Acquired Bleeding Disorders Flashcards
Elements involved in hemostasis
Vessel wall
platelets
coagulation proteins and inhibitors
fibrinolysis
Which is more common inherited disorder of coagulation or acquired coagulation disorder
Acquired coagulation disorders are more common
Should you expect multiple factor if coagulation proteins are affected
Yes
Classification of acquired coagulation disorders
Deficiency of vitamin K liver function related antibody induced drug/ transfusion induced interference from abnormal proteins consumptive coagulopathy
What is the function of vitamin K
Helps in synthesis of factors II,VII, IX, X which are important in coagulation pathway
Main way to obtain vitamin K
Diet by green vegetable
bacterial synthesis in the guts
In which case is do you see deficiency of vitamin K
Newborn -hemorrhagic disease of the newborn
biliary obstruction
malabsorption from surgery ,tropical sprue ,gluten sensitive enteropathy
inhibition of vitamin K for example warfarin therapy
What is formed in the absence of vitamin K
Protein induced in vitamin K absence PIVKA Which leads to a bleeding the tendency themselves
Play this in the liver cause bleeding tendency
Because synthesis of coagulation factors take place in the liver
What type of liver disease can Leads to bleeding tendencies
Viral hepatitis
Cirrhosis
hepatocellular carcinoma
How can Antibodies cause bleeding
They can be directed against factor VIII ( induced or spontaneous )
Auto immunity Like in von willebrands disease against von willbrand factor
Administration of certain drugs leading to anaphylactic reaction like ciprofloxacin, griseofulvin
Which type of drugs can cause bleeding tendencies
Defibrinating agents or thrombolytics
Massive transfusion
Why do defibrinating and thrombolytics cause bleeding
Enhance production of fibrin degradation products which inhibits coagulation
Drugs themselves inhibits coagulation factors
Why do massive transfusion cause bleeding tendencies
Dilution of coagulation factors
anticoagulants effects from anticoagulants treatment of blood transfused
Disease that can cause interference from abnormal proteins
Plasma cell myeLoma
Paraproteinemias
How do interference in protein cause bleeding
Poor function of platelets due to coating
interference of fibrin formation
What is comsuptive coagulopathy
Any condition that may initiate sustained coagulation in vivo
What is the initiating point of consumptive coagulopathy
Tissue wall damage with tissue factor released and platelet aggregation
What can lead to visible damage so initiate Consumptive coagulopathy
Infections malignancies Obstetric complications hypersensitivity reactions widespread tissue damage vascular abnormalities hypothermia heat stroke acute hypoxia
What are the two factors in acquired bleeding disorder in the newborn because of hemorrhagic disease of the newborn
Vitamin K deficiency
liver cell immaturity
Why is there vitamin K deficiency in hemorrhagic disease of the newborn
Because low vitamin K in breast milk
lack of gut bacterial synthesis of the vitamin
What does liver cell immaturity in hemorrhagic disease of the newborn cause
Poor synthesis of coagulation factors
Pronunciation of hemorrhagic disease of the newborn
Bleeding by the second to fourth day of life
How do you diagnose hemorrhagic disease of the newborn
Prolonged prothrombin time
normal platelet counts
prolonged activated partial thromboplastin clotting time
What is prophylaxis in hemolytic disease of the newborn
Vitamin K with 1 mg intramuscular at birth
Treatment of hemolytic disease of the newborn
Vitamin K 1 mg intramuscular every six hours
prothrombin complex concentrates in severe bleeding
What is the presentation of acquired liver disease
Underlying disease
jaundice
bleeding
What is the reason of breathing in liver disease acquired
Biliary obstruction leading to impaired vitamin K absorption so decreased coagulation factors synthesis
What is DIC
Widespread in vivo inappropriate formation and deposition of fibrin leading to
bleeding
thrombotic syndrome
End organ damage
consumption of coagulation factors and platelets
What is the pathogenesis of DIC
Sustained Trombin activation in circulation
widespread platelet aggregation
Fibrin formed and is degraded to fdps
Fibrin formed leading to thrombotic events
high consumption of factors and increased fibrin degradation products lead to bleeding
Presentation of DIC
Bleeding from all orifices
venipuncture sites
Thrombotic events leading to endorgan failure ,skin necrosis , gangrene
sub acute and chronic forms not so obvious
Investigation of DIC
Underlying disease
bleeding diathesis - full blood counts( low platelets PT, APTT,TT ,fibrinogen levels ,fibrin degradation products (D dimmer increased )
hemolytic anemia due to microangiopathy -film comment
Treatment of DIC
Treat underlying cause
Correct bleeding tendencies( red cells ,platelets, cryoprecipitate ,FFP)
Thrombosis with heparin
