Aani Haem: Clotting and bleeding

Question 1

Von Wilibrand Factor (VWF) is cleaved by which molecule?

Answer 1

ADAMTS13

Question 2

VWF binds to which protein to bind platelets to collagen?

Answer 2

GP1B

Question 3

What is another way of saying thrombin?

Answer 3

Factor 2A

Question 4

What does thrombin do to speed up coagulation?

Answer 4

It speeds up activation of 8 to 8A and 5 to 5A

Question 5

Which molecule is used to platelets bind directly to collagen?

Answer 5

GP1A

Question 6

What breaks down the fibrin clot?

Answer 6

Plasmin

Question 7

How is plasmin formed?

Answer 7

TPA (tissue plasmin activator) activates plasminogen into plasmin

Question 8

What does warfarin do?

Answer 8

Inhibits Vit K dependent gamma carboxylation of factor 2,7,9,10 AND inhibits protein C and S and Z

Question 9

What are the natural anticoagulants?

Answer 9

Protein C
Protein S
Anti Thrombin 3
TPA

Question 10

What does TPA do?

Answer 10

TPA activates plasminogen to plasmin

Question 11

What does heparin do?

Answer 11

It enhances the action of anti-thrombin 3 (which inhibits 2,11,9,10a)- same as warfarin but 11 instead of 7

Question 12

Which factor does the extrinsic pathway begin with?

Answer 12

7

Question 13

Virchow’s Triad?

Answer 13

Hypercoagubility
Vessel Damage
Blood stasis

Question 14

Which coagulation factors can a pt have an excess of?

Answer 14

8,2, fibrinogen

Question 15

Which acquired conditions can lead to hypercoagubility? (Therefore increased VTE risk)

Answer 15

Factor V leiden, Deficiency in protein C, deficiency in protein S, deficiency in antithrombin

Question 16

Which acquired condition causes most severe risk of VTE?

Answer 16

Antithrombin deficiency

Question 17

How does INR work?

Answer 17

The higher the number, the thinner the blood. The more risk factors a person has for developing VTE, the higher the target INR should be

Question 18

When to stop LMWH?

Answer 18

When INR is within target range

Question 19

How to reverse the effects of warfarin?

Answer 19

IV Vit K or Factor concentrates

Question 20

How to reverse the effect of heparin?

Answer 20

Protamine Sulphate

Question 21

Unwanted side effects of Heparin?

Answer 21

Heparin induced thrombocytopaenia (HIT)
Osteoporosis

These are more common in unfractionaed heparin

Question 22

Which measurement is used to monitor heparin therapy?

Answer 22

APTT

Question 23

Which measurement is used to monitor warfarin therapy?

Answer 23

PT

Question 24

What is post-phlebitic syndrome?

Answer 24

Injury to veins/valves following a DVT

Question 25

How to prevent post-phlebitic syndrome?

Answer 25

TED stockings

Question 26

Explain genetics of Osler Weber Rendu (HHT)

Answer 26

Autosomal Dominant (positive FH common)

Question 27

Sturge-Weber syndrome cosmetic defect?

Answer 27

Port-wine stain on face

Question 28

Symptoms of Osler Weber Rendu? (HHT)

Answer 28

Bleeds e.g. nose bleeds & gut. Can lead to IDA. | Can get RED spider web telangiectasia on lips, skin etc.

Question 29

Von Recklinghausen disease cutaneous presentation?

Answer 29

Cafe Au Lait spots and neurofibromas. (This condition is also called Neurofibromatosis 1- NF1)

Question 30

Pzeuts-Jegher's Syndrome?

Answer 30

Tan brown lesions on skin and oral mucosa - does not result in bleeding

Question 31

Categories of platelet disorders

Answer 31

- Low Platelet FUNCTION (acquired or congenital) | - Low platelet COUNT (high destruction or low production)

Question 32

Platelet COUNT disorders - give details

Answer 32

Low production: Bone marrow failure Increased destruction: AITP (autoimmune thrombocytopaenic purpura)/ Drugs (e.g. Herparin) /DIC / HUS/ TTP - these vessel abnormalities cause damage to platelets as they pass through fibrin mesh

Question 33

Platelet FUNCTION disorders - give details

Answer 33

Acquired: Aspirin . uraemia , Cardiopulmonary bypass - cardiac surgery releases PF4 which induces Heparin Induced Thrombocytopaenia Congenital: Thrombasthenia (Glycoprotein deficiency) & storage pool disease

Question 34

How does Aspirin affect platelets?

Answer 34

It inhibits COX 1 and COX 2. These are needed to create thromboxane A2 for platelet aggregation

Question 35

Is Aspirin reversible or irreversible?

Answer 35

Irreversible

Question 36

What is Storage Pool disease?

Answer 36

Platelets don't have enough granules so leads to platelet dysfunction --> bleeding

Question 37

What are the types of immune thrombocytopaenic purpura?

Answer 37

Acute and Chronic.

Question 38

What are the differences between Acute and Chronic AITP? (Thombocytopaenic Purpura)

Answer 38

``` Acute: Children Equal genders Preceding infection is common Self limiting VERY low plt count (<20,000) Resolves after 1-6 weeks ``` ``` Chronic: Adults Females more likely Rare to have preceding infection IVIg/Steroids/splenectomy usually needed Moderately low plt count (<50,000) Long Term ```

Question 39

Which factor is deficient in Haemophilia A?

Answer 39

8 (Sounds like A) A Eight

Question 40

Which factor is deficient in Haemophilia B?

Answer 40

9

Question 41

Which haemophilia is more common?

Answer 41

A

Question 42

How can VWF help Haemophilia A?

Answer 42

VWF carries factor 8 in circulation

Question 43

Treatment of Haemophilia?

Answer 43

Factor concentrates

Question 44

How do you diagnose Haemophilia?

Answer 44

Normal PT, High APTT

Question 45

How do antibiotics affect bleeding?

Answer 45

Abx can prevent warfarin breakdown so increase warfarin levels so reduce coagulation factors levels and lead to bleeding

Question 46

Causes of DIC?

Answer 46

- Trauma - Malignancy - Sepsis - Toxins

Question 47

Diagnosing DIC?

Answer 47

- Low platelets - Low fibrinogen - High D dimers - High FDP - Long PT

Question 48

How to treat DIC?

Answer 48

FFP Transfusions Platelets

Question 49

Diagnosing von wilibrand disease

Answer 49

- Low VWF - Low Factor 8 - High APTT - High bleeding time