer)
- Kidd system
- Duffy system
Correct answer: Rhesus (Rh) system
After ABO, the Rhesus system (particularly D antigen) is the most clinically significant for transfusion reactions and hemolytic disease.
Question 3: A patient receiving massive transfusion develops ionized hypocalcemia. What is the cause?
- Red cell hemolysis releasing calcium binders
- Citrate in stored blood chelating ionized calcium (Correct answer)
- Potassium displacing calcium
- Albumin infusion binding calcium
Correct answer: Citrate in stored blood chelating ionized calcium
Citrate is used as an anticoagulant in stored blood and chelates ionized calcium, causing hypocalcemia with massive transfusion.
Question 4: Which monitoring test is most appropriate for assessing direct thrombin inhibitor (e.g., dabigatran) effect?
- Prothrombin time
- Ecarin clotting time or diluted thrombin time (Correct answer)
- Anti-Xa level
- Bleeding time
Correct answer: Ecarin clotting time or diluted thrombin time
Ecarin clotting time and diluted thrombin time most reliably reflect dabigatran anticoagulant activity.
Question 5: What is the initial treatment of choice for von Willebrand disease type 1 in a bleeding patient?
- Factor VIII concentrate
- Desmopressin (DDAVP) (Correct answer)
- Platelet transfusion
- Cryoprecipitate
Correct answer: Desmopressin (DDAVP)
DDAVP stimulates endothelial release of stored von Willebrand factor and is first-line for mild type 1 vWD.
Question 6: Disseminated intravascular coagulation (DIC) is best described as:
- Isolated thrombocytopenia with normal coagulation
- Simultaneous activation of coagulation and fibrinolysis leading to both clotting and bleeding (Correct answer)
- Primary fibrinolysis without thrombosis
- Isolated factor XII deficiency
Correct answer: Simultaneous activation of coagulation and fibrinolysis leading to both clotting and bleeding
DIC involves paradoxical simultaneous activation of both coagulation and fibrinolysis, consuming clotting factors and causing multi-organ dysfunction.
Question 7: Which parameter on ROTEM (EXTEM) specifically reflects fibrinogen contribution to clot strength?
- CT (clotting time)
- CFT (clot formation time)
- FIBTEM MCF (Correct answer)
- Alpha angle
Correct answer: FIBTEM MCF
FIBTEM MCF measures maximum clot firmness using a platelet inhibitor, isolating fibrinogen's contribution to clot strength.
EDAIC Coagulation and Transfusion Medicine 4
During liver transplantation, which coagulation abnormality is most expected during the anhepatic phase?