3 - Hemostasis and Transfusion 2026

Primary hemostasis

This type of hemostasis refers to platelet plug formation and aggregation

Secondary hemostasis

This type of hemostasis refers to the deposition of insoluble fibrin generated by the coagulation cascade

von Willebrand disease

What is the most common congenital bleeding disorder?

Intermediate-purity factor VIII or DDAVP (desmopressin)

What is the treatment of choice for von Willebrand disease?

Hemophilia A (factor VIII deficiency)

What is the most common coagulation factor deficiency?

Storage pool disease

What is the most common intrinsic platelet defect?

Dense granule deficiency

What is the most prevalent form of storage pool disease?

<9 g/dL

Critically ill patients should receive blood transfusion if indicated at a hemoglobin level of ___ g/dL

<7 g/dL

The minimum threshold to receive blood transfusion in hemodynamically stable patients is ___ g/dL

< 8 g/dL

The minimum threshold to receive blood transfusion for patients undergoing cardiac surgery, orthopedic surgery, or those with preexisting CVD is ___ g/dL

Replenishment of blood volume

The most common indication for blood transfusion in surgical patients is:

Crystalloid solution

Blood loss of up to 20% of total blood volume can be initially corrected with:

Packed RBCs in addition to crystalloids, and FFPs in the case of massive transfusion

Blood loss of more than 20% of total blood volume requires correction with:

Packed RBCs, platelets, and fresh frozen plasma (FFP) in a 1:1:1 ratio

According to the Massive Transfusion Guideline, the blood bank should provide what blood products, in what ratio?

Massive Transfusion Guideline (MTG)

Patients who are unstable or has received 1-2 units of packed RBCs and do not rapidly respond are candidates for what protocol or guideline?

DIC

DIC vs primary fibrinolysis: decreased platelets are seen in?

DIC

DIC vs primary fibrinolysis: protamine test is positive in?

Primary fibrinolysis

DIC vs primary fibrinolysis: decreased duration of whole blood clot lysis is seen in?

DIC

DIC vs primary fibrinolysis: FFP or cryoprecipitate is used to treat?

Primary fibrinolysis

DIC vs primary fibrinolysis: EACA (aminocaproic acid) is used to treat?

Disseminated intravascular coagulation (DIC)

Metastatic prostate cancer is classically associated with what coagulopathy?

Primary fibrinolysis

DIC vs primary fibrinolysis: its mechanism involves excessive plasminogen activation

DIC

DIC vs primary fibrinolysis: manifests as thrombocytopenia, low fibrinogen, and elevated D-dimer

Platelet dysfunction → give platelets and initiated directed therapy

Patient presents with unexplained ongoing bleeding. Coagulation parameters show normal PT and normal aPTT. Considerations?

Extrinsic

Play tennis outside (PT, extrinsic)

Play table tennis inside (aPTT, intrinsic)

Patient presents with unexplained ongoing bleeding. Coagulation parameters show increased PT/INR and normal aPTT. This indicates a defect in which pathway of the coagulation cascade?

Warfarin

Other etiologies of prolonged PT/INR include cirrhosis, hepatic failure, malnutrition

Patient presents with unexplained ongoing bleeding. Coagulation parameters show increased PT/INR and normal aPTT. Use of what drug is the likely etiology?

DIC

Patient presents with unexplained ongoing bleeding. Coagulation parameters show increased PT/INR and prolonged aPTT. D-dimer is elevated. What is the most likely diagnosis?

Secondary hemostasis (coagulation cascade)

Expect changes in PT or aPTT

Warfarin and heparin interfere with which stage of hemostasis?

Fresh frozen plasma (FFP)

Which blood product contains all coagulation factors?

Thrombocytopenia

What is the most common abnormality of hemostasis?

Normal PT, normal aPTT

Bleeding time is expected to be prolonged

On pre-op consult, your patient tells you that they are on aspirin. What do you expect to see on PT and aPTT?

Primary hemostasis (platelet plug formation)

Aspirin interferes with what stage of hemostasis?