309. Thrombophilia and immunosuppresive Flashcards
What is thrombophilia?
Presisposition to thrombosis
What are general risk factors for arterial thromboembolism?
Smoking
Hypertension
Hyperlipidaemia
Diabetus
What are general risk factors for venous thromboembolism?
Surgery
Trauma
Immbolity
Pregnancy, pill, HRT
Age
Obesity
Varicose veins
List some examples of genentic causes of thromboembolism
Protein c defieciency- factor V leiden, most common cause
Prothrombin gene mutation- causes high prothrombin levels
Protein C and S deficiency- vit k dependent. skin necrosis on warfarin
Antithrombin deficiency
When should you suspect that an individual has an inherited thrombophilia and needs tested?
Arterial thrombosis under 50
Unprovoked DVT
VTE on oral contraceptive
Unexplained reccurent VTE
Unusual site
Recurrent fetal loss
What tests should be carried out in those with high suspicion of thrombophilia?
FBC, FILM
PT,APTT,fibrinogen
lupus anticoagulant, anticardiolipin antibodies
proteins c and s deficiency
(done when patient well, not pregnant and off anticoagulaion for 1 month)
What treatment should be delivered to those who have antithrombin defeciency?
High doses of heparin
What is true about steroids and growth
What interactions are important with steroids
What can we say about steroids and pregnancy?
Reduced growth, elderly have more side effects
Efficacy reduced by anti-epileptics and rifampicin
May cause IUGR
What are the side effects of Immunosuppresive drugs?:
GI side effects- pancreatitis, candidiasis, oesophageal ulceration, peptic ulceration
MSK_ myopathym osteopereosis, fractures, growth suppression
Endocrine- adrenal suppreision, cushing’s
CNS- aggravated epilepsy, depression, psychosis
What are the side effects of azathioprine?
What can it interact with?
Diarrhoea, abdo pain, marrow suppresion
Nephritis, pancreatitis
Allopurinol
What are the side effects of ciclosporin and tacrolimus
Nephrotoxicity
Gum hyperplasia
tremor,oedmea, paraethesia
skin cancer, lymphoma
