Bleeding Flashcards
How do clots form?
Platelets, vWF ( von Williebrand factor) and coagulation factor
Clot remains confined to site of injury; natural coagulants
How do clots vanish?
Fibrinolytic system
What is the role of platelets in haemostasis?
Adherance, activation, aggregation
Provide phospholipid surface for coagulation
What is deficient in haemophilia A?
Factor VIII
What is deficient in Haemophilia B?
Factor IX
What does thrombin do?
Changes fibrinogen to fibrin
What are some heparins?
Rivaroxaban, edoxaban, apixaban
What is important bleeding history points?
Has the patient got a bleeding disorder? How severe is the disorder? Pattern of bleeding Congenital or acquired Mode of inheritance
What are important times of history of bleeding?
Bruising Epistaxis Post-surgical bleeding Menorrhagia Post-partum haemorrhage Post-trauma Dental surgery Circumcision Tonsillectomy Appendicectomy
What are important considerations in determining whether a bleeding disorder is congenital or acquired?
Previous episodes?
Age at first event
Previous surgical challenges
Associated history
Describe haemophilia A and B inheritance
X linked
Identical phenotypes
Severity of bleeding depends on residual coagulation factor acitivity
What are clinical features of haemophilia?
Haemarthrosis Muscle haematoma CNS bleeding Retroperitoneal bleeding Post surgical bleeding
What are clinical complications of haemophilia?
Synovitis
Chronic haemophilic arthropathy
Neurovascular compression (compartment syndromes)
Other sequela of bleeding (stroke)
Describe diagnosis of haemophilia
Clinical
Prolonged APTT
Normal PT
Reduced FVIII or FIX
Genetic analysis
Describe haemophilia treatment of bleeding diathesis
Coagulation factor replacement FVIII or IX
DDAVP; only in mild cases
Tranexamic acid
Emphasis on prophylaxis in severe haemophilia
Describe haemophilia treatment
Splints Physiotherapy Analgesia Synovectomy Joint replacement
What are complications of hamophilia treatment?
Viral infection; HIV, HBV, HCV
Inhibitors; anti FVIII Ab, rare in FIX
Describe von Williebrand disease (general)
Common; 1 in 200 Variable severity Autosomal Platelet type bleeding Quantitative and qualitative abnormalities of vWF
Describe type 1 von Williebrand disease
Quantitative deficiency in vWF
Describe type 2 von Willibrand disease
Qualitative deficiency determined by site of mutation in relation to wVF function
Describe type 3 von Williebran disease
Severe (complete) deficiency
What is treatment of von Williebrand disease?
vWF concentrate of DDAVP
Tranexamic acid
Topical applications
OCP etc
What is DDAVP?
desmopressin
What are acquired beeding disorders?
Thrombocytopaenia Liver failure Renal failure DIC Drugs warfarin, heparin, aspirin, clopidogrel, rivaroxaban, apixaban, dabigatran, bivalirudin
Describe the classifications of thrombocytopaenia?
Decreased production
- marrow failure
- aplasia
- infiltration
Increased consumption
- immune ITP
- non-immune DIC
- hypersplenism
What are clinical features of thrombocytopaenia?
Petechiae
Ecchymosis
Mucosal bleednig
Rare CNS bleeding
What is ITP?
Immune thromobytic purpura
Immune system destroys platelets
Describe ITP
Adult v child
Associations; infection, collagenosis, lymphoma, drug induced
Blood isolated thrombocytopaenia
ITP treatment
Children normally don’t require treatment
Adults; steroids, IV IgG, splenectomy, thrombopoetin analogues
Describe haemorrhagic disease of newborn
Immature coagulation systems and vitamin k deficient diet (esp breast)
Fatal and incapacitating haemorrhage
Completely preventable by administration of pit K at birth
