Approach to bleeding disorders Flashcards
When assessing a bleeding patient, what are the 3 main questions which you want to answer?
- Is there an emergency?
- Why is the patient bleeding?
- In cases of bleeding disorders, what is the mechanism?
When assessing if a bleeding patient should be treated as an emergency, what would you want to establish?
- Is the patient exanguinating?
- Is there hypovolaemia?
- Is there CNS bleeding?
- Underlying condition which can develop from minor into catastophic haemorrhage?
What are signs of CNS bleeding?
- Meningism
- CNS/Retinal signs
What would you want to find out when trying to figure out why the patient is bleeding?
- Is there a secondary cause of bleeding?
- Is there unexplained bruising, bleeding or purpura?
- PMH or FH of excess bleeding?
- What is the pattern of bleeding?
- Is clotting screen abnormal?
What are secondary causes of bleeding?
- Drugs
- Alcohol
- Liver disease
- Sepsis
What tests would you do as part of a clotting screen?
- FBC, Platelets
- PT, APTT
- Thrombin Time
- Bleeding time
- Consider D-Dimer, Factor assays
What are teh main patterns of bleeding which you would look for when trying to find out why someone is bleeding?
- Vascular
- Platelet
- Coagulation
How would you go about trying to determine the mechanism of a suspected bleeding disorder?
- PT
- APTT
- Thrombin time
- D-Dimer
- Bleeding time
What factors does the PT asses?
I, II, V, VII, X
What can cause a prolonged PT?
- Warfarin
- Vit K Deficiency
- Liver disease
- DIC
What factors does the APTT test?
I, II, V, VIII, IX, X, XI XII
What can cause a prolonged APTT?
- Heparin
- Haemophilia
- DIC
- Liver disease
What is the normal range for thrombin time?
10-15s
What can cause a prolonged thrombin?
- Heparin
- DIC
- Dysfibrinogenaemia
What are D-Dimers?
Fibrin degredation products, released from cross-linked fibrin during fibrinolysis
