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Clin med sem 2 > Bleeding Disorders > Flashcards

Bleeding Disorders Flashcards

1
Q

Thrombocytopenia- description

A

<50 K plt

Nl= 150-460k

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2
Q

Thrombocytopenia- cause

A

Spontaneous bleeding - <20K
Found incidentally after a CBC

  1. Decreased plt production
    - BM suppression/failur - meds, chemo, aplastic anemia
    - BM destruction - lysis, Ca
  2. Inc plt destruction - DIC, TTP, HELLP, ITP, HIT, HUS
  3. Other - sepsis, blood loss
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3
Q

Thrombocytopenia- s/s

A

Capillary rupture:

  • petechia <3mm
  • purpura- 3-10mm
  • ecchymosis >10

Long bleeding after trauma- easy bruising
Mild bleeding- gingival and nasal

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4
Q

Thrombocytopenia- labs & imaging

A

CBC- thrombocytopenia

- bleeding time long

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5
Q

Thrombocytopenia- treatment

A

Address underlying causes

  • remove meds
  • BM failure or destruction? Get BMA
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6
Q

Idiopathic thrombocytopenic purpura (ITP)- description

A

Autoimmune disease characterized by abnormal dec in number of platelets
- IgG antibody binds to platelets and “tags” them for destruction by spleen

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7
Q

Idiopathic thrombocytopenic purpura (ITP)- cause

A

Children w viral infections- self limiting

Worse in adults- chronic

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8
Q

Idiopathic thrombocytopenic purpura (ITP)- s/s

A

Come in for non-blanching rash- petechia, purpura

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9
Q

Idiopathic thrombocytopenic purpura (ITP)- labs & imaging

A

Diagnosis:

  • Plt <50K
  • must rule out other causes
  • serum antiplatelet antibody assay and antiplatelet glycoprotein antibody - poor sensitivity, but may be helpful

Bleeding time - long
Pt, aPPT, Firbrinogen, BM - nl

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10
Q

Idiopathic thrombocytopenic purpura (ITP)- treatment

A 
Children- self limiting- monitor 
Adults: 
- 20k w out bleeding plt- no tx needed
- should recover in 3w 
- <20k or bleeding plt: prednisone, IVIG,, plt transfusions, splenectomy
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11
Q

Thrombotic thrombocytopenic purpura (TTP)- description

A

Autoimmune process- extensive microscopic intravascular clotting—> plt clump —> thrombocytopenia—> easy bleeding

Shearing of RBCs —> lysis

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12
Q

Thrombotic thrombocytopenic purpura (TTP)- cause

A

Enzyme defect or 2nd to other process

Drugs - quinine, plt aggregation inhibitors, immunosuppressants
Bact infection
Pregnancy
Other autoimmune dis
BMT

F>M
Adult

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13
Q

Thrombotic thrombocytopenic purpura (TTP)- s/s

A

PENTAD:

  • fever
  • thrombocytopenic purpura
  • microangiopathic hemolytic anemia
  • neurological symptoms- sz, TIA, AMS
  • renal failure
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14
Q

Thrombotic thrombocytopenic purpura (TTP)- labs & imaging

A 
Plt <50K 
Anemia 
Un conjugated hyperbilirubinemia 
LDH- inc 
Renal failure 
Urine- hematuria, proteinuria 
Smear- RBC fragments
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15
Q

Thrombotic thrombocytopenic purpura (TTP)- treatment

A

Emergent- Admit
- corticosteroids, pRBCs plasmapheresis, ASA, splenectomy
Avoid- plt transfusion unless catastrophic bleeding

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16
Q

Hemolytic uremic syndrome- description

A

Occurs after a gastrointestinal infection- ecoli, shigella, salmonella

Bacterial toxins damage vascular endothelium —> thrombus formation —> thrombocytopenia

17
Q

Hemolytic uremic syndrome- cause

A

Toxins- attack kidneys —> failure
Thrombi cause shearing of RBCs —> hemolytic anemia

Children- esp w renal failure and diarrhea

18
Q

Hemolytic uremic syndrome- s/s

A

TRIAD

  • thrombocytopenia
  • renal failure
  • hemolytic anemia
19
Q

Hemolytic uremic syndrome- labs & imaging

A 
Plt <50K 
Anemia 
Un conjugated hyperbilirubinemia
LDH elevated 
Evidence of renal failure 
Urine- hematuria and proteinuria 
Smear- fragmented RBCs
20
Q

Hemolytic uremic syndrome- treatment

A

Children- self limiting

  • admit for observation and IVF
  • monitor renal function

Adults- same as TTP
-ADMIT- corticosteroids, pRBC’s, plasmapharesis, ASA, splenectomy

Avoid abx- inc bacterial lysis w releasing more toxins

21
Q

Hemolysis elevated liver enzymes and low plt (HELLP)- description

A

Complication of pregnancy- occur anytime during last trimester to weeks after postpartum
- combo w preeclampsia or eclampsia

22
Q

Hemolysis elevated liver enzymes and low plt (HELLP)- cause

A

Unknown- but halts after delivery

23
Q

Hemolysis elevated liver enzymes and low plt (HELLP)- s/s

A 
Fatigue 
NV
HA
Blurry vision 
Epistaxis 
RUQ abdominal pain- liver
24
Q

Hemolysis elevated liver enzymes and low plt (HELLP)- labs & imaging

A

Thrombocytopenia
Anemia- low H/H, hyperbilirubinemia, inc LDH
LFTs- inc

25
Q

Hemolysis elevated liver enzymes and low plt (HELLP)- treatment

A

Delivery

26
Q

Hemolysis elevated liver enzymes and low plt (HELLP)- risks

A

Mother- 1% mortality risk- may develop DIC

Baby- placenta rupture, premature

27
Q

Disseminated intravascular coagulation (DIC)- description

A

Acquired bleeding disorder

Event that accompanies dieases - infect, trauma, cancer, pregnancy

Alternation in blood blotting mechanism - abnormal acceleration of coag cascade —> thrombosis, depletion of clotting factors, hemorrahge occurs simultaneously

28
Q

Disseminated intravascular coagulation (DIC)- s/s

A 
Bleeding- multiple sites 
Manifested by ecchymosis, petechiae, purpura
Cool/molted extremities
Dyspnea 
Chest pain 
Hematuria
29
Q

Disseminated intravascular coagulation (DIC)- labs & imaging

A

Coag panel is off

30
Q

Disseminated intravascular coagulation (DIC)- treatment

A

Supportive care- treat underlying disorder
Transfuse blood product as needed- PRBCs- platelet <20k- FFP
Heparin- maybe?

31
Q

Heparin induced thrombocytopenia (HIT)- description

A

Thrombocytopenia after admin of heparin
Heparin —> fine for 5 days —> formation of abnormal antibodies —> activate platelet —> clots formed —> platelet count dec —> fewer platelets= more bleeding

32
Q

Heparin induced thrombocytopenia (HIT)- s/s

A

Rarely symptomatic- thrombosis

33
Q

Heparin induced thrombocytopenia (HIT)- labs & imaging

A

Plt- dec

34
Q

Heparin induced thrombocytopenia (HIT)- treatment

A 
Stop heparin! 
- replace another anticoag- NOT WARFARIN 
Eval pt 
Rare- plt tranfusion 
Avoid heparin indef 
HOSP!!

Clin med sem 2 (30 decks)

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