Bleeding and Clotting Disorders Flashcards
What are some possible problems when dealing with coagulopathy?
Bleeding
Clot formation
Both bleeding and clot formation
What types of issues will you see with bleeding?
Immediate or delayed
If you have immediate bleeding due to a platelet problem (van Willebrand problem) what could be the causes?
Low number (platelet count) Poor function (bleeding time)
What are clinical findings of immediate (primary) hemostasis defects? *
Mucosal and subcutaneous bleeding (Petechiae, purpura, ecchymoses) Spontaneous bleeding (platelet count less than 20 or 30 or non-functioning platelets)
What is the main treatment for a low number of platelets?
Transfusion of platelets
Replace von Willebran factor (factor VIII and fibrinogen)
What medications could be used in the instance of poor platelet function?
Aspirin (irreversibly)
What types of issues will you see with delayed bleeding?
Intrinsic factor PTT
Extrinsic pathway PT (INR)
What are the clinical findings of delayed secondary defects?
Hematoma and hemarthroses
If there is an abnormal PT (INR)?
Extrinsic pathways affected
Vit K dependent factors depleted
Liver disease
Warfarin (Coumadin)
If there is an abnormal PTT?
Intrinsic pathways affected
Inhibited by heparin
If there an abnormal PTT and PT/INR?
Common pathway
In a 1:1 mixing study, what could normalized test results mean? Non-normalized?
Factor deficiency, factor inhibitor
What is the treatment for a elevated PT/PTT?
Immediate, fresh frozen plasma (FFP) medicine to clot blood
For vitamin k dependent factor deficiency what should be done?
Vit K 10 units IV only
Vit K orally
Need to synth factors
If there is a bleeding and clotting disorder what could occur?
Disseminated intravascular coagulopathy (DIC)
- Inc thrombin a clot formed
What is the main product of fibrinolysis due to DIC?
D-dimer +
What are some areas of clot formation?
Arterial, microcircular
Venous
Either
What is arterial clotting disorder induced by?
Platelets
What could arterial clotting lead to?
Myocardial infarction, CVA.stroke, peripheral arterial disease
What is the platelet count for essential thrombocytosis?
450-999
What would you see in microcirculation clotting disorders?
Thrombotic thrombocytopenic purpura (TTP)
What is the the treatment for TTP/HELLP?
Glucocorticoidsteroid for immunosuppression
Immediate: fresh frozen plasma
(to replace the vWF)
What is HELLP?
Hypertension, elevated liver enzymes and low platelets (in pregnancy)
If you have arterial or venous or both in clotting, what can you expect?
Heparin-induced thrombocytopenia (HIT)
Antiphospholipid antibody syndrome *
Hyperhomocysteinemia
Describe Antiphospholipid antibody syndrome *
Thrombosis, fetal loss
Lupus anticoagulant antibody
What could occur in a venous clotting disorder?
Deep vein thrombosis
Pulmonary emboli
How are venous clotting disorders treated?
Heparin/LMWH short term
Warfarin
What is factor V leiden due to?
Venous clotting disorders
Factor V leiden
Pts with recurrent VTE, most common hereditary cause
Antithrombin (AT) III deficiency
Protein C and S deficiency
