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AANIYA PATH > Aani Haem: Clotting and bleeding > Flashcards

Aani Haem: Clotting and bleeding Flashcards

1
Q

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

A

ADAMTS13

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2
Q

VWF binds to which protein to bind platelets to collagen?

A

GP1B

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3
Q

What is another way of saying thrombin?

A

Factor 2A

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4
Q

What does thrombin do to speed up coagulation?

A

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

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5
Q

Which molecule is used to platelets bind directly to collagen?

A

GP1A

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6
Q

What breaks down the fibrin clot?

A

Plasmin

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7
Q

How is plasmin formed?

A

TPA (tissue plasmin activator) activates plasminogen into plasmin

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8
Q

What does warfarin do?

A

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

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9
Q

What are the natural anticoagulants?

A

Protein C
Protein S
Anti Thrombin 3
TPA

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10
Q

What does TPA do?

A

TPA activates plasminogen to plasmin

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11
Q

What does heparin do?

A

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

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12
Q

Which factor does the extrinsic pathway begin with?

A

7

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13
Q

Virchow’s Triad?

A

Hypercoagubility
Vessel Damage
Blood stasis

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14
Q

Which coagulation factors can a pt have an excess of?

A

8,2, fibrinogen

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15
Q

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

A

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

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16
Q

Which acquired condition causes most severe risk of VTE?

A

Antithrombin deficiency

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17
Q

How does INR work?

A

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

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18
Q

When to stop LMWH?

A

When INR is within target range

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19
Q

How to reverse the effects of warfarin?

A

IV Vit K or Factor concentrates

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20
Q

How to reverse the effect of heparin?

A

Protamine Sulphate

21
Q

Unwanted side effects of Heparin?

A

Heparin induced thrombocytopaenia (HIT)
Osteoporosis

These are more common in unfractionaed heparin

22
Q

Which measurement is used to monitor heparin therapy?

A

APTT

23
Q

Which measurement is used to monitor warfarin therapy?

A

PT

24
Q

What is post-phlebitic syndrome?

A

Injury to veins/valves following a DVT

25
Q

How to prevent post-phlebitic syndrome?

A

TED stockings

26
Q

Explain genetics of Osler Weber Rendu (HHT)

A

Autosomal Dominant (positive FH common)

27
Q

Sturge-Weber syndrome cosmetic defect?

A

Port-wine stain on face

28
Q

Symptoms of Osler Weber Rendu? (HHT)

A

Bleeds e.g. nose bleeds & gut. Can lead to IDA.

Can get RED spider web telangiectasia on lips, skin etc.

29
Q

Von Recklinghausen disease cutaneous presentation?

A

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

30
Q

Pzeuts-Jegher’s Syndrome?

A

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

31
Q

Categories of platelet disorders

A
  • Low Platelet FUNCTION (acquired or congenital)

- Low platelet COUNT (high destruction or low production)

32
Q

Platelet COUNT disorders - give details

A

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

33
Q

Platelet FUNCTION disorders - give details

A

Acquired: Aspirin . uraemia , Cardiopulmonary bypass - cardiac surgery releases PF4 which induces Heparin Induced Thrombocytopaenia

Congenital: Thrombasthenia (Glycoprotein deficiency) & storage pool disease

34
Q

How does Aspirin affect platelets?

A

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

35
Q

Is Aspirin reversible or irreversible?

A

Irreversible

36
Q

What is Storage Pool disease?

A

Platelets don’t have enough granules so leads to platelet dysfunction –> bleeding

37
Q

What are the types of immune thrombocytopaenic purpura?

A

Acute and Chronic.

38
Q

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

A 
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
39
Q

Which factor is deficient in Haemophilia A?

A

8 (Sounds like A) A Eight

40
Q

Which factor is deficient in Haemophilia B?

A

9

41
Q

Which haemophilia is more common?

A

A

42
Q

How can VWF help Haemophilia A?

A

VWF carries factor 8 in circulation

43
Q

Treatment of Haemophilia?

A

Factor concentrates

44
Q

How do you diagnose Haemophilia?

A

Normal PT, High APTT

45
Q

How do antibiotics affect bleeding?

A

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

46
Q

Causes of DIC?

A
  • Trauma
  • Malignancy
  • Sepsis
  • Toxins
47
Q

Diagnosing DIC?

A
  • Low platelets
  • Low fibrinogen
  • High D dimers
  • High FDP
  • Long PT
48
Q

How to treat DIC?

A

FFP
Transfusions
Platelets

49
Q

Diagnosing von wilibrand disease

A
  • Low VWF
  • Low Factor 8
  • High APTT
  • High bleeding time

AANIYA PATH (35 decks)

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