An 80 year old man presents for evaluation prior to laparoscopic hernia

• An 80 year old man presents for

• evaluation prior to laparoscopic hernia

• repair

• Known severe aortic stenosis (no angina, syncope, CHF)
• No prior history of abnormal bleeding, or clotting disorder
• Bp 120/70 HR 90 sinus
• III/VI mid peaking crescendo-decrescendo murmur of aortic stenosis heard in aortic area and radiating to carotids and precordium
• Stool heme positive

Echo: Severe aortic stenosis, normal left ventricular function

• Echo: Severe aortic stenosis, normal left ventricular function

• No change from echo performed one year ago

• Hbg 7.5

• Hbg was 14.0 six months ago, microcytic hypochromic

• Colonoscopy

Which of the following, in addition to the finding noted at colonoscopy, best explains the cause of his anemia?

• Which of the following, in addition to the finding noted at colonoscopy, best explains the cause of his anemia?

• A. Acquired disorder impairing platelet adhesion

• B. Inherited disorder impairing platelet adhesion

• C. Acquired disorder of thrombin generation

• D. Inherited disorder of thrombin generation

• 80 year old man

• Severe aortic stenosis

• GI bleed

• Colonic A-V malformation

• Gigantic multimeric protein

• Mediates adhesion of platelets to sites of vascular damage

• Large multimers cleaved by plasma metalloprotease under conditions of high shear stress

• Absence of large multimers of vWF cause bleeding from gastrointestinal angiodysplasia

Which of the following, in addition to the finding noted at colonoscopy, best explains the cause of his anemia?

• Which of the following, in addition to the finding noted at colonoscopy, best explains the cause of his anemia?

• A. Acquired disorder impairing platelet adhesion

• B. Inherited disorder impairing platelet adhesion

• C. Acquired disorder of thrombin generation

• D. Inherited disorder of thrombin generation