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My Haem Cue Cards > Bleeding and Clotting > Flashcards

Bleeding and Clotting Flashcards

1
Q

haemostasis

A

the arrest of bleeding and the maintenance of vascular patency

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2
Q

what is primary haemostasis?

A

primary haemostasis

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3
Q

what is secondary haemostasis?

A

formation of fibrin clot

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4
Q

platelets are formed by

A

budding on megakaryocytes

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5
Q

lifespan of platelets

A

7-10 days

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6
Q

endothelial wall damage leads to

A

exposure of collagen
release of von Willebrand factorrelease of proteins to which platelets attach
secretion of chemicals which leads to platelet aggregation

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7
Q

causes of failure of platelet plug

A

vascular
platelets (reduced number or function)
von Willebrand factor

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8
Q

screening tests for primary haemostasis

A

platelet

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9
Q

what is extrinsic pathway of secondary haemostasis?

A

TF / VIIa acting on

factor V/Xa

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10
Q

what is intrinsic pathway?

A

VIII/IXa acting on factor V/Xa

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11
Q

what is the common pathway for secondary haemostasis?

A

V/Xa activates propagation of prothrombin to thrombin

fibrinogen to fibrin

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12
Q

Causes of failure of secondary haemostasis

A 
Single clotting factor deficiency
usually hereditary
eg Haemophilia
Multiple clotting factor deficiencies
usually acquired
eg Disseminated Intravascular Coagulation
Increased fibrinolysis
usually part of complex coagulopathy
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13
Q

what is fibrinolysis ?

A

plasminogen to plasmin activated by tPA

leads to conversion of fibrin to FDPs

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14
Q

prothrombin time

A

extrinsic pathway

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15
Q

APTT

A

intrinsic pathway

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16
Q

Naturally occurring anticoagulants

A

Serine protease inhibitors (anti thrombin 1)

Protein C and S

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17
Q

what is thrombophilia?

A

Deficiency of naturally occuring anticoagulants may be hereditary
Increased tendency to develop venous thrombosis (deep vein thrombosis/pulmonary embolism)

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18
Q

what happens as a direct result of hypoperfusion?

A

acidosis
microcapillary thrombus
eventual cellular necrosis

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19
Q

urine output in sepsis

A

<0.5

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20
Q

lactate levels

A

> 0.2

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21
Q

massive haemorrhage clinical definition

A

bleeding which leads to a heart rate of >110 beats per minute and/or systolic blood pressure less than 90mmHg
bleeding which has already prompted use of emergency O Rh(D) negative red cells.

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22
Q

multiple factor deficiency

A

factor concentrates

23
Q

what replaces fibrinogen?

A

cryoprecipitate

24
Q

vascular causes of failure of the platelet plug

A

HSP - vasculitis

25
Q

acquired causes of thrombocytopenia

A 
reduced production (marrow problem) 
Increased destruction (DIC/ITP/ hypersplenism)
26
Q

platelet functional defects - acquired

A

drugs (nsaids)

renal failure

27
Q

vwf deficiency is autdom or aut rec

A

aut dom

28
Q

commonest cause of primary haemostatic failure

A

thrombocytopenia

29
Q

multiple factor deficiencys causes

A

Liver failure
Vitamin K Deficiency/Warfarin therapy
Complex coagulopathy
Disseminated intravascular coagulation

30
Q

PT and APTT prolongued

A

multiple factor deficiencies

31
Q

what are reduced n liver failure

A

coag factors

32
Q

Factors ….. are carboxylated by vitamin K which is essential for function

A

II, VII, IX & X

33
Q

vitamin k absorbed in

A

upper intestine

34
Q

vitamin k requires ….. for absorption

A

bile salts

35
Q

causes of vitk deficiency

A 
Poor dietary intake
Malabsorption
Obstructive jaundice
Vitamin K antagonists (warfarin)
Haemorrhagic disease of the newborn
36
Q

what is dic?

A

Excessive and inappropriate activation of the haemostatic system
Primary, secondary and fibrinolysis
Microvascular thrombus formation
end organ failure
Clotting factor consumption
Bruising, purpura and generalised bleeding

37
Q

causes of dic

A

sepsis
obstetric emergencies
malignancy
hypovolaemic shock

38
Q

treat dic

A 
Treat the underlying cause
Replacement  therapy
Platelet transfusions
Plasma transfusions
Fibrinogen replacemen
39
Q

what is haemophilia

A

An X-linked, hereditary disorder in which abnormally prolonged bleeding recurs episodically at one or a few sites on each occasion

40
Q

what are the two types of haemophilia and what are they deficient in?

A 
Haemophilia A (factor VIII deficiency)
five times as common as

Haemophilia B (factor IX deficiency)

41
Q

haemophilia is a defect of …. haemostasis

A

secondary

42
Q

common cause of arterial thrombosis

A

atherosclerosis

43
Q

type of clot - arterial

A

platelet rich

44
Q

treat arterial clot

A

aspirin or other antiplatelets

45
Q

type of clot in venous thrombosis

A

fibrin clot

46
Q

virchows traid

A

stasis
vessel wall
hypercoag

47
Q

treat vt

A

heparin/ warfarin/ new oral anti coags

48
Q

what are the 5 main hereditary thrombophilias?

A 
Factor V Leiden
Prothrombin 20210 mutation
Antithrombin deficiency
Protein C deficiency
Protein S deficienc
49
Q

when do you give long term anticoag in thrombophilia patients

A

recurrent thrombotic events

50
Q

genetics of APS

A

Antibodies lead to a conformational change in β2 glycoprotein 1 (a protein with unknown function in health) which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities.

51
Q

antibodies in aps

A

lupus anticoagulants

52
Q

treat aps

A

it causes activation of both primary and secondary haemostasis so you need both aspirin and warfarin

53
Q

how do you reverse warfarin?

A

omit warfarin
administer oral vitk (takes 6 hours to work)
give clotting factors

My Haem Cue Cards (6 decks)

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