Acquired Bleeding Disorders

Question 1

Elements involved in hemostasis

Answer 1

Vessel wall
platelets
coagulation proteins and inhibitors
fibrinolysis

Question 2

Which is more common inherited disorder of coagulation or acquired coagulation disorder

Answer 2

Acquired coagulation disorders are more common

Question 3

Should you expect multiple factor if coagulation proteins are affected

Answer 3

Yes

Question 4

Classification of acquired coagulation disorders

Answer 4

Deficiency of vitamin K 
liver function related 
antibody induced 
drug/ transfusion induced 
interference from abnormal proteins 
consumptive coagulopathy

Question 5

What is the function of vitamin K

Answer 5

Helps in synthesis of factors II,VII, IX, X which are important in coagulation pathway

Question 6

Main way to obtain vitamin K

Answer 6

Diet by green vegetable

bacterial synthesis in the guts

Question 7

In which case is do you see deficiency of vitamin K

Answer 7

Newborn -hemorrhagic disease of the newborn
biliary obstruction
malabsorption from surgery ,tropical sprue ,gluten sensitive enteropathy
inhibition of vitamin K for example warfarin therapy

Question 8

What is formed in the absence of vitamin K

Answer 8

Protein induced in vitamin K absence PIVKA Which leads to a bleeding the tendency themselves

Question 9

Play this in the liver cause bleeding tendency

Answer 9

Because synthesis of coagulation factors take place in the liver

Question 10

What type of liver disease can Leads to bleeding tendencies

Answer 10

Viral hepatitis
Cirrhosis
hepatocellular carcinoma

Question 11

How can Antibodies cause bleeding

Answer 11

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

Question 12

Which type of drugs can cause bleeding tendencies

Answer 12

Defibrinating agents or thrombolytics

Massive transfusion

Question 13

Why do defibrinating and thrombolytics cause bleeding

Answer 13

Enhance production of fibrin degradation products which inhibits coagulation
Drugs themselves inhibits coagulation factors

Question 14

Why do massive transfusion cause bleeding tendencies

Answer 14

Dilution of coagulation factors

anticoagulants effects from anticoagulants treatment of blood transfused

Question 15

Disease that can cause interference from abnormal proteins

Answer 15

Plasma cell myeLoma

Paraproteinemias

Question 16

How do interference in protein cause bleeding

Answer 16

Poor function of platelets due to coating

interference of fibrin formation

Question 17

What is comsuptive coagulopathy

Answer 17

Any condition that may initiate sustained coagulation in vivo

Question 18

What is the initiating point of consumptive coagulopathy

Answer 18

Tissue wall damage with tissue factor released and platelet aggregation

Question 19

What can lead to visible damage so initiate Consumptive coagulopathy

Answer 19

Infections malignancies 
Obstetric complications 
hypersensitivity reactions 
widespread tissue damage 
vascular abnormalities 
hypothermia 
heat stroke 
acute hypoxia

Question 20

What are the two factors in acquired bleeding disorder in the newborn because of hemorrhagic disease of the newborn

Answer 20

Vitamin K deficiency

liver cell immaturity

Question 21

Why is there vitamin K deficiency in hemorrhagic disease of the newborn

Answer 21

Because low vitamin K in breast milk

lack of gut bacterial synthesis of the vitamin

Question 22

What does liver cell immaturity in hemorrhagic disease of the newborn cause

Answer 22

Poor synthesis of coagulation factors

Question 23

Pronunciation of hemorrhagic disease of the newborn

Answer 23

Bleeding by the second to fourth day of life

Question 24

How do you diagnose hemorrhagic disease of the newborn

Answer 24

Prolonged prothrombin time
normal platelet counts
prolonged activated partial thromboplastin clotting time

Question 25

What is prophylaxis in hemolytic disease of the newborn

Answer 25

Vitamin K with 1 mg intramuscular at birth

Question 26

Treatment of hemolytic disease of the newborn

Answer 26

Vitamin K 1 mg intramuscular every six hours

prothrombin complex concentrates in severe bleeding

Question 27

What is the presentation of acquired liver disease

Answer 27

Underlying disease
jaundice
bleeding

Question 28

What is the reason of breathing in liver disease acquired

Answer 28

Biliary obstruction leading to impaired vitamin K absorption so decreased coagulation factors synthesis

Question 29

What is DIC

Answer 29

Widespread in vivo inappropriate formation and deposition of fibrin leading to
bleeding
thrombotic syndrome
End organ damage
consumption of coagulation factors and platelets

Question 30

What is the pathogenesis of DIC

Answer 30

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

Question 31

Presentation of DIC

Answer 31

Bleeding from all orifices
venipuncture sites
Thrombotic events leading to endorgan failure ,skin necrosis , gangrene
sub acute and chronic forms not so obvious

Question 32

Investigation of DIC

Answer 32

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

Question 33

Treatment of DIC

Answer 33

Treat underlying cause
Correct bleeding tendencies( red cells ,platelets, cryoprecipitate ,FFP)
Thrombosis with heparin