Acquired Bleeding Disorders Flashcards
What are the major Acquired bleeding disorders? [4]
1) Thrombocytopenia
2) Liver Failure
3) Drugs
4) Haemorrhagic Disease of Newborn
How would you spot someone who’s thrombocytopenic? [4]
Largely a clinical diagnosis
Petechiae, purpura, ecchymosis
Mucosal bleeding
CNS bleed - rare
Then FBC
Thrombocytopenia causes can be classified into 2 categories:
- Decreased production [3]
- Increased consumption [3]
- Marrow failure, aplasia or infiltration
2. ITP, DIC or hypersplenism
What could trigger Idiopathic Thrombocytopenic Purpura? [6]
But note that it is an insidious onset and doesn’t follow an infection. Bone marrow examination rarely needed, only in atypical cases.
EBV HIV, Hep C Lymphoma Collagenosis Quinine use Autoimmune eg APS, SLE
How do we treat ITP acutely? [2]
Steroids & IV IgG
Rituximab
How do we manage ITP chronically?
When do you give thrombopoietin analogues [2]
Surgical management [1]
Most cases are just one episode but if its long term:
- Platelet count good between episodes? Then leave it
- Platelet count consistently low? –> Thombopoietin Analogues
Splenectomy - surgical mx
How does liver disease contribute to bleeding?
Where do people with liver disease tend to bleed from?
Liver produces a lot of coagulation factors as well as procoagulants
So someone with chronic liver disease will produce less of both –> Excess of both bleeding & thrombosis
Varices
Drugs cause most cases of acquired bleeding disorder, what ones particularly? [5]
Warfarin Heparins Aspirin Anti-platelets DOACs
What is haemorrhagic disease of a newborn?
Babies with immature coagulation system + Vit K deficiency —> Fatal Haemorrhage
Very rare in the western world as we give newborns a Vit K inj
Thrombotic Thrombocytopenia Purpura is a rare blood disorder resulting in low platelet count. What is it the pentad of TTP?
Tx [1]
Pentad:
- Microangiopathic hemolytic anemia
- Thrombocytopenia purpura
- Neurologic abnormalities
- Fever
- Renal disease
Tx: plasmapheresis
