Acquired Bleeding Disorders Flashcards

1
Q

Name 6 acquired bleeding disorders

A
Vit K deficiency
Massive transfusion syndrome
DIC
Iatrogenic
Acquired inhibitors
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2
Q

How do you determine if a bleeding disorder is due to an inhibitor or a deficiency?

A

If APTT is prolonged, repeat with 50:50 mix patient to normal plasma. Deficiency= significant correction, inhibitor=no correction

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3
Q

In which aquired bleeding disorder is the TT the longest?

A

DIC

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4
Q

Why does liver disease result in clotting disorders?

A

Clotting factors are synthesised in the liver

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5
Q

Why does massive transfusion result in bleeding disorders?

A

Dilution of clotting factors

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6
Q

In which bleeding disorders is the thrombin time increased?

A

DIC and heparin overuse

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7
Q

In which bleeding disorders is the platelet concentration decreased?

A

Liver disease
DIC
Massive transfusion

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8
Q

What are the vitamin K dependent clotting factors?

A

2,7,9,10

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9
Q

How does vit. K usually work?

A

Acts as a cofactor in a modification step after the synthesis of the clotting factors- vit K reductase works to reduce vit k epoxidase back to its active form- vit k (red)

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10
Q

How does warfarin work?

A

Inhibits the recycling of vitamin K i.e. blocks the synthesis of vit k reductase

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11
Q

4 causes of vitamin K deficiency

A

Obstructive jaundice (bile salts can’t reach the gut, fat and subsequently vit. k can’t be absorbed)
Prolonged nutritional deficiency
Broad spectrum antibiotics
Neonates (1-7 days) ‘haemorrhagic disease of the newborn

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12
Q

What is the cause of haemorrhagic disease of the newborn?

A

Vit K deficiency at birth

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13
Q

What is the monitoring blood test for warfarin and what is the normal range?

A

International normalised ratio INR (PT)

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14
Q

How does heparin work?

A

Activates antithrombin III which results in an increased rate of inactivation of thrombin and factor Xa

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15
Q

How does fondaparinux work?

A

Acts against factor Xa

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16
Q

What is the monitoring blood test for fondaparinux?

A

It does not require monitoring

17
Q

How does aspirin work?

A

Irreversible Cox 1 and cox 2 (mainly) inhibitor which blocks the synthesis of thromboxane which is a procoagulant in primary haemostasis

18
Q

Causes of bleeding disorders in liver disease

A

Thrombocytopenia (splenic congestion)
Platelet dysfunction
Low plasma concentration of all factors, apart from factor 8
Less fibrin
Excessive plasmin
Impaired vit. K absorption- reduced synthesis of vit K dependent facotrs

19
Q

What is the definition of massive transfusion

A

Transfusion of a volume equal to the patient’s total blood volume in less than 24hrs or 50% in less than 3 hrs.

20
Q

Causes of bleeding in massive transfusion

A

Dilutional depletion of platelets and coagulation factors (5, 8 and fibrinogen)
DIC

21
Q

Causes of DIC

A

Infections
Malignancy
Obstetic complications

22
Q

Lab tests in DIC

A

thrombocytopenia
PT prolonged
D-dimer (fibrin degredation product) increased

23
Q

Complications of DIC

A

tissue damage caused by thrombosis- necrosis and further activation of coagulation and fibrinolysis
Purpura, ecchymoses, GI bleeding
Renal function impaired due to microvascular thrombosis
Acute respiratory distress syndrome, adrenal necrosis, chock and thromboembolism

24
Q

What affects warfarin metabolism in the liver

A

Erythromycin/antibiotics slow down metabolism of warfarin- over anti-coagulation

25
Q

What is the treatment for over anti-coagulation by warfarin

A

Vitamin K