[khanar]

22 yo male with hemophilia presented with coffee ground vomiting and positive guaiac in stool. BP 110/70. He said that he has been adequately controlled in the past and had never required blood transfusion.
Labs: Hb 10 Hct 0.3 Platelets 160K PT 14.5 s PTT 42.5 s

What should be given?
a- platelets
b- factor VIII concentrate
c- fresh frozen plasma
d- cryoprecipitate
e- two RBC units

 

[Sabio]

I choose factor 8
platelets are still within normal limits
he has prolonged PTT
so his hemophilia is the cause for upper GI bleeding and the best action is to give him the concentrate
no need for blood transfusion at this time as he has normal blood pressure excluding hypovolemic shock.

 

[DrSeddik]

Either this (hemophilia-factor 8) or the question is not written well and he means VWD, the type of bleeding (mucous membrane) goes more with that of von Willebrand's and platelet deficiency but since there's increased PTT then it's vWD.

In case he mean vWD the only answer is cryoprecipitate.

 

[khanar]

Either this (hemophilia-factor 8) or the question is not written well and he means VWD, the type of bleeding (mucous membrane) goes more with that of von Willebrand's and platelet deficiency but since there's increased PTT then it's vWD.

In case he mean vWD the only answer is cryoprecipitate.

Do we have prolonged PTT in von Willerbrand disease and should think of it, if the question telling us it's hemophilia!

 

[DrSeddik]

Yes PTT can be prolonged in vWD. But typically if the question says haemophilia then it's hemophilia. But beside this, the question and choices point towards vWD, because in hemophilia typically bleeding is deep (into joints and subcutanuous tissue) not into mucous membranes. Besides you can treat hemophilia with factor 8 or cryoprecipitate with the same efficacy, but you only treat vWD with cryo.

 

[khanar]

you can treat hemophilia with factor 8 or cryoprecipitate with the same efficacy, but you only treat vWD with cryo.

Cryoprecipitate is not as efficacious in hemophilia as factor 8 besides it carries higher risk of blood borne infections.

 

[DrSeddik]

I insist that cryoprecipitate and factor 8 concentrate treat hemophilia A with the same efficacy. You are correct about the factor 8 concentrate only the ones prepared with recombinant DNA technology are free of infections, and those come with a high price (literally not metaphorically ), those which are derived from plasma pools carry the same risk of transmitting infection as cryo.

Anyway I'm just saying that it's a possibility that the writer meant vWD, if I had that question I wouldn't take that chance, I would choose factor 8.

 

[khanar]

I insist that cryoprecipitate and factor 8 concentrate treat hemophilia A with the same efficacy. You are correct about the factor 8 concentrate only the ones prepared with recombinant DNA technology are free of infections, and those come with a high price (literally not metaphorically ), those which are derived from plasma pools carry the same risk of transmitting infection as cryo.

Anyway I'm just saying that it's a possibility that the writer meant vWD, if I had that question I wouldn't take that chance, I would choose factor 8.

OK thanks

 

[roshan dinparast]

this question is not a typical scenario for Hemophillia, I think. but the best answer seems to be Factor VIII.