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Lecture 29 (Disorders of secondary haemostasis)

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DVM2 HLI (Semester 1) (Pathology (Jenny's lectures)) Quiz on Lecture 29 (Disorders of secondary haemostasis), created by Kathryn Borg on 15/04/2016.
Kathryn Borg
Quiz by Kathryn Borg, updated more than 1 year ago
Kathryn Borg
Created by Kathryn Borg about 8 years ago
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Resource summary

Question 1

Question
What are the major mechanisms responsible for defective secondary haemostasis?
Answer
  • inherited coagulation factor deficiencies
  • vitamin K antagonism or deficiency
  • severe acute or chronic liver disease
  • excessive fibrinolysis or fibrinogenolysis
  • von Willebrand's disease

Question 2

Question
Which mechanism is the most common cause of secondary haemostasis in domestic animals?
Answer
  • inherited coagulation factor deficiencies
  • vitamin K antagonism
  • severe acute or chronic liver disease
  • excessive fibrinolysis or fibrinogenolysis
  • von Willebrand's disease
  • vitamin k deficiency

Question 3

Question
Clinical signs suggestive of defective secondary haemostasis may include?
Answer
  • Large volume bleeds
  • Haematoma formation
  • Bleeding into body cavities or joints
  • Petechiae, purpura or ecchymoses in skin or mucous membranes

Question 4

Question
In what domestic species are inherited coagulation factor deficiencies most often identified?
Answer
  • dogs
  • cats
  • horses
  • cattle
  • rabbits

Question 5

Question
Deficiencies in relation to which of the below factors are yet to be confirmed in domestic animals?
Answer
  • factor III (tissue factor)
  • factor V
  • factor XIII
  • high molecular weight kininogen (HMWK)
  • factor XII
  • prekallikrein
  • factor I

Question 6

Question
Why does factor XI deficiency (haemophilia C) usually only cause mild bleeding?
Answer
  • because factor X can be activated by the extrinsic system
  • because factor V can be activated by the extrinsic system
  • because factor X can be activated by the intrinsic system
  • because factor XI is not required for coagulation

Question 7

Question
When might deficiencies in factor XI result in massive bleeding?
Answer
  • Following trauma (including surgical trauma) when sustained coagulation is required (as factor XI is required for sustained X activation)
  • When the disease manifests in a male (as it is inherited as an X-linked recessive disorder)
  • Factor XI has major roles in pregnancy
  • When the disease occurs in a Saint Bernard dog

Question 8

Question
The most severe haemorrhage is associated with inherited deficiencies of factor(s)?
Answer
  • factor I
  • factor II
  • factor X
  • factor VIII
  • factor IX
  • combined factor deficiencies
  • factor XII
  • factor V

Question 9

Question
Which inherited factor deficiency is the most common inherited coagulopathy in domestic animals and humans?
Answer
  • factor VIII (haemophilia A)
  • factor IX (haemophilia B)
  • factor XI (haemophilia C)
  • factor VII

Question 10

Question
Haemophilia A it is inherited as an X-linked recessive disorder and manifests almost exclusively in hemizygous females (usually in the first six months of post-natal life)
Answer
  • True
  • False

Question 11

Question
Which factors are vitamin K-dependent? Choose the correct combination
Answer
  • factors II, VII, IX and X
  • factors III, VIII, IX and X
  • factors II, VII, IX and XI
  • factors II, VII, IIX and X
  • factors I, II, IIX and XI

Question 12

Question
A mutation in which gene (what does it encode for) causes a deficiency of the vitamin k-dependent factors?
Answer
  • γ-glutamyl carboxylase gene
  • Acetyl-CoA carboxylase gene
  • α-glutamyl carboxylase gene
  • Pyruvate carboxylase gene

Question 13

Question
Ingestion of which of the below can cause haemorrhage via antagonism of vitamin K epoxide reductase?
Answer
  • anticoagulant rodenticides containing hydroxycoumarins or indandiones
  • mouldy sweet clover (Melilotus alba) or sweet vernal grass (Anthoxanthum odoratum) containing bishydroxycoumarin
  • sulphaquinoxaline (a coccidiostat)
  • overdose with therapeutic coumadins (eg. warfarin)
  • paracetamol
  • 2-acetoxybenzoic acid (aspirin)
  • cholecalciferol (Vitamin D3)

Question 14

Question
Mild intoxication by ingestion of anticoagulant rodenticides is a common cause of haemorrhage in cats and dogs. How can this be treated?
Answer
  • vitamin K1 administration
  • administration of warfarin
  • administration of prednisolone
  • vitamin D3 administration
  • Cartrophen (DMOAD) administration

Question 15

Question
Dietary vitamin K deficiency although rare, is most commonly reported in what species of domestic animals?
Answer
  • dogs
  • cats
  • horses
  • sheep
  • rabbits

Question 16

Question
What can cause vitamin K deficiency?
Answer
  • complete extrahepatic bile duct obstruction
  • exocrine pancreatic insufficiency
  • intestinal malabsorption
  • chronic lipid maldigestion/malabsorption syndromes
  • long term oral antibiotic use
  • prolonged anorexia or malnutrition
  • diabetes
  • diarrhoea

Question 17

Question
Which coagulation factors are deficient in the inherited coagulopathy recognised in Devon rex cats?
Answer
  • II, VII, IX and X
  • III, VII, IX and XI
  • II, VI, X, XII
  • I, V, VI, X

Question 18

Question
Where in the body are most of the coagulation factors produced?
Answer
  • liver
  • spleen
  • bone marrow
  • endothelial cells
  • macrophages

Question 19

Question
What percentage reduction of functional liver mass causes significant decreases in coagulation factor activity?
Answer
  • ≥70%
  • ≥40%
  • ≥60%
  • ≤45%

Question 20

Question
Surprisingly, most animals with hepatic disease of enough severity to cause inadequate synthesis of coagulation factors do not bleed spontaneously, instead, they are at risk of uncontrollable haemorrhage if haemostatic capacity is challenged (e.g. if a liver biopsy is undertaken)
Answer
  • True
  • False

Question 21

Question
What is mandatory before subjecting an animal with known hepatic disease to a liver biopsy or other invasive surgery?
Answer
  • Laboratory tests of haemostatic capacity
  • Radiography
  • Leukogram
  • Physical exam

Question 22

Question
Why are animals with significant hepatic disease not only at risk of haemorrhage but also at risk of thrombosis?
Answer
  • Hepatocytes synthesise anticoagulants, fibrinolytic agents and fibrinolytic inhibitors
  • The liver is responsible for clearance from the circulation of many of the activated products of coagulation and fibrinolysis
  • Most of the coagulation factors are synthesised by hepatocytes
  • The liver is responsible for the maturation of platelets

Question 23

Question
Why would excessive fibrinolysis be an issue?
Answer
  • Premature breakdown of secondary haemostatic fibrin plugs
  • Can result in the formation of a thrombus
  • Premature breakdown of primary haemostatic platelet plugs

Question 24

Question
[blank_start]Fibrinolysis[blank_end]- enzymatic lysis of fibrin by plasmin [blank_start]Fibrinogenolysis[blank_end]- enzymatic lysis of fibrinogen by plasmin
Answer
  • Fibrinolysis
  • Fibrinogenolysis
  • Fibrinocatalase

Question 25

Question
In which conditions is excessive fibrinogenolysis thought to be a contributor to defective secondary haemostasis in domestic animals?
Answer
  • snake envenomation - e.g. Eastern and Western diamondback rattlesnakes
  • administration of plasminogen activators - e.g. t-PA, streptokinase
  • excessive endothelial release of t-PA - e.g. shock, heat stroke, severe tissue trauma
  • Disseminated intravascular coagulation (DIC)
  • prolonged anorexia or malnutrition
  • anticoagulant rodenticides containing hydroxycoumarins or indandiones

Question 26

Question
In which condition is excessive fibrinolysis a contributor to defective secondary haemostasis in domestic animals?
Answer
  • Disseminated intravascular coagulation (DIC)
  • snake envenomation - e.g. Eastern and Western diamondback rattlesnakes
  • administration of plasminogen activators - e.g. t-PA, streptokinase
  • excessive endothelial release of t-PA - e.g. shock, heat stroke, severe tissue trauma
  • prolonged anorexia or malnutrition

Question 27

Question
In what circumstances might a dog develop deficiency of vitamin K?
Answer
  • prolonged anorexia or malnutrition
  • long term antibiotics (which can kill off gut bacteria, which synthesise vit K)
  • chronic lipid maldigestion/malabsorption syndromes (eg. bile duct obstruction)
  • ingestion of anticoagulant rodenticides
  • snake envenomation - e.g. Eastern and Western diamondback rattlesnakes
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