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  #1  
Old 09-29-2011
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Blood Bleeding after Prostatectomy

A 70-year-old man requires a radical prostatectomy for prostate cancer. Prior to surgery, his platelet count, bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT) time are all normal. Following surgery he develops severe bleeding from the penis that requires blood transfusions. Which of the following sets of hemostasis studies is most likely to be present in this patient?

A. platelet count normal, bleeding time increased, PT normal, PTT increased
B. platelet count normal, bleeding time normal, PT normal, PTT increased
C. platelet count decreased,bleeding time increased,PT increased, PTT increa
D. platelet count normal, bleeding time increased, PT increased, increased
E. platelet count normal, bleeding time normal, PT increased, PTT increased
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  #2  
Old 09-29-2011
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B? I think he has hemophilia
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Old 09-29-2011
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I think it's the answer is A.
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Old 10-01-2011
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tough question idk the answer
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Old 10-01-2011
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Correct Answer Answer is D

Answer is D
The patient has primary fibrinolysis, which may occur in radical prostate surgery. In this setting, urokinase is released from the tissue causing activation of plasminogen and the release of plasmin.
Plasmin degrades multiple coagulation factors (e.g., V, VIII, fibrinogen).
This increases the PT and PTT, because factors V and VIII are in the final common pathway.
The degradation products of fibrinogen interfere with platelet aggregation causing an increase in the bleeding time. The platelet count is not affected.
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Old 10-01-2011
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Originally Posted by kalsabek View Post
B? I think he has hemophilia
how hemophilia he is 70 years old and now u discover he has heamphilia
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Old 10-01-2011
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Originally Posted by mayursn39 View Post
Answer is D
The patient has primary fibrinolysis, which may occur in radical prostate surgery. In this setting, urokinase is released from the tissue causing activation of plasminogen and the release of plasmin.
Plasmin degrades multiple coagulation factors (e.g., V, VIII, fibrinogen).
This increases the PT and PTT, because factors V and VIII are in the final common pathway.
The degradation products of fibrinogen interfere with platelet aggregation causing an increase in the bleeding time. The platelet count is not affected.
i thought it is DIC so the answer is E

andkeep posting these q they r very imp
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Originally Posted by docnok View Post
I think it's the answer is A.
it is not VWB disease it appear in early age (AD)inherited disease
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Old 10-01-2011
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Originally Posted by miss patho View Post
it is not VWB disease it appear in early age (AD)inherited disease

bleeding time is a corelation to platelets and their numbers... (except of bernard soulier disease where platelets are normal in number and still BT is increased)

PT and PTT are both related to the coagulation cascade...

now in this question bleeding occurs POST SURGERY and is not immediate.
hence... it cannot be due to a platelet problem... cos that causes immediate bleeds.
so it has to be either a problem with the clotting cascade... ie variations in PT and PTT only (but that is not an option)

hence the only other thing left is DIC..

and in DIC u will have all things abnormal... hence i think the answer is C...

please correct me if i am wrong or applying wrong logic anywhere.
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Quote:
Originally Posted by mayursn39 View Post
Answer is D
The patient has primary fibrinolysis, which may occur in radical prostate surgery. In this setting, urokinase is released from the tissue causing activation of plasminogen and the release of plasmin.
Plasmin degrades multiple coagulation factors (e.g., V, VIII, fibrinogen).
This increases the PT and PTT, because factors V and VIII are in the final common pathway.
The degradation products of fibrinogen interfere with platelet aggregation causing an increase in the bleeding time. The platelet count is not affected.

plasmin degrades only activated factors... since only activated factors are depleted u will not manifest as a bleed.. cos newer factors can still work...
is that correct??
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Old 10-01-2011
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The new factors will take time for synthesis .
The bleeding is due to defective platelet aggregation.
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  #12  
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Quote:
Originally Posted by mayursn39 View Post
Answer is D
The patient has primary fibrinolysis, which may occur in radical prostate surgery. In this setting, urokinase is released from the tissue causing activation of plasminogen and the release of plasmin.
Plasmin degrades multiple coagulation factors (e.g., V, VIII, fibrinogen).
This increases the PT and PTT, because factors V and VIII are in the final common pathway.
The degradation products of fibrinogen interfere with platelet aggregation causing an increase in the bleeding time. The platelet count is not affected.
Thanks and keep on posting Qs,they are really helpful
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Old 06-12-2014
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very good q, thanks.
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