303. Bleeding

Question 1

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

Answer 1

Vasocontriction

Gap plugging

Coagulation cascade

Question 2

What common vascular deficincies lead to increased bleeding?

Answer 2

Hereditary talangectasia

Eshler dahmos

Infection (meningitis)

steroids, scurvy

HSP

Question 3

What are the platelet dysfunctions that cause increased bleeding?

Answer 3

aplastic anaemia, megaloblastic anaemia, marrow suppresion (chemo)

SLE, ITP, heparin

DIC, TTP, HUS

NSAIDS

Question 4

What common disorders cause problems with the coagulation cascade?

Answer 4

Heamophilia, Von willibrands disease,

Anticoagulants, liver disease, DIC, Vitamin K deficiency

Question 5

What is haemophilia A?

Answer 5

X linked recessive Factor 8 deficiency

up to 30% dont have family history

Question 6

How does it present?

How is heamophilia A diagnosed

Answer 6

Depends on severity

Heamoartorisis- bad joint problems

Muscle heamotomas- compartment syndrome

Diagnosis is made by prolonged APTT and reduced factor 8 assay

Question 7

How do you manage heamophilia A?

Answer 7

Get help

Avoid NSAIDS and IM injections

Desmopressin raises factor 8 levels

major bleeds- recombient factor 8 levels

Question 8

What is heamophilia B?

Answer 8

Factor IX deficiency, x linked

Question 9

What is acquired heamophilia?

Answer 9

Causes big mucousal bleeds

Factor 8 deficiency

Question 10

What pathologies lead to reduced vitamin K absorbtion

Answer 10

Fat malabsorption syndromes

diffuse liver disease

Absence of vitamin K synthesizing flora (antibiotics, babies)

Question 11

What is immune thrombocytopeania?

Answer 11

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

Chronic IPT typically causes bleeding, purpura, epistaxis and menorrhagia

Question 12

How is ITP treated?

Answer 12

Iv prednisolone
Immunoglobulin to increase platelets
splenomegaly
rituximab

Question 13

What is von willibrands disease?

Answer 13

deficiency in VwF that binds platelets with factor 8

Question 14

How is von willibrands diseases managed?

Answer 14

Managed by expert, avoid NSAIDS

Desmopressin for mild bleeds,

VwF containing factor 8 for surgery or major bleeds

Question 15

What are the causes of bleeding with a prolonged prothrombin time

Answer 15

Extrinsic system pathologies:

Liver disease
DIC
Vit K deficiency
Warfarin

Question 16

What prolongs activated partial prothrombin time?

Answer 16

Extrinsic system pathologies:

Heparin
Heamophilia
DIC
Liver disease

Question 17

How do you manage someone with a bleeding disorder?

Answer 17

If shcoked, resuccitate

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

Question 18

What are the typical bleeding results for heparin?

Answer 18

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

Question 19

With regards to DIC discuss the heamatological values?

Answer 19

PT- increased

APTT- increased

Thrombin time- increased

Platelet count decreased

Question 20

Liver disease. what are the heamatological values?

Answer 20

Increased INR,

increased APTT,

increased/normal thrombin,

normal/low platelets

Question 21

Vit k defiecency heamatological values

Answer 21

Increased INR, Increased APT

normal thrombin, normal platelets

Question 22

Heamophili and VwD what are the heamatological values

Answer 22

Normal INR

Increased APTT

Normal platelets

Normal Thrombin

Question 23

When would you correct red cells

Answer 23

anaemia or blood loss

Question 24

When would you transfuse or platelets?

Answer 24

If actively bleeding or count is below 20

If getting surgery get advice if platelets are below 100

Question 25

Fresh frozen plasma is transfused in which scenario?

Answer 25

DIC Warfarin overdose Liver disease TTP

Question 26

What are the early complications of acute reactions

Answer 26

acute heamolytic reaction anaphylaxis bacterial contamination febrile reactions allergic reactions acute lung injury

Question 27

What is an aitologous transfusion?

Answer 27

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

Question 28

What is an autologous transfusion?

Answer 28

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

Question 29

When would you transfuse or platelets?

Answer 29

If actively bleeding or count is below 20 If getting surgery get advice if platelets are below 100

Question 30

Fresh frozen plasma is transfused in which scenario?

Answer 30

DIC Warfarin overdose Liver disease TTP

Question 31

What are the early complications of acute reactions

Answer 31

acute heamolytic reaction anaphylaxis bacterial contamination febrile reactions allergic reactions acute lung injury

Question 32

What is an aitologous transfusion?

Answer 32

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

Question 33

What are symptoms of an acute haemolytic reaction?

Answer 33

Agitation Increased temperature Rapid onset REduced BP Flushing Abdo/chest pain DIC

Question 34

How should an acute haemolytic reaction be managed?

Answer 34

Stop transfusion Phone heamatology send FBC, U&E, clotting, cultures and urine Keep line open with saline Treat DIC

Question 35

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

Answer 35

Bronchospams Cyanosis Reduced BP Soft tissue swelling

Question 36

What are the symptoms of a bacterial reaction to transfusion?

Answer 36

Increased temperature Reduced BP Rigor Managed same as acute heamolytic reaction except broad spectrum antibiotics are given

Question 37

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

Answer 37

Both give dyspnoea, hypoxia, and CXR changes TRALI- White out on CXR, hypotension FLuid overload- Hyperte3nsion, raised JVP

Question 38

How do you manage TRALI?

Answer 38

Stop transfusion Give 100% O2 Treat as ARDS- ITU, CPAP, Low pressure ventilation with with high peak expiratory pressures. Art. line, conservative fluid management

Question 39

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

Answer 39

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