Lecture on Hemostasis - Common Clinical Vignettes

Introduction

• Presenter: Eric from Strong Medicine
• Topic: Hemostasis series, focusing on clinical vignettes
• Objective: Evaluate recall on hemostasis material with a mix of old and new information

Clinical Vignettes Overview

• Format: Case-based board-style multiple-choice questions
• Focus: Common scenarios in this session; uncommon in the next
• Instruction: Listen to vignette, pause for answers, then hear explanations

Case 1: Von Willebrand Disease

• Patient: 35-year-old woman, pre-op for cholecystectomy
• History: Bleeding post-tooth extraction, family history of bleeding
• Labs: Normal CBC, normal INR, prolonged PTT
• Diagnosis: Von Willebrand disease
  • Tests: von Willebrand factor antigen, factor VIII activity
• Management: Desmopressin trial
• Genetics: Autosomal dominant inheritance, 50% chance for offspring

Case 2: Acute Disseminated Intravascular Coagulation (DIC)

• Patient: 24-year-old woman, pregnant, placental abruption
• Presentation: Uncontrollable hemorrhage post-delivery
• Diagnosis: Acute DIC
• Labs: Low platelets, high INR/PTT, low fibrinogen, high D-dimer
• Treatment: Priority on IV fluids for hemodynamic stability
• Blood Smear: Schistocytes
• Treatment Note: Avoid antifibrinolytics

Case 3: Heparin-Induced Thrombocytopenia (HIT) Type 2

• Patient: 60-year-old man, post-surgery complications
• Presentation: Thrombocytopenia, pulmonary embolism
• Diagnosis: Type 2 HIT
• Management: Discontinue heparin, use argatraban
• Testing: ELISA & functional assays

Case 4: Warfarin Overdose

• Patient: 75-year-old man, on warfarin, prescribed Bactrim
• Presentation: Bleeding, elevated INR
• Immediate Treatment: Vitamin K
• Prophylaxis: Closer INR monitoring during antibiotic therapy
• Mechanism: Antibiotics reduce gut vitamin K-producing bacteria

Case 5: Antiphospholipid Syndrome

• Patient: 30-year-old woman, stroke, miscarriage history
• Presentation: Mild thrombocytopenia, prolonged PTT
• Diagnosis: Antiphospholipid syndrome
• Testing: Mixing study for PTT, anti-cardiolipin antibodies
• Association: Most strongly associated with lupus

Conclusion

• Part 1 of the clinical vignettes focuses on common scenarios
• Next session will cover uncommon scenarios in hemostasis