Bleeding And Thrombosis Flashcards
What does spontaneous hemarthroses indicate?
Factor VII / XI deficiency
What does mucosal bleeding indicate?
VWD disease
What does epistaxis indicate?
Hereditary hemorrhagic telangectasia
VWD in boys
What is heavy menstruated bleeding quantitatively defined as?
Loss of >80 mL of blood per cycle
What three things can heavy menstrual bleeding clue you into?
VWD, factor XI deficiency, hemophilia carrier
Which drugs can cause excessive bleeding?
NSAIDS
Clopidogrel
Fish oil
Vitamin E
Which organs systems can exacerbate bleeding?
Liver
Renal
Hypothyroidism
Bone marrow failure
What factors does PT assess?
Factor I (fibrinogen) Factor II (prothrombin) Factor V Factor VII Factor X
What factors does the aPTT assess?
Factors XI, IX, VIII, X V, II; fibrinogen; prekallikrein, minion gen, and factor XII.
What is the Pentad for TTP?
Thrombocytopenic purpura Microangiopathic hemolytic anemia Fever Neurological signs Renal dysfunction
What is ADAMTS13 also known as?
Von Willebrand Factor cleaving protease
A mutation in what causes TTP?
ADAMTS13
What is the treatment for TTP?
Plasmapheresis
How do you treat VWD?
Cryoprecipitate
Desmopressin
what disease is characterized by a thinning of vessel walls with telangiectatic formations, arteriovenous malformations, and a aneurysmal dilutions throughout the body?
Hereditary hemorrhagic telangectasia
What is the inheritance for hereditary hemorrhagic telangectasia? Mutation?
AD; defect in the gene coding for endoglin (CD 105)
What are the two clinical features of hereditary hemorrhagic telangectasia
Telangectasia
Bleeding (epistaxis)
Which thrombotic disorder presents with recurrent lower extremity thrombophlebitis and deep vein thrombosis, venous insufficiency and chronic leg ulcers?
Antithrombin III deficiency
What is the treatment for AT III Deficiency?
Prophylactic treatment with anticoagulants
Heparin
What does protein C do?
Inactivated factors V and VIII
What does protein S do?
It’s a cofactors for protein C
How do you treat protein C/S deficiency?
Warfarin
What part of the coagulation cascade is disrupted in Factor V Leiden disease?
Factor V binding with Protein C to inactivate it
What are the four associated features of antiphospholipid syndrome?
Thromboembolic phenomena
Miscarriage
Thrombocytopenia
Cerebral ischemia and recurrent stroke
What are three tests/indicators of antiphospholipid syndrome?
Prolonged aPTT
Lack of correction in mixing studies using normal plasma
Neutralization of inhibitor with excess phospholipid
What is the treatment for antiphospholipid syndrome?
Anticoagulation with SC heparin
Hydroxychloroquine
Which three antineoplastic drugs can cause malignancy?
Tamoxifen
Bevacizumab
Thalidomide
What is the most common cause of easy bruising?
Thrombocytopenia -decreased platelet numbers
What is the term for antibodies interacting with platelet surfaces?
Immune thrombocytopenic purpura
How do you treat DIC?
Correct the underlying problem
Which disease shows normal aggregation to ADP, collagen, arachidonic acid, epinephrine but absent aggregation to restocetin?
Bernard-soulier syndrome
A patient with advanced liver cirrhosis would show what platelet abnormalities? (4)
Thrombocytopenia
A prolonged PT
A prolonged PTT
Low Hgb
What is a normal PT?
10-12
What is a normal PTT?
30-45
What does a mixing study used for?
To evaluated a prolonged aPTT or PT, to distinguish between a factor deficiency and a inhibitor.
If there is a isolated factor deficiency, the aPTT will correct with mixing
If there is lupus anticoagulant, the mixing and incubation will show no correction
Acquired factor VIII inhibitor - mixing will not correct.
Mixing will not correct with the presence of other inhibitors such as heparin, fibrin split products and paraproteins
What is liskers signs?
Pain with percussion of the anteromedial tibia; not sensitive or specific for DVT
What is lowenbergs sign?
Pain when a BP cuff is applied to the mid calf
