bleeding disorders

Question 1

vascular causes of bleeding disorders

Answer 1

margans (reduced collagen) // ageing // vasculitis // scurvy

Question 2

causes moderate thrombocytopenia

Answer 2

meds // alcohol // liver // hypersplenism // EBV, HIV // pregnancy // APS // vit B12 def

Question 3

meds that cause thrombocytopenia

Answer 3

heparin!!! // quinine // diuretics eg furosomide // sulphonamides, penicillin // aspiri // thiazides // AED

Question 4

causes severe thrombocytopenia

Answer 4

haem malignancy // ITP // TTP //DIC

Question 5

most common inherited bleeding disorder

Answer 5

von willebrands

Question 6

inheritance von willebrand disease

Answer 6

autosomal dominant

Question 7

function von willebrand factor

Answer 7

released in response to vascular damage –> promotes platelet aggregation (+ carries factor VIII)

Question 8

types von willebrand disease

Answer 8

1 = partical reduction vWF // 2 = abnormal vWF // 3 = total lack of vWF (recessive type)

Question 9

symptoms von willebrand disease

Answer 9

bleeding gums, menorrhagia, haemorrhoids

Question 10

invx von willebrand disease

Answer 10

prolonged bleeding //normal PT // raised APTT (from reduced VIII action) // reduced VIII

Question 11

mx von willebrand disease

Answer 11

tranexamic acid // desmopressin (stimulates vwf) // factor VIII

Question 12

how does liver disease cause bleeding

Answer 12

all made in liver (except VIII)

Question 13

function vit K

Answer 13

carboxylates clotting factors

Question 14

bloods in vit K deficiency

Answer 14

raised APTT, raised PT, normal bleeding time

Question 15

inheritance haemophilia

Answer 15

X linked (mainly affects men)

Question 16

deficiency of haemophilia A

Answer 16

VIII

Question 17

deficiency haemophilia B

Answer 17

IX

Question 18

symptoms haemophilia

Answer 18

haemoarthoses (stiff, painful, red knees) // haematoma // prolonged bleeding after surgery

Question 19

bloods and bleeding time haemophilia

Answer 19

raised APTT // normal PT // normal bleeding (except after surgery)

Question 20

mx haemophilia

Answer 20

tran acid

Question 21

what is DIC

Answer 21

dysregulation of coagulation + fibrinolysis –> lots of clotting + lots of bleeding

Question 22

causes DIC

Answer 22

sepsis // trauma // obsteterics eg HELLP // cancer

Question 23

bloods DIC

Answer 23

low platelets // low fibrinogen // raised PT // raised APTT // raised DDimer

Question 24

blood film DIC

Answer 24

shistocytes - haemolytic anaemia

Question 25

what is TTP

Answer 25

abnormally large vwf cause platelets to clump

Question 26

symptoms TTP

Answer 26

female // neuro!! // fever // haemolytic anaemia // thrombocytopenia (low platelets) // renal failure

Question 27

causes TTP

Answer 27

post infection eg UTI, GI // pregnant // meds eg ciclo, COCP, pen // tumour // SLE // HIV

Question 28

antibodies in immune thrombocytopenia (ITP)

Answer 28

glycoprotein II/III or I,V,IX complex

Question 29

symptoms ITP

Answer 29

elderly women // petechia, pupura // bleeding eg epistaxis // (major bleed not common presentation)

Question 30

what can cause ITP in kids

Answer 30

infection or vaccine // (acute in kids, chronic in adults)

Question 31

invx ITP

Answer 31

FBC (isolated low platelets) // blood film: megakaryocytes) // platlet antibodies (IgG

Question 32

when is bone marrow biopsy indicated in ITP

Answer 32

abnormal presentation RF for maligancy // lymph nodes, splenomegaly, WCC affected, not responding to treatment

Question 33

mx ITP kids

Answer 33

usually self-resolving 6 months // avoid trauma

Question 34

mx ITP severe kdis

Answer 34

oral or IV prednisolone // Iv Ig // platelet transfusion (emergency bleed)

Question 35

mx ITP adults

Answer 35

1 = oral sterods // IV Ig // splenectomy // cyclophosphamide

Question 36

when is splenectomy indicated ITP

Answer 36

platelets <30 after 3 months steroids

Question 37

what is heparin induced thrombocytopenia

Answer 37

immune against platelet factor 4