CICM SAQ 2010.1 Q30
30.1. A 62 year old lady has very significant bleeding following an uncomplicated total hip replacement. Her coagulation profile post blood transfusion is as follows:
- (a) List two (2) likely causes of her deranged coagulation profile.
- (b) List two (2) additional pieces of information from her history which might be of importance.
- (c) Name two (2) further tests you will undertake to elucidate the cause of her coagulopathy and bleeding tendency.
30.2. List five (5) likely causes for the following coagulation profile:
30.3. A 78 year old man presented after a fall resulting in a bruised hip. His Full blood count is the following:
- (a) List four (4) causes for the raised MCV
Answers
Answer and interpretation
30.1. (a) List two (2) likely causes of her deranged coagulation profile.
- Factor 8 deficiency
- Factor 9 deficiency
- Dilutional coagulopathy
- vWD
30.1. (b) List two (2) additional pieces of information from her history which might be of importance.
- Patient – past history of bleeding
- Family history of bleeding
- History of anti-platelet drugs
30.1. (c) Name two (2) further tests you will undertake to elucidate the cause of her coagulopathy and bleeding tendency.
- Factor assay.
- A Von Willebrands Disease screen.
30.2. List five (5) likely causes for the coagulation profile.
- DIC
- Primary fibrinolysis
- Dilutional coagulopathy from massive transfusion
- Post thrombolysis
- Snake bite
30.3. (a) List four (4) causes for the raised MCV.
- B12 deficiency
- Folate deficiency
- Myelodysplastic syndrome
- Therapy with cytotoxics or immunosuppressants
- Alcohol
- Hypothyroidism
Alcohol and hypothyroidism do not produce such high levels of MCV usually, but if mentioned answers accepted.
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