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Year 4 Block 3-Acute medicine > 303. Bleeding > Flashcards

303. Bleeding Flashcards

1
Q

After bleeding what are the three processes the body undertakes to stop bleeding?

A

Vasocontriction

Gap plugging

Coagulation cascade

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2
Q

What common vascular deficincies lead to increased bleeding?

A

Hereditary talangectasia

Eshler dahmos

Infection (meningitis)

steroids, scurvy

HSP

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3
Q

What are the platelet dysfunctions that cause increased bleeding?

A

aplastic anaemia, megaloblastic anaemia, marrow suppresion (chemo)

SLE, ITP, heparin

DIC, TTP, HUS

NSAIDS

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4
Q

What common disorders cause problems with the coagulation cascade?

A

Heamophilia, Von willibrands disease,

Anticoagulants, liver disease, DIC, Vitamin K deficiency

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5
Q

What is haemophilia A?

A

X linked recessive Factor 8 deficiency

up to 30% dont have family history

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6
Q

How does it present?

How is heamophilia A diagnosed

A

Depends on severity

Heamoartorisis- bad joint problems

Muscle heamotomas- compartment syndrome

Diagnosis is made by prolonged APTT and reduced factor 8 assay

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7
Q

How do you manage heamophilia A?

A

Get help

Avoid NSAIDS and IM injections

Desmopressin raises factor 8 levels

major bleeds- recombient factor 8 levels

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8
Q

What is heamophilia B?

A

Factor IX deficiency, x linked

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9
Q

What is acquired heamophilia?

A

Causes big mucousal bleeds

Factor 8 deficiency

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10
Q

What pathologies lead to reduced vitamin K absorbtion

A

Fat malabsorption syndromes

diffuse liver disease

Absence of vitamin K synthesizing flora (antibiotics, babies)

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11
Q

What is immune thrombocytopeania?

A

Antiplatelet autoantibodies, typically develops after infection in the young causes self limiting purpura

Chronic IPT typically causes bleeding, purpura, epistaxis and menorrhagia

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12
Q

How is ITP treated?

A

Iv prednisolone
Immunoglobulin to increase platelets
splenomegaly
rituximab

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13
Q

What is von willibrands disease?

A

deficiency in VwF that binds platelets with factor 8

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14
Q

How is von willibrands diseases managed?

A

Managed by expert, avoid NSAIDS

Desmopressin for mild bleeds,

VwF containing factor 8 for surgery or major bleeds

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15
Q

What are the causes of bleeding with a prolonged prothrombin time

A

Extrinsic system pathologies:

Liver disease
DIC
Vit K deficiency
Warfarin

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16
Q

What prolongs activated partial prothrombin time?

A

Extrinsic system pathologies:

Heparin
Heamophilia
DIC
Liver disease

17
Q

How do you manage someone with a bleeding disorder?

A

If shcoked, resuccitate

If bleeding continues discuss need for FFP, cryoprecipitate, platelets. Speak to heam

18
Q

What are the typical bleeding results for heparin?

A

Increased INR,
increased APTT,
increased thrombin time,
normal platelets

19
Q

With regards to DIC discuss the heamatological values?

A

PT- increased

APTT- increased

Thrombin time- increased

Platelet count decreased

20
Q

Liver disease. what are the heamatological values?

A

Increased INR,

increased APTT,

increased/normal thrombin,

normal/low platelets

21
Q

Vit k defiecency heamatological values

A

Increased INR, Increased APT

normal thrombin, normal platelets

22
Q

Heamophili and VwD what are the heamatological values

A

Normal INR

Increased APTT

Normal platelets

Normal Thrombin

23
Q

When would you correct red cells

A

anaemia or blood loss

24
Q

When would you transfuse or platelets?

A

If actively bleeding or count is below 20

If getting surgery get advice if platelets are below 100

25
Q

Fresh frozen plasma is transfused in which scenario?

A

DIC

Warfarin overdose

Liver disease

TTP

26
Q

What are the early complications of acute reactions

A

acute heamolytic reaction

anaphylaxis

bacterial contamination

febrile reactions

allergic reactions

acute lung injury

27
Q

What is an aitologous transfusion?

A

Patients own blood taken and save it for later. Usually use EPO.

28
Q

What is an autologous transfusion?

A

Patients own blood taken and save it for later. Usually use EPO.

29
Q

When would you transfuse or platelets?

A

If actively bleeding or count is below 20

If getting surgery get advice if platelets are below 100

30
Q

Fresh frozen plasma is transfused in which scenario?

A

DIC

Warfarin overdose

Liver disease

TTP

31
Q

What are the early complications of acute reactions

A

acute heamolytic reaction

anaphylaxis

bacterial contamination

febrile reactions

allergic reactions

acute lung injury

32
Q

What is an aitologous transfusion?

A

Patients own blood taken and save it for later. Usually use EPO.

33
Q

What are symptoms of an acute haemolytic reaction?

A

Agitation

Increased temperature

Rapid onset

REduced BP

Flushing

Abdo/chest pain

DIC

34
Q

How should an acute haemolytic reaction be managed?

A

Stop transfusion

Phone heamatology

send FBC, U&E, clotting, cultures and urine

Keep line open with saline

Treat DIC

35
Q

What are the symptoms of an analyphylactic reaction to a transfusion?

A

Bronchospams

Cyanosis

Reduced BP

Soft tissue swelling

36
Q

What are the symptoms of a bacterial reaction to transfusion?

A

Increased temperature

Reduced BP

Rigor

Managed same as acute heamolytic reaction except broad spectrum antibiotics are given

37
Q

How do you differentiate with a transfusion associated lung injury and fluid overload?

A

Both give dyspnoea, hypoxia, and CXR changes

TRALI- White out on CXR, hypotension

FLuid overload- Hyperte3nsion, raised JVP

38
Q

How do you manage TRALI?

A

Stop transfusion

Give 100% O2

Treat as ARDS- ITU, CPAP, Low pressure ventilation with with high peak expiratory pressures. Art. line, conservative fluid management

39
Q

How do you manage Non heamolytic febrile transfusion reactions and allergic reactions (not anaphylaxis)

A

Non haemolytic reaction- fever 30-60 mins after onset. Slow or stop transfusion and give paracetamol

Allergic reation- urticaria and itch, stop or slow transfusion and give IV chlorophenamine

Year 4 Block 3-Acute medicine (85 decks)

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