Acquired bleeding disorders Flashcards
1
Q
Name the main acquired bleeding disorders
A
- Vitamin K deficiency
- Liver disease
- Iatrogenic
- Disseminated intravascular coagulation
- Acquired inhibitors
- Massive transfusion syndrome
2
Q
What does factor II become?
A
II–> thrombin–> fibrinogen–> fibrin–> fibrin degradation products
3
Q
How is an inhibitor or a bleeding deficiency problem diagnosed?
A
- Mix patient & normal plasma
- Correction= deficiency
- No correction= inhibitor
4
Q
Describe vitamin K deficiency
A
- Deficient factors 2, 7, 9, 10
- Functional deficiency
- Causes: obstetrics, jaundice, broad spectrum antibiotics, neonates, prolonged nutrient deficiency
5
Q
What are types of impaired haemostasis in liver disease?
A
- Excessive plasmin activity
- Thrombocytopenia
- Platelet dysfunction
- Reduced plasma conc of all coagulation factors except 8
- Delayed fibrin monomer polymerisation due to altered fibrinogen glycosylation
- Treated with fresh frozen plasma/platelet transfusion
6
Q
What are the causes of haemostatic abnormalities in massive transfusion?
A
- Dilutional depletion of platelets & coagulation factors
- Underlying disease-liver/renal drug treatment
- DIC-trauma, head injury, prolonged hypotension
7
Q
Describe the dilutional effects of haemostasis
A
- Thrombocytopenia
- Citrate toxicity
- Coagulation factor depletion (5,8 & fibrinogen)
- Hypocalcaemia
8
Q
What is the pathophysiology of DIC? How is it treated?
A
- Consumption of platelets & clotting factors
- Activation of fibrinolysis
- Microangiopathic haemolysis
- Microvascular thrombosis: tissue ischaemia & organ damage
- Disruption in balance of procoagulant & anticoagulant mechansims
- Treat underlying condition-antibiotics,obs, folic acid, it K, maintain tissue perfusion
9
Q
What are acute causes of DIC?
A
- ABO incompatible transfusion
- Fulminant liver disease
- Sepsis
- Trauma/tissue necrosis
- Obstetrics complications
10
Q
What are chronic causes of DIC?
A
- Malignancy
- End stage liver disease
- Severe localised intravascular coagulation
- Obstetrics: retained dead foetus
11
Q
What drugs can interact with oral anticoagulants?
A
- Corticosteroids
- Sulphonylureas
- NSAIDs
- Ampicillin
- Erythromycin
- Cephalosporins
12
Q
Which drugs antagonise the effects of warfarin?
A
- Spironolactone
- Vitamin K
- Rifampicin
- Cholestyramine
13
Q
What are the causes of haemostatic abnormalities in renal disease?
A
- Changed interaction of different components of the coagulation system
- coagulation cascade, platelets and vessel wall
14
Q
What are recommendations for reversal of oral anticoag treatment?
A
- Life threatening= Vit K IV, four factor concentrate/PCC, octaplex
- Non major= withhold warfarin, Vit K IV
- INR>8 no haemorrhage= withhold warfarin, vit K orally
15
Q
How are the following monitored: warfarin heparin fondaparinux aspirin fibrinolytic agents
A
- W=INR
- H= APTT test sensitive anti-thrombin not routinely required
- F=Haematocrit, PT, platelet count, serum creatinine
- A=CBC, platelets, PT, BUN, serum creatinine
- FA=
