8) Bleeding Dysfunction Flashcards
What can cause neutrophilia?
Bacterial infection Cancer Myeloproliferative disease Drugs e.g. Steroids Smoking
What are the functions of monocytes?
Respond to inflammation and antigenic stimuli
Phagocytosis and pinocytosis
What can cause monocytosis?
Chronic inflammatory conditions: RA, SLE, UC, Crohn’s
Chronic infection: TB
Malignancy
Myelodysplasia
What is the function of eosinophils?
Mediate hypersensitivity reactions
Phagocytosis
What can cause eosinophilia?
Allergic diseases
Parasitic infections
Churg-Strauss
Lymphomas and leaukemias
What is the function of basophils?
Allergic reactions and inflammatory conditions
What can cause basophilia?
Immediate hypersensitivity reactions
UC
RA
Myeloproliferative: CML
What can cause a lymphocytosis?
Viral and bacterial infections
Stress related: MI, cardiac arrest
CLL
Lymphoma
What can cause a thrombocytosis (reactive)?
Infection and inflammation
Post surgery
Malignancy
Bleeding
What primary haematological conditions can result in thrombocytosis?
Essential thrombocythemia
CML
Myelofibrosis
Polycythemia vera
What is the pathophysiology behind leucoerythroblastic anaemia?
Due to space occupying lesions in bone marrow
Why may there be anaemia in renal disease?
Lack of erythropoietin
How can there be secondary polycythemia in renal disease?
Post renal transplant (EPO production)
Renal tumour
Why might there be high white cell count in renal disease?
Inflammation
Underlying connective tissue disease
Infection
Why might there be a low white cell count in renal disease?
Immunosuppression
Drugs
What might there be a high platelet count in renal disease?
Reactive
Due to bleeding
What might there be a low platelet count in renal disease?
Effect or uraemia on production of platelets
Haemolytic uraemia syndrome
How should anaemia in renal disease be managed?
Treatment with erythropoietin
Iron infusion
What might there be anaemia in rheumatoid arthritis?
Blood loss due to NSAIDs
Anaemia of chronic disease
What might there be a high WCC in rheumatoid arthritis?
Inflammation
Infection
What might there be a low WCC in rheumatoid arthritis?
Drugs e.g. Methotrexate
Reactive neutropenia
What might there be a high platelet count in rheumatoid arthritis?
Bleeding related to NSAID use
What might there be a low platelet count in rheumatoid arthritis?
Drugs
Autoimmune
Splenomegaly
What is the role of the vessel wall during the clotting cascade?
Vasoconstriction
Production of Von Willebrand’s factor
Exposure of collagen and tissue factor
What are the function of platelets?
Adhesion
Secretion- ADP, thromboxane, fibrinogen
Aggregation
Coagulation factor activation
What are some natural anticoagulants?
Protein C and S
Anti-thrombin
Tissue factor pathway inhibitor
How can we measure coagulation in the body?
Prothrombin time
Activated partial thromboplastin time
Thrombin time
What is prothrombin time?
Measure of clotting time by extrinsic pathway
What is activated partial thrombolplastin time?
Speed of blood clotting by intrinsic and common coagulation pathways
What is thrombin time?
Measure time it takes for a clot to form in plasma after excess thrombin has been added
What is INR?
Normalised ratio of prothrombin time
Describe the features of hereditary haemorrhagic telangiectasia:
Autosomal dominant
Dilated microvascular swellings
Chronic bleeding problems
What acquired problems can affect blood vessels?
Senile purpura
Steroids
Infection - measles, meningococcal
Scurvy
How do problems with blood vessels present clinically?
Easy bruising
Spontaneous bleeds from small vessels
Seen on skin and mucous membranes
What can cause disorder to platelet function?
Bernard-Soulier
Aspirin/NSAIDs/clopidogrel
Uraemia
Myeloma
What is Von Willebrand’s disease?
Abnormal platelet adhesion to vessel wall
Reduced vWF production
Bleeding tendency
How does Von Willebrand’s disease present clinically?
Skin and mucous membrane bleeding- epistaxis, gum bleeding, bruising
Prolonged bleeding after trauma - heavy periods, post surgery/dental
What conditions can affect coagulation factor function?
Haemophilia A and B
Liver disease
Warfarin
Vitamin K deficiency
How do problems with clotting factors present clinically?
Recurrent haemarthroses Muscle haematoma Joint pain Prolonged bleeding post trauma and operation Intracerebral haemorrhage
What physiological factors affect the rate of red cell production?
Exercise Altitude Age Sex Temperature
What are some differences between thrombocytopenia due to marrow failure and thrombocytopenia due to peripheral destruction?
Increased progenitor cells and increased breakdown products in peripheral destruction
