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YEAR 3 Manchester Medicine > 6 - Clotting disorders > Flashcards

6 - Clotting disorders Flashcards

1
Q

What is the extrinsic pathway?

A

Exposer to tissue factor

F VII –> VIIa

=> activation of the common pathway

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2
Q

What is the intrinsic pathway?

A

Platelets activate FXII

cascade activates XI, IX IXa and VIIIa

activates common pathway

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3
Q

How does warfarin work?

A

Inhibits Vit. K reductase

inhibits protein C and S - inhibits clotting factors and enhances fibrinolysis decreases PT

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4
Q

What is the common pathway?

A

FX become acite and with co FV helps activate FII (to thrombin), which in turn activates fibrin.

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5
Q

How does Heparin?

A

inhibits FII and increase antithrombin activation.

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6
Q

What effects PT?

A

Warfarin

Factor II

Factor V

Factor VI

Factor X

Measures the extrinsic and common pathway

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7
Q

What effects APTT?

A

Heparin

Factor VIII

Factor IX

Factor XI

Factor XII (but no bleeding diathesis)

von Willebrand’s Disease

Measures the intrinxic and common pathway

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8
Q

If APTT and PT are prolonged consider:

A

Vit K deficiency

disseminated intravascular coagulation

rarely vWF deficiency

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9
Q

What are the VIt. K dependent factors?

A

Factor II

Factor VII

Factor IX

Factor X

Protein C

Protein S

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10
Q

What is the 50/50 mixture test?

A

APTT and PT done compared to with 50% normal bloodcontent

same times = factor deficiency

still prolonged times = factor inhibition

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11
Q

What is heamophillia A?

A

X linked disorder

deficiency of F VIII

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12
Q

What is haemophilia B?

A

X linked disorder

deficiency of FIX

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13
Q

What is Von Willibrand’s disease?

A

vWF deficiency which would have stabilised VIII and clotting

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14
Q

Reasons for Vit. K deficiency?

A

1) inadequate stores - malnutrition and haemorrhage disease
2) Vit. K malabsorption - Jaundice (fat soluble)
3) Oral anticoagulants

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15
Q

What is the treatment for haemophilia A?

A

IV FVIII concentrate

DDAVP

Tanexamic acid

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16
Q

What is the treatment for haemophilia B?

A

IV FIX concentrate

17
Q

Which blood thinner can cause thrombocytopenia?

A

heparin

18
Q

Treatment for VTE?

A

Anti-embolism stockings

LMWH and UFH

DOACs

Do not use Wafrin

19
Q

What is Homan’s sign?

A

Tenderness with dorsiflexion of the ankle.

Indicates of DVT

20
Q

Calf has a circumference >3cm compared to other.

What does this indicate?

A

DVT

21
Q

What is Virchows triad?

A

1) Damaged endothelium
2) Blood stasis
3) Hypercoagulopathy

22
Q

What does Tranexamic acid do?

A

Anti-fibrinolytic

23
Q

What can Dessmopressin treat?

A

Haemophilia A and vW disease

24
Q

How is LWMH different?

A

Longer half life greater bio availability Greater activity against Xa than IIa

25
Q

What to ask in a history of bleeding?

A

bruising

epistaxis greater than 30 mins

GI tract bleeding

menses

heamaturia

bleeding at dentist, surgery family history

26
Q

How to investigate a clotting disorder?

A

Thrombocytonpenia?

50/50 mixture test?

consider vWF deficeincy?

27
Q
A
28
Q

Management of PE

A

Start treatment unless investigations within 1 hour

Initially start LMWH before investigations

Later add warfarin or replace with DOAC

Investigaiton include: CTPA or V/Q scan

29
Q

Diagnosis of PE

A

Wells score > 4

Wells score >4 and + D-dimer

Can confirm with CTPA

30
Q

Symptoms of PE

A

Syncope

Tachycardia

Hypotension

Heamoptysis

Dyspnoea

pleuritic chest pain

31
Q

What can mangement for recurrent PE/ DVT and not able to anti-coagulate sufficeintly?

A

IVC filter

32
Q

Risk factors for PE

A

Stasis

recent surgery

pregnancy

oral contraceptive

previous VTE

FH

malignancy or chemotherapy

33
Q

Diagnosis of DVT

A

Wells score >/= 2 and positive USS

Wells score = 1 and posotive D dimer

34
Q

Management of DVT

A

Start LMWH if unless <4 hours until investigaiton

Add warfarin or replace with DOAC

35
Q

What is an advantage of LMWH?

A

Quick onset

Easily stopped with protamine

36
Q

How is anticoagulation via warfarin reversed?

A

PCC - prothrombine complex concentrate
Contains F II, V, VII, IX and X

takes 30 mins

Used instead of FFP - fresh frosen plasma

Vit. K takes 4-6 hours to work

37
Q

PT is prolonged and the patient is not on warfarin. What is the most likley cause?

A

FVII deficiency

38
Q
A

YEAR 3 Manchester Medicine (34 decks)

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