Bleeding Flashcards
What causes bleeding? (4)
Vascular defects
Platelet disorders
Coagulation disorders
Over-anticoagulation
Give examples of vascular defects (2)
Congenital: connective tissue disease
Acquired: infection
Give examples of platelet disorders (3)
DEC marrow production: marrow suppression (cytotoxic drugs), aplastic anaemia
Excess destruction: ITP, TTP
Poorly functioning platelets: myeloproliferative disease, NSAIDs, INC urea
Give examples of coagulation disorders (2)
Haemophilia
vWF disease
What is the cause of haemophilia A?
Factor VIII deficiency
What is the cause of haemophilia B?
Factor IX deficiency
When might bleeding be caused by over-anticoagulation?
Patients on vit K antagonists eg warfarin, DOACs eg apixaban
Why might patients be over anticoagulated? (3)
Poor compliance
Artificial valves
New/ interlacing drugs
What is disseminated intravascular crisis (DIC)?
Initial thrombosis (depleting platelets/ coagulation factors) followed by excessive bleeding
How would you treat DIC? (2)
Treat underlying cause
Replace platelets, coagulation factors, fibrinogen
Which thrombocytopenic disease is more common?
ITP is more common than TTP
What is immune thrombocytopenic purpura (ITP)?
Autoimmune destruction of platelets
Antibodies coat platelets and are removed by binding to Fc receptors on macrophages
What are the clinical features of platelet disorrders? (4)
Easy bruising
Purpura (red/purple spots on skin)
Epistaxis (nosebleeds)
Menorrhagia
What are the investigations for ITP? (3) (ITP is a diagnosis of EXCLUSION)
FBC: isolated thrombocytopenia
Increased marrow megakaryocytes
May detect antiplatelet autoantibodies
How would you treat ITP? (5)
Corticosteroids eg prednisolone
IV Ig
Transfuse platelets
Splenectomy (if unresponsive to immunosuppressants)
Anti D (elevates platelet count, keeps antibody-coated platelets in circulation for longer)
