Bleeding time is prolonged in all the following EXCEPT

JIPMER Nursing Officer-2017

Medical & Surgical Nursing

Hard

Appeared in: JIPMER Nursing Officer-2017

Explanation

Haemophilia A is a disorder of the coagulation cascade (secondary hemostasis), specifically a deficiency in Factor VIII.
Primary hemostasis, which involves platelet function, is unaffected in Haemophilia A.
Bleeding time (BT) is a measure of primary hemostasis.
Therefore, the platelet count and bleeding time are normal in individuals with Haemophilia A, while the Activated Partial Thromboplastin Time (aPTT) is prolonged.

Option A: Viper venom can induce a consumptive coagulopathy (DIC), which leads to thrombocytopenia (low platelet count). A low platelet count impairs primary hemostasis, resulting in a prolonged bleeding time.
Option B: Idiopathic Thrombocytopenic Purpura (ITP) is an autoimmune condition characterized by the destruction of platelets, leading to a significantly low platelet count. This deficiency directly impairs the formation of the primary platelet plug, causing a prolonged bleeding time.
Option D: Von Willebrand disease is caused by a defect in von Willebrand factor (vWF), which is crucial for platelet adhesion to injured endothelium. Impaired platelet adhesion disrupts primary hemostasis, leading to a prolonged bleeding time.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The question tests the understanding of hemostasis, specifically the difference between primary and secondary hemostasis and how various bleeding disorders affect laboratory tests like bleeding time as background academic context rather than a clinical decision trigger.
Nurses must understand the underlying cause of bleeding to anticipate patient needs and implement appropriate interventions. For a patient with Haemophilia A, the nurse would focus on replacing the missing clotting factor and protecting from trauma, knowing that initial clot formation is not the issue.
In contrast, for a patient with ITP or DIC from a viper bite, the nurse's priority would be managing severe thrombocytopenia, which might involve platelet transfusions and monitoring for spontaneous bleeding.
A key nursing responsibility is to correctly interpret lab results (BT, aPTT, PT, platelet count) to assess the patient's bleeding risk and the effectiveness of treatment.

How to Approach the Question

First, identify the core concept of the question, which is 'bleeding time'. Recall that bleeding time measures primary hemostasis (platelet function).
Next, note the negative framing: the question asks for the 'EXCEPT' case, meaning you need to find the condition where bleeding time is NOT prolonged.
Evaluate each option's effect on primary hemostasis:
Does Viper bite affect platelets? Yes, it can cause thrombocytopenia.
Does ITP affect platelets? Yes, it's a primary platelet disorder.
Does Haemophilia A affect platelets? No, it's a clotting factor (Factor VIII) deficiency.

Concept Tested & Keywords

Concept Tested: The question tests the understanding of hemostasis, specifically the difference between primary and secondary hemostasis and how various bleeding disorders affect laboratory tests like bleeding time.
Stem keywords: Bleeding time, prolonged, Viper bite, Idiopathic thrombocytopenia, Haemophilia A, Von Willebrand disease
Lead-in keywords: EXCEPT
Negative lead-in flag: The question asks for the condition that is an exception, meaning the one where bleeding time is NOT prolonged.

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