https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis en-us 2018-08-01 16:12:36 UTC 2022-02-16 11:09:04 UTC hello@padlet.com hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683128 Mr M, a saudi arabian was admitted in A n E after an automobile accident with several superficial cuts and bruises to the head and arms. He was bleeding profusely, having more severe bleeding than would be expected from the nature if his wound.]]> 2018-08-01 16:12:54 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683128 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683475 What lab test, hematology and hemostasis, that would be more informative in interpreting the cause of the patient's bleeding would likely ordered immediately?]]> 2018-08-01 16:17:28 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683475 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683601 Does the patient most likely have a disorder of primary or of secondary hemostasis? Why]]> 2018-08-01 16:18:50 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683601 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683711 Lab result:
WBC 10.5 x 10 9/L                        PT  11.2 sec
RBC 2.3 x 10 12/L                         APTT 25.6 sec
Hb 6.6 g /dL
Hct 19.3
PLT  133 x 10 9/L

Explain how this lab test comfirm that the patient's bleeding is related to a defect in primary hemostasis rather than secondary hemostasis?]]> 2018-08-01 16:20:02 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271683711 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684272 Is the bleeding more likely related to problems with the vascular system or with platelets? Why? ]]> 2018-08-01 16:26:49 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684272 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684423 Is this profuse bleeding with the presence of petechiae 
 consistent with the platelet count? Why? ]]> 2018-08-01 16:28:27 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684423 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684560  What additional testing would be helpful in identifying the cause of the patient’s excess bleeding? ]]> 2018-08-01 16:29:38 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684560 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684584 Mr M hematology report included a finding that at least 65% of the plt were large and giant forms with intense granulation.
 Is there a possibility that the patient’s platelet count is spuriously increased or decreased? Why? ]]> 2018-08-01 16:29:58 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684584 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684645 When asked if he had had bleeding problems in the past,Mr M recounted having petichiae, lots of bruises off and on since childhood, frequent nose bleeds and bleeding for a long time after cuts. Several testa are orders as below:

BT > 20 sec
Closure time on PFA increased
Plt aggregation studies shoed normal aggregattion with ADp, collagen, epineprine and thrombin.
Agglutination with ristocetin was abnormal and was not corrected when VWF was added.
Is this patient’s problem more likely acquired or inherited? Why? ]]> 2018-08-01 16:30:22 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271684645 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271685220 What is the significance of these platelet function tests?

]]> 2018-08-01 16:36:28 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271685220 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271685320 10. What is the most likely condition? ]]> 2018-08-01 16:37:19 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271685320 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271685430 What additional testing would be considered? ]]> 2018-08-01 16:38:31 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/271685430 hibuddy87 https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/2050503280 Q1 FBC, PT/aPTT
Q2 Primary hemostasis disorder. bleeding is profuse despite superficial cut, which is more suggestive in abnormalities in platelet plug formation
Q3 PT/aPTT is normal, thus unlikely secondary hemostasis disorder
Q4 bleeding is likely due to platelet abnormality  as vascular bleeding disorders are unlikely to cause profuse bleeding comparing platelet disorder
Q5 there is thrombocytopenia but doesnt correlate with bleeding in this case. in normal person, 30-50x10⁹ is sufficient for hemostasis
Q6 platelet function assay & aggregation tests, VWF antigen, multimer test and ristocetin induced platelet aggregation test.
Q7 large number of Giant plt result in lower platelet count as there is relative lower number of normal small platelets
Q8 abnormal ristocetin test not corrected with addition of VWF suggests defect in Gp1b/IX/V, thus defect in ability of platelt to bind to VWF. Gp1b/IX/V defect, giant plt with thrombocytopenia suggestive of Bernard Soulier Syndrome, which is hereditary disorder with autosomal recessive inheritance
Q9 platelet function test is done to identify possible defects that lead to failure in proper platelet plug formation. Aggregation response to ADP and collagen rules out defect in GPIIB/IIIA; collagen response rules out GP1a defect; adrenaline counteracts thromboxane A2 inhibition; ristocetin normally fascilitate VWF factor binding with GPIb/IX/V
Q10 Bernard soulier syndrome
Q11 molecular genetic test to confirm diagnosis]]> 2022-02-16 09:56:32 UTC https://padlet.com/hafizuddinmohamedfauzi/primaryhemostasis/wish/2050503280