Bleeding Disorders Flashcards
Disseminated intravascular coagulation
Excessive and inappropriate activation of the haemostatic system
Causes of Disseminated intravascular coagulation (4)
Sepsis, obstetric emergencies, malignancy and Hypovolaemic shock
What may be seen on blood film in Disseminated intravascular coagulation
Fragmented RBCs
What happens to PT, APTT and TT in Disseminated intravascular coagulation
Very prolonged
What happens to fibrinogen levels in Disseminated intravascular coagulation
Reduced
Is D dimer positive or negative in Disseminated intravascular coagulation
Positive
FBC results in Disseminated intravascular coagulation
Severe thrombocytopenia
Clinical sign of Disseminated intravascular coagulation
Bleeding from the mouth, nose and venepuncture sites, easy bruising
What is haemophilia
Condition which affects bloods ability to clot causing prolonged bleeding
What is the inheritance of haemophilia
X linked recessive
What is deficient in haemophilia A
Factor VII
What is deficient in haemophilia B
Factor IX
What is more common, haemophilia A or B
A
What is a consequence of haemophilia
Bleeding into the joints
Clinical presentation of mild haemophilia
Bleeding associated with an injury or surgery
Clinical features of severe haemophilia (3)
Recurrent haemarthrosis
Recurrent bruising
Prolonged bleeding after procedures
Test result indicating haemophilia
Isolated prolonged APTT
Management of haemophilia
Replace clotting factors
Complication of the treatment of haemophilia
Formation of antibodies against the clotting factor meaning the treatment is ineffective
Management of acute episodes of bleeding in haemophilia
Infusion of clotting factor
Desmopressin to stimulate VWF
antifibrinolytics
Give an example of an antifibrinolytic
Tranexamic acid
Von willebrands disease
A deficiency or abnormality of VWF
Where is the VWF gene located
Chromosome 12
Consequence of low VWF
Impaired platelet adhesion to the subendothelium
Consequence of reduced VWF on other clotting factors
Causes factor VII deficiency as it is not protected from premature degradation
Clinical presentations of Von willebrands disease
Nosebleeds , menorrhagia etc.
Epistaxis
Nose bleed
Menorrhagia
Heavy or prolonged periods
Thrombotic thrombocytopenic purpura
Formation of small blood clots throughout the body
What causes Thrombotic thrombocytopenic purpura
Deficiency of metalloproteinase ADAMTS13
Clinical presentation of Thrombotic thrombocytopenic purpura (5)
Fever
Haemolytic anaemia
Thrombocytopenia
Acute renal failure
Neurological symptoms
Blood film in Thrombotic thrombocytopenic purpura
Schistocytes and elevated reticulocyte count
Urinalysis result in Thrombotic thrombocytopenic purpura
Proteinuria and microscopic haematuria
Management of Thrombotic thrombocytopenic purpura
IV plasma exchange
Second line management in patients with Thrombotic thrombocytopenic purpura
Splenectomy
Massive haemorrhage
Bleeding with signs of shock , already required prompt transfusion
What can cause haemorrhage
Traumatic bleeding
Infection
What can we give to patients to replace fibrinogen
Cryoprecipitate
Role of tranexamic acid
Reduces or prevents excessive bleeding by inhibiting the break down of blood clots
Causes of secondary ITP
Anti phospholipid antibody syndrome
SLE
viral infections (cytomegalovirus, varicella-zoster, hepatitis C, HIV)
h.pylori infection
Meds
Lymphoproliferative disorders
What causes immune thrombocytopenic purpura
Type 2 hypersensitivity reaction - production of antibodies that target and destroy platelets
ITP
Immune thrombocytopenic purpura
When does ITP usually present
Children under 10
Usual history in ITP
History of recent viral illness
Symptoms of ITP
Bleeding, bruising and petechial or purpurin rash
Investigation for ITP
Full blood count
Positive result that indicates ITP
Isolated thrombocytopenia
Usual management of patients with ITP
Monitoring until platelets return to normal
Management of severe thrombocytopenia
Prednisolone
IV immunoglobulins
Blood transfusions if required