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Uro/Heme > Bleeding D/O > Flashcards

Bleeding D/O Flashcards

1
Q

MCC of abnormal bleeding

A

thrombocytopenia

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2
Q

Idiopathic thrombocytopenic purpura (ITP) general

A

IgG d/o; chronic peaks from 20 to 50 y/o, more CMN in women

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3
Q

ITP s/sx

A

petechiae on skin/mucous membranes; rarely febrile – also present w/ epistaxis, oral bleeding, menorrhagia, USU NO SPLENOMEGALY

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4
Q

MCC of ITP in hospitalized

A

heparin (HIT); other causes: sulfonamides, quinine, thiazides, cimetidine, gold
SLE and CLL can cause it too

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5
Q

ITP (acute and chronic) lab findings

A

acute: platelets- 10-20k, eosinos, mild lymphocytosis
chronic: platelets- 25-75k
mild anemia

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6
Q

ITP peripheral smear

A

megathrombocytes; NML coag studies

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7
Q

ITP tx

A

acute: usu self-limited, some req. CS or splenectomy
chronic: RARELY self-lim, initial tx: HD prednisone, splenectomy usu definitive
life-threatening bleed: platelet transfusion!

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8
Q

Thrombotic Thrombocytopenia Purpura (TTP) general

A

rare, but often fatal
mostly b/w 20-50 y/o, previously healthy people
More in women, HIV patients

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9
Q

TTP precipitated by…

A

estrogen use, pregnancy, drugs (quinine and ticlopidine)

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10
Q

TTP-like syndrome in kids

A

HUS (hemolytic uremia syndrome): < 10y/o usu., particularly after infxn w/ e. coli (0157:H7), shigella, salmonella
Can be seen in adults w/ estrogen use and pregnancy

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11
Q

TTP s/sx

A

severe thrombocytopenia w/ purpura/petechiae, pallor, abd pain, fever, abnl neuro, renal failure
POSS pancreatitis
microangiopathic hemolytic anemia

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12
Q

HUS s/sx

A

similar to TTP, but NO neuro findings

More renal problems than TTP

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13
Q

DIC s/sx

A

skin and mucous membrane bleeding, shock CMN, thrombosis less CMN

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14
Q

TTP and HUS lab findings

A

anemia, red cell fragments (schistocytes), NML WBC, polychromatophilia, reticulocytosis, thrombocytopenia (LESS severe in HUS)

INC LDH, indirect bili
NML coag tests

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15
Q

DIC labs

A

HYPOfibrinogenemia
INC fibrin degradation products (D-DIMER IS MOST SENSITIVE)
thrombocytopenia
PROLONGED PT
microangiopathic hemolytic anemia w/ schistocytes in 25% of cases

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16
Q

TTP tx

A

EMERGENT large-vol. plasmapherresis

Prednisone and ANTI-platelet agents

17
Q

HUS tx

A

conservative mgmt in kids: fluids, electrolyte balance

adults: plasmapheresis

18
Q

DIC tx

A

PROMPT and aggressive tx of underlying cause
Replace finbrinogen
(heparin is controversial)

19
Q

Platelet dysfxn general

A

more CMNly acquired than congenital
MCC: asa and NSAID
also w/ uremia, alcoholism, myeloproliferative dz, hypothermia, vitamin deficiencies

20
Q

VWD general

A

VWF: AUTOSOMAL dominant
MC congenital coagulopathy
most are mild
6 types, but type 1 is 75-80%

21
Q

VWD patho

A

DEC lvls of factor 8 Ag or ristocetin cofactor

22
Q

difference b/w hemophilia A and VWD

A

Hemo A: MORE spontaneous hemarthrosis and soft-tissue bleeds

23
Q

VWD s/sx

A

nasal, sinus, vaginal, and GI mucous membrane bleeds
WORSENED: w/ asa
BETTER w/ estrogen use, pregnancy

24
Q

VWD labs

A

PT and PTT generally NML
bleeding time usually prolonged
VWF low

25
Q

VWD tx

A

type 1: desmopressin acetate

Factor 8 preferred if factor replacement is necessary

26
Q

Hemophilia A general

A 
factor 8 or classic hemophilia
MC congenital coagulopathy after VWD
most severe bleeding d/o
X-linked recessive (1 in 7500 males)
genetic mutation causes 1/3 of cases
27
Q

hemophilia A s/sx

A

hemarthoses, epistaxis, IC bleeding, hematemesis, melena, microscopic hematuria, bleeding into soft tissue and gingiva

28
Q

hemophilia A labs

A

PTT prolonged
PT, bleeding time, fibrinogen level, platelets NML
DEC factor 8
FEMALE CARRIERS: low/nml factor 8

29
Q

hemophilia A tx

A

infusion of heat-tx or recombinant factor 8
desmopressin can elevate factor 8 in pts w/ mild-mod dz
AVOID asa, celecoxib or opioids

30
Q

Hemophilia B gen

A

factor 9 deficiency or Xmas dz

X-linked recessive (1/25000 males)

31
Q

Factor 11 deficiency

A

Ashkenazi Jews
mild, AUTOSOMAL REC
tx w/ FFP (fresh frozen plasma)

32
Q

Vit K dependent factor deficiencies

A

MC ACQUIRED coagulopathies

33
Q

Vit K deficiency causes

A

poor diet, liver failure, malabsorption, malnutrition, drugs (broad spectrum ABX)

34
Q

vit K s/sx

A

typical pt is post op, not eating well, on broad ABX

soft tissue bleeding

35
Q

vit k def labs

A

PT prolonged, PTT may be prolonged
NML: fibrinogen, thrombin time, platelets
elev liver enz
vit K, factors 2, 7, 9, and 10 DEC

36
Q

vit k def tx

A

tx underlying cause
PO or parenteral vit K (phytonadione)
tx hemorrhage w/ FFP
diet high in leafy vegetables, tx malabsorption

Uro/Heme (2 decks)

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