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BDS3 Human Disease > Acquired bleeding disorders > Flashcards

Acquired bleeding disorders Flashcards

1
Q

Common causes of acquired bleeding disorders?

A

Antithrombotic drugs

Thrombocytopenia

Liver disease

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2
Q

Some uncommon causes of acquired bleeding disorders?

A

Vitamin K deficiency

Severe renal failure

Coagulation inhibitors : acquired Haemophelia

Scurvy

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3
Q

Cause of thrombocytopenia?

A

Medications

Infections

Bone marrow disorders

These cause: reduced survival or reduced production

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4
Q

Thrombocytopenia?

A

a condition that occurs when the platelet count in your blood is too low

An aunt immune disease

Antibody-induced platelet destruction

May be triggered by medications or infection

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5
Q

Anticoagulants drugs?

A

Warfarin

Heparins

Dabigatran - Direct thrombin inhibitor

Direct FXa inhibitors - rivaroxaban, apixaban, edoxaban

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6
Q

Platelet inhibitors?

A

Aspirin

Dipyridamole

Clopidogrel/ prasugrel

Ticagrelor

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7
Q

INR?

A

A standardised prothrombin time

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8
Q

Use of warfarin?

A

AF

Prosthetic heart valve

Arterial thromboembolism

Venous thromboembolsims

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9
Q

Drawbacks of warfarin?

A

High indices fo drug interactions

Dietary interaction (dark green veg)

Serious/fatal bleeding in around 1% of users per year

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10
Q

Target enzyemof warfarin?

A

Vitamin K epoxied reductive

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11
Q

Metabolism of warfarin?

A

Cytochrome p-450 dependent

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12
Q

What is the bleeding die to warfarin dependent on?

A

INR

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13
Q

When to INR due to warfarin before dental procedure?

A

Under INR=4, go ahead

Over INR=4
No more than 24 values

Up to 73 hours for a stable anti-coagulated pt

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14
Q

Advise for warfarin and dental surgery?

A

Check INR

Suture and packing

Consider tranexamic acid mw

Avoid nsaids

Single use antibiotic prophylaxis unlikely to affect inr

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15
Q

Heparin?

A

Inhibits thrombin and fXa indirectly

Polysaccharide

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16
Q

When to use LMWH?

A

Used in the prophylaxis of venous thrombi’s and tx of arterial and venous thrombi’s

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17
Q

What to do if pt is on LMWH?

A

Need to interrupt at least 24 hours pre procedure

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18
Q

DOACs anti-Xa?

A

Rivaroxaban

Apixaban

Edoxaban

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19
Q

DOACs antithrombn?

A

Dabigatran

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20
Q

Movement of DOACs

A

Metabolism in liver

Excretion kidneys

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21
Q

How to proceed with pt on DOACs with a low bleeding ris procedure?

A

Treat pt without interruption of anticoagulatin

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22
Q

How to proceed with pt on DOACs witha. High bleeding risk procedure?

A

Advise to omit dose of DOAC on morning of procedure.

Possibly omit for linger (48-72 hours) of creatinine clearance diminished

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23
Q

How does aspirin work?

A

Arreversible inhbir of platelet clycooxygenase

Reduces platelet aggregability

Impairs primary haemostasis

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24
Q

How does clopidogrel work?

A

Blocks platelet ADP receptor (P2Y12 receptor)

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25
Q

How does dipyridamole work?

A

Blocks platelet phosphodieterase and adenosine deaminase

26
Q

Why is aspirin widely used?

A

Secondary prophylaxis of arterial thrombosis

27
Q

When is aspirin used with dipyridamole?

A

Stroke

28
Q

When is aspirin used with clopidogrel?

A

After coronary intervention

29
Q

When is aspirin used with rivaroxaban?

A

In peripheral area disease and coronary artery disease

30
Q

How long do the effects of aspirin last?

A

7 days due to irreversibleacetylation of platelet cyclyoxygenase

31
Q

How long do the effects of clopidogrel last?

A

Over 5 days due to irreversible blockade of ADP receptor

32
Q

Do you interrupt pt medication: within 12 months of placement of. A drug - eluding coroary stent taking clopidogrel?

A

No, do not interrupt

33
Q

When do ou to interrupt clopidogrel?

A
34
Q

Why may a pt have reduced survival of platelets?

A

Immune thrombocytopenic purpura [ITP]

Drug induced

35
Q

Why may a pt have reduced platelet production?

A

After chemo

Bone marrow malignancy/ failure

Megaloblastic anaemia

Drug induced

Alcohol excess

36
Q

Tx for ITP?

A

Responsive to immunosuppressive therapy/splenectomy

37
Q

How does liver failure affect clotting?

A

All clotting factors and fibrinogen are synthesised by hepatocytes and almost all are reduced in plasma in liver failure

38
Q

Effect of liver disease on spleen?

A

Enlarged

39
Q

Why does the spleen engage in liver disease?

A

Due to portal hypertension

  • leads to thrombocytopenia
40
Q

Common manifestation of hyperspleenism?

A

Thrombocytopenia

Caused by liver disease

41
Q

Coagulopathy?

A

a condition that affects how your blood clots, resulting in more bleeding during surgery, injury, delivery of a baby and/or menstruation

42
Q

How does coagulopathy from liver disease result in bleeding?

A

Reduced clotting factors and thrombocytopenia

43
Q

How does coagulopathy of liver disease cause thrombosis?

A

Reduced natural anticoagulants

44
Q

Why is the management of pre ad post op for coagulopathy of liver disease complex?

A

Striking balance between preventing bleeding and thrombosis

Often avoid replacement of clotting factors unless haemorrhagic

45
Q

Rare causes of acquired bleeding - acquired Haemophelia

What are the signs?

A

New onset bruising/ subcutaneous leading/ internal haemorrhage

46
Q

Rare causes of acquired bleeding - acquired Haemophelia

Causes of AH?

A

Isolated prolonged APTT and low levels FVIII

Antibody to FVIII

47
Q

Management of acquired Haemophelia?

A

Bypassing agent e.g. vovoseven to control bleeding

Immunosuppressive with high dose steroid +/- cyclophosphamide

Refractory cases may require B cell depletion with rituximab

48
Q

Rare causes of acquired bleeding - vitamin C deficiency

What is vitamin C needed for with regard to bleeding?

A

A co-factor in collagen synthesis

49
Q

Rare causes of acquired bleeding - vitamin C deficiency

Daily dose?

A

Requir at least 40 mg daily

50
Q

Rare causes of acquired bleeding - vitamin C deficiency

What demographic need more vit C?

A

Smokers need more

51
Q

Rare causes of acquired bleeding - vitamin C deficiency

Deficiency causes what?

A

Scurvy after a few months

Normocytic anaemia

Bleeding with normal platelet and coagulation

Skin and gum changes

52
Q

High risk groups for scurvy?

A

Alcohol excess

Malignancy

53
Q

Rare causes of acquired bleeding - myoproliferative neoplasm

Arises due to what?

A

Somatic mutation in haematopoietic stem cell disorder

54
Q

Types of myeloproliferative neoplasm?

A

Polycythaemia

Essential thrombocythaemia

Myelofibrosis - mixed picture

55
Q

myeloproliferative neoplasm

What is essential thrombocythaemia?

A

Increased platelet count

56
Q

myeloproliferative neoplasm

What is polycythaemia?

A

Excess red cells leading to high Hb and Hct

57
Q

Myeloproliferative neoplasm

What is Myelofibrosis?

A

Myelofibrosis is an uncommon type of bone marrow cancer that disrupts your body’s normal production of blood cells. Myelofibrosis causes extensive scarring in your bone marrow, leading to severe anemia that can cause weakness and fatigue

58
Q

What to do if pt has myeloproliferative neoplasm, what should you do?

A

Discuss with haematology department

59
Q

Hct?

A

Percentages RBC in pt blood

60
Q

What can raised Hb/hct and thrombocytosis paradoxically lead to?

A

Acquired bleeding phenotype

You would think it would do the opposite

BDS3 Human Disease (33 decks)

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