Bleeding disorders

Question 1

What is primary haemostatic failure?

Answer 1

Primary haemostatic failure is caused by thrombocytopenia, leading to a lack of platelet adhesion.

Question 2

What causes primary haemostatic failure?

Answer 2

(1) Marrow failure
(2) Peripheral destruction
both acquired or hereditary conditions

Question 3

What is secondary haemostatic failure?

Answer 3

Secondary haemostatic failure involves clotting factor deficiencies, which impair fibrin clot formation

Question 4

What factors contribute to secondary haemostatic failure?

Answer 4

(1) deficiencies in clotting factors, most of which require vitamin K.

(2) Warfarin, as an anticoagulant, causes vitamin K deficiency, affecting factors 10, 7, 9, and 2 (prothrombin

Question 5

Define Disseminated Intravascular Coagulation (DIC)

Answer 5

Excessive and inappropriate activation of the haemostatic system - Primary, secondary and fibrinolysis (clinical syndrome)

Question 6

What is the cause of excessive activation of the haemostatic system?

Answer 6

(1) sepsis
(2) obstetric emergencies
(3) malignancy
(4) hypovolaemic shock
(5) ABO incompatibility

Question 7

What is the pathophysiology of DIC

Answer 7

Microvascular thrombi form, causing end-organ failure, while clotting factor consumption leads to bruising, purpura, and bleeding

Question 8

What are the clinical features of excessive haemostatic system activation? - DIC

Answer 8

(1) Patients are often acutely ill

(2) with bleeding from various sites and thrombotic events affecting organs like the skin, brain, and kidneys

Question 9

What is the management for excessive haemostatic system activation? - DIC

Answer 9

(1) The underlying cause should be treated.

(2) Replacement therapy includes platelet transfusions, plasma transfusions, and fibrinogen replacement

Question 10

What is haemophilia?

Answer 10

An X-linked recessive hereditary disorder characterised by abnormally prolonged bleeding, usually at one or a few sites on each occasion

Question 11

What are the types of haemophilia and their causes?

Answer 11

Haemophilia A: Factor VIII deficiency (5x more common)

Haemophilia B: Factor IX deficiency

Question 12

What is the pathophysiology of haemophilia?

Answer 12

(1) No abnormality in primary haemostasis
= Platelet function is normal; the issue is in the coagulation cascade

(2) Bleeding occurs in medium to large blood vessels, often in joints.

(3) Severity depends on the level of factor VIII or IX involved

= Haemophilia is a clotting disorder due to Factor VIII (A) or IX (B) deficiency, impairing the intrinsic pathway. This leads to reduced thrombin, poor fibrin clot formation, and prolonged bleeding, especially in joints and muscles

Question 13

What are the clinical features of haemophilia?

Answer 13

Mild - Bleeding after injury or surgery

Severe -
(1) Recurrent haemarthroses - bleeding in joint space

(2) Recurrent soft tissue bleeds

(3) Bruising in toddlers

(4) Prolonged bleeding after dental extractions, surgery, and invasive procedures

(5) Joint, muscle bleeding

Question 14

How is haemophilia diagnosed?

Answer 14

(1) Isolated prolonged APTT
(activated partial thromboplastin time)
(2) coagulation factor assays (VIII for A, IX for B)
(3) genetic testing

Question 15

How are the affected clotting factors in haemophilia replaced?

Answer 15

Replaced by IV infusions, either prophylactically or in response to bleeding

Question 16

What is a complication of clotting factor replacement in haemophilia?

Answer 16

Formation of antibodies against the clotting factor, which can make the treatment ineffective

Question 17

What causes von Willebrand’s disease?

Answer 17

Von Willebrand disease (VWD) is a common inherited bleeding disorder caused by a reduced quantity or function of von Willebrand factor (VWF).

This leads to an increased risk of bleeding, especially among women during their menstrual periods, pregnancy, and childbirth

Question 18

How do symptoms of von Willebrand disease compare to haemophilia A?

Answer 18

Von Willebrand disease has milder symptoms compared to haemophilia A, with ;

(1) no haemarthrosis (Bleeding into a joint space)

(2) more common occurrences of epistaxis (nose bleeds)

(3) and menorrhagia (Excessively heavy menstrual bleeding)

(4) Haemophilia is more common in men than von villebrand sydrome is

Question 19

What is the cause of Immune Thrombocytopenic Purpura (ITP)?

Answer 19

Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterised by a reduction in circulating platelets.

In children, it usually follows a viral infection and is self-limiting

Autoimmune body produces antibodies agaisnt its thrombocytes or platelets

Question 20

What is the difference between primary and secondary ITP?

Answer 20

(1) Primary ITP occurs in isolation

(2) while secondary ITP is associated with other conditions such as autoimmune disorders, viral infections, or lymphoproliferative disorders

Question 21

What is the pathophysiology of ITP?

Answer 21

ITP is caused by a type II hypersensitivity reaction, where antibodies target and destroy platelets, often triggered by viral infections or other factors

Question 22

What are the common clinical features of ITP?

Answer 22

(1) Easy or excessive bruising (purpura)

(2) Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs

(3) Prolonged bleeding from cuts

(4) Spontaneous bleeding from the gums or nose - ITP presents with mucocutaneous bleeding

(5) Blood in urine or stools

(6) Unusually heavy menstrual flow in females

(7) It is most common in children under 10

Question 23

How is ITP diagnosed?

Answer 23

(1) Full Blood Count (FBC) - isolated thrombocytopenia
(2) blood film and exclusion of differential diagnoses.

(3) Management generally involves a ‘watch and wait’ approach due to the high rate of spontaneous remission

Question 24

What causes Thrombotic Thrombocytopenic Purpura (TTP)?

Answer 24

By a deficiency of the metalloproteinase ADAMTS13, which is associated with triggers such as medication, AIDS, and malignancy

Question 25

What is the classic pentad of symptoms in TTP?

Answer 25

The classic pentad includes (1) fever (2) hemolytic anaemia (3) thrombocytopenia (4) acute renal failure (5) neurological symptoms

Question 26

What is the mainstay of treatment for TTP?

Answer 26

IV plasma exchange = If unresponsive, splenectomy may be considered for chronic relapses

Question 27

A 5-year-old male patient presents to the emergency department with fever, headache, and vomiting. On physical examination, he is pyrexial, with neck stiffness and a petechial skin rash. He is admitted to the intensive care unit but deteriorates, with evidence of blood oozing from the cannula sites, gingival bleeding, and hypotension What is the correct coagulation profile consistent with the most likely diagnosis?

Answer 27

Decreased fibrinogen, decreased platelets, elevated D-dimer = is DIC DIC because the patient has sepsis, petechial rash and bleeding signs

Question 28

What is a characteristic finding in DIC?

Answer 28

schistocytes on blood film

Question 29

Patients with DIC commonly present with what?

Answer 29

(1) Excessive bleeding (2) Fever (3) Confusion (4) Potential coma

Question 30

Physical signs of DIC include what?

Answer 30

(1) Petechiae (2) Bruising (3) Confusion (4) Hypotension

Question 31

What would DIC clotting profile show in tests?

Answer 31

(1) Increased prothrombin time (2) increased APTT (3) decreased fibrinogen (4) Increased D Dimer

Question 32

Prolonged PT and APTT with low platelets point to what disease?

Answer 32

Disseminated intravascular coagulation

Question 33

A 43-year-old patient presents to the hospital feeling generally unwell. For the last 3 months, he has noticed weight loss and a reduced appetite. More recently, he has had blood in his urine, easy bruising, and oozing from his gums whenever he brushes his teeth. In the past few days, he has noticed a few digits on his lower limbs go cold and turn dusky. His blood tests are shown below: Haemoglobin: 72g/L (110-180) Platelets: 36 x 10^9/L (150-400) Blood film: schistocytes present INR: 4.5 (<1.1) APTT: 100 seconds (27-41) What is the most likely diagnosis?

Answer 33

Disseminated intravascular coagulation (DIC)

Question 34

A concerned mother brings her 6-year-old daughter to paediatric A&E because she has noticed a new non-blanching rash and is worried her daughter has meningitis. The mother reports that her daughter has complained of a sore throat and cough over the past week, which has improved. On examination, the girl's legs are covered with a petechial rash. Blood tests show low platelets but no other abnormalities. The urine dipstick is normal. What is the most likely diagnosis?

Answer 34

Immune thrombocytopenic purpura

Question 35

A concerned mother brings her 5-year-old son to paediatric A&E because she has noticed a new non-blanching rash and is worried her son has meningitis. The mother reports that her son has complained of a sore throat and cough over the past few days, which has improved. On examination, the boy's legs are covered with a petechial rash. Blood tests show low platelets but no other abnormalities. Given the most likely diagnosis of immune thrombocytopenic purpura, what is the best next step in managing this patient?

Answer 35

Reassure the mother this is a self-limiting illness

Question 36

Isolated low platelet count of unknown cause indicates what condition?

Answer 36

Immune thrombocytopenia

Question 37

What drug should be avoided in children with ITP?

Answer 37

Ibuprofen

Question 38

What blood results on the clotting screen would you expect to see in Von Willebrand's disease?

Answer 38

PT time is normal but APTT is prolonged. Bleeding time is prolonged

Question 39

What is the mode of inheritance of Von Willebrand disease?

Answer 39

Autosomal dominant

Question 40

What are the main ways to treat a patient with Von Willebrand disease who is bleeding?

Answer 40

(1) Desmopressin (2) Tranexamic acid (3) Factor VIII concentrate (severe bleeding)

Question 41

A 19-year-old woman presents to the emergency department after a tooth extraction earlier in the day. She has a history of heavy periods since menarche but is otherwise fit and well. She has a family history of a bleeding disorder. On examination, there is still bleeding from the tooth extraction site, but no other abnormalities are noted. What is the best next step in the management of this patient?

Answer 41

Desmopressin

Question 42

Define von Willebrand disease

Answer 42

von Willebrand disease (vWD) is an autosomal dominant bleeding disorder characterised by episodes of prolonged mucosal bleeding (eg. epistaxis, gum bleeding) and menorrhagia It is caused by a deficiency/loss of function of von Willebrand factor (VWF), which usually mediates platelet aggregation and factor VIII activation

Question 43

First-line treatment in most subtypes of vWD is what?

Answer 43

Desmopressin

Question 44

A 17-year-old boy is referred for blood tests due to recurrent epistaxis and bruising that appears to spontaneously develop on his shins. His father suffers similar symptoms. Blood tests are as follows: (1) Prothrombin time (PT): 12 seconds (10-14 seconds) (2) Activated partial thromboplastin time (APTT): 37 seconds (25-35 seconds) (3) Bleeding time: prolonged What is the most likely diagnosis?

Answer 44

Von Willebrand disease

Question 45

A 16-year-old girl with known iron deficiency anaemia attends her GP complaining of continuing fatigue and exercise intolerance, despite treatment with iron tablets. On further questioning, you learn that her period is every 28 days with heavy bleeding for seven days. She also explains how she bruises easily, and her gums often bleed when she brushes her teeth. She has no other medical history. Further investigations reveal that she has normal platelet levels, but they do not agglutinate properly Which investigation findings are also likely?

Answer 45

Normal prothrombin time

Question 46

A 19-year-old woman is referred to haematology outpatients with recurrent and persistent nosebleeds and severe bruising. There is a dominant family history of Von Willebrand disease. What is the expected pattern on routine clotting tests?

Answer 46

Normal platelets Prolonged bleeding time Prolonged APTT Normal PT and TT

Question 47

A 17-year-old female has prolonged bleeding after a tooth extraction. She tells her dentist that her gums often bleed when she brushes her teeth and she gets frequent nosebleeds. Her mother also has similar problems and she thinks there may be a bleeding disorder that runs in her family. Which clotting factor is most likely to be affected in this patient?

Answer 47

Factor 8

Question 48

Key signs and symptoms of Von Willebrand disease include what?

Answer 48

(1) prolonged bleeding from minor wounds (2) easy bruising (3) menorrhagia (4) epistaxis (5) GI bleeding (6) menstrual bleeding

Question 49

How does Haemophilia often present in toddlers?

Answer 49

Presents as failure to walk or walking late due to bleeding into joints

Question 50

At what age do patients tend to present with Hereditary Hemochromatosis?

Answer 50

(1) Women can present later than men due to regular iron loss every month (menstruation) (2) Men tend to present in their forties or fifties

Question 51

What are the two types of Haemophilia?

Answer 51

The two types of Haemophilia are Type A (deficiency in Factor 8) Type B (deficiency in Factor 9)

Question 52

A mother attends the genetics clinic. She is concerned as she has become pregnant and is having a boy. Her father died at age 25 from internal bleeding. She suffers from mild symptoms of occasional nosebleeds and prolonged bleeding times. Her investigation results are shown below: (1) Activated partial thromboplastin time (APTT): 50 seconds (24-37 seconds) (2) Factor VIII: 90IU/dL (50-150IU/dL) (3) Factor IX: 40IU/dL (65-150IU/dL) She is worried about the chance that her son will inherit the disease. What is the chance her son will inherit her underlying genetic disease? and why?

Answer 52

50% = This patient is a carrier of haemophilia B. This is evidenced by the fact that her father was affected, and she has reduced Factor IX activity. Haemophilia B is an X-linked condition. Therefore, males with the condition will always pass the affected X chromosome to daughters but never to sons. Mothers who are carriers of haemophilia B have a 50% chance of a male child being affected by haemophilia B

Question 53

What do blood tests show in haemophilia?

Answer 53

(1) Clotting profile - APTT is elevated (2) vWF antigen is normal in haemophilia A (3) Defective platelet function

Question 54

Management for minor, major and severe bleeds

Answer 54

Minor = Minor bleeds in patients with Haemophilia A can be managed with desmopressin Major = recombinant factor VIII or IX severe = use of regular prophylactic recombinant clotting factor treatment, physiotherapy and education

Question 55

A 24-year-old presents to the emergency department with severe haemarthrosis. He has a background of haemophilia A, diagnosed shortly after birth. On examination, his chest is clear, and his observations are as follows: (1) Heart rate: 110 beats per minute (2) Blood pressure: 105/87 mmHg (3) Respiratory rate: 12 breaths per minute (4) SpO2: 100% on room air What is the most appropriate treatment?

Answer 55

Recombinant factor VIII

Question 56

A 3-year-old boy presents to the GP with his mother following the development of severe bruising after minor trauma. On examination, there is a large, deep ecchymosis along the patient’s right thigh (there is nil else of note). Blood tests reveal a normal blood count, urea & electrolytes and liver function. A coagulopathy screen reveals a normal bleeding time, normal PT (INR) and normal fibrinogen; but the APTT is prolonged. What is the single most likely diagnosis? and explain why your answer

Answer 56

Haemophilia A = Haemophilia A is an inherited bleeding disorder, which presents in early life with deep bleeding (haemarthrosis, muscular haematomas) associated with deranged coagulation tests (prolonged APTT) and a normal platelet count. NORMAL BLEEDING TIME

Question 57

What will the confirm the diagnosis of haemophilia A?

Answer 57

Factor VIII assay

Question 58

When is factor VIII normal?

Answer 58

Haemophilia B

Question 59

An 11-year-old boy presents to the GP with his mother with several nosebleeds and excessive bleeding from his gums after visiting the dentist. He says his 8-year-old sister does not have any of these symptoms, but his maternal grandfather used to have regular hospital appointments for an injection. His blood tests show a prolonged APTT. Given the most likely diagnosis, which of the following is the most likely pattern of inheritance?

Answer 59

X Linked Recessive

Question 60

A 2-year-old boy with a diagnosis of haemophilia B attends the haematology clinic. He has recently had an admission to the hospital with a right knee joint hemarthrosis. He is currently well, with no symptoms and no clinical evidence of joint deformity. What treatments are most appropriate to minimise the risk of complications in this patient?

Answer 60

Factor IX replacement

Question 61

A 35-year-old man presents with a history of recurrent joint bleeds and easy bruising. His blood test results reveal a prolonged activated partial thromboplastin time (aPTT) with a normal prothrombin time (PT) and thrombin time (TT) What bleeding disorder is this?

Answer 61

Haemophilia A

Question 62

A patient who is 36 weeks pregnant is seen during the obstetrics ward round. She has heard some of the staff on the ward talking about vitamin K and asks whether this is something her baby will need. The doctor explains that babies are born deficient in vitamin K so all newborns are offered vitamin K to reduce their risk of bleeding and a condition called haemorrhagic disease of the newborn. What is the correct way to give vitamin K to newborns?

Answer 62

Intramuscular vitamin K on the first day of life

Question 63

A 6-month-old exclusively breastfed infant presents with bruising, bleeding from gums and nose, and blood in the diaper. What is the most likely cause of his symptoms? and why is this the answer?

Answer 63

Vitamin K deficiency = Breast milk has low levels of vitamin K, which is essential for the production of coagulation factors. Infants who are exclusively breastfed may have a deficiency of vitamin K, which can lead to bleeding tendencies

Question 64

An 8-year-old boy presents to the GP with his mother following the development of several blood blisters in his mouth. Blood tests reveal an isolated thrombocytopenia (30) and a prolonged bleeding time, but are otherwise normal. What is the single most likely diagnosis? and why is that your answer?

Answer 64

Immune thrombocytopenic purpura Given the presence of oral blood blisters, associated isolated thrombocytopenia (30) and prolonged bleeding time

Question 65

When would Observation be the best course of action for the management of a patient with Immune thrombocytopenic purpura (ITP)?

Answer 65

Platelet count of >30 × 109/L with no symptoms or additional risk factors

Question 66

When would corticosteroids (eg, oral prednisolone) be the correct management for a patient with Immune thrombocytopenic purpura (ITP)?

Answer 66

Patients with a platelet count of (1) <30 × 109/L or a platelet count >30 × 109/L + features of minor bleeding/high risk (e.g. the high-risk profession or upcoming surgery)

Question 67

Treatment for patients diagnosed with ITP

Answer 67

Treatment may be required if the patient is actively bleeding or severe thrombocytopenia (platelets ≤10): - Prednisolone - IV immunoglobulins - Blood transfusions if required - Platelet transfusions only work temporarily

Question 68

“Bleeding when they brush their teeth” suggests what?

Answer 68

ITP

Question 69

Immune vs thrombotic thrombocytopaenia. Who is more healthier?

Answer 69

Thrombotic patients are more unwell

Question 70

What are the differences between haemophilia A and haemophilia B?

Answer 70

Haemophilia A and B have no significant difference in symptoms. Both cause: (1) Spontaneous bleeding (joints, muscles) (2) Prolonged bleeding after injury/surgery (3) Haemarthrosis (joint swelling, pain, stiffness) (4) Easy bruising The only difference is cause: Haemophilia A → Factor VIII deficiency Haemophilia B → Factor IX deficiency Diagnosis is confirmed by factor level testing

Question 71

Which bleeding symptoms are more common in Von Willebrand disease (VWD) compared to Haemophilia?

Answer 71

Von Willebrand disease is more likely to cause nosebleeds (epistaxis) and heavy menstrual bleeding (menorrhagia) = affecting primary haemostasis (platelet adhesion). Haemophilia primarily causes deep tissue bleeding (joints, muscles) due to a deficiency in clotting factors (Factor VIII or IX) = affecting secondary haemostasis

Question 72

What are the typical blood results for Haemophilia

Answer 72

Platelet count: Normal Bleeding time: Normal Prothrombin time (PT): Normal APTT: Prolonged

Question 73

What are the typical blood results for DIC?

Answer 73

Platelet count: Low Bleeding time: Prolonged Prothrombin time (PT): Prolonged APTT: Prolonged Fibrinogen: Low INR: Prolonged D-dimer: Elevated

Question 74

What are the typical blood results for TTP?

Answer 74

Platelet count: Low Bleeding time: Prolonged Prothrombin time (PT): Normal APTT: Normal LDH: Elevated Schistocytes: Present on peripheral blood smear

Question 75

What are the typical blood results for ITP?

Answer 75

Platelet count: Low Bleeding time: Prolonged Prothrombin time (PT): Normal APTT: Normal

Question 76

What are the typical blood results for Vitamin K deficiency or Warfarin overdose?

Answer 76

Platelet count: Normal Bleeding time: Normal Prothrombin time (PT): Prolonged APTT: Prolonged INR: Prolonged

Question 77

A 25-year-old woman presented with bleeding from her nose. She had not had similar problems before and was usually well. Her observations are normal. Test Result Normal range (1) Haemoglobin 130 g/L (M) 130 - 170, (F) 115 - 155 (2) Platelet count 20 × 109/L 150 - 450 × 109/L What is the most appropriate first-line treatment for this condition?

Answer 77

Oral corticosteroids = First line for ITP

Question 78

What are the differences between Haemophilia, ITP, TTP, Von Willebrand disease and DIC?

Answer 78

Haemophilia = (1) Deep tissue bleeding, joint and muscle bleeds (2) Normal platelets, prolonged APTT ITP = (1) Mucosal bleeding (nosebleeds, gum bleeding), Petechiae, purpura brusing (2) Low platelets, normal PT/APTT TTP = (1) Neurological symptoms (headache, confusion, seizures), hemolysis (2) Low platelets, Schistocytes, normal PT/APTT Von Willebrand Disease = (1) Mucosal bleeding (nosebleeds, heavy periods) (2) Normal platelets, prolonged bleeding time, normal PT, prolonged APTT DIC = (1) Widespread bleeding (from multiple sites), organ failure (2) Low platelets, prolonged PT/APTT, elevated D-dimer, reduced fibrinogen

Question 79

fever, headache, vomiting, petechial rash, shock

Answer 79

Suggests meningococcal infection =classic cause of DIC

Question 80

What bleeding disorders respond well to Desmopressin (DDAVP)?

Answer 80

Von Willebrand Disease Mild Haemophilia A

Question 81

What bleeding disorders respond well to steroids?

Answer 81

ITP Acquired Haemophilia Atypical HUS

Question 82

A 25-year-old woman comes to the clinic due to easy bruising and heavy menstrual bleeding. Laboratory studies show decreased factor VIII and ristocetin cofactor activity and decreased VWF antigen. What disease is this describing?

Answer 82

Von Willebrand disease

Question 83

Factor V Leiden is associated with what?

Answer 83

Haemophilia B

Question 84

Why do von Willebrand disease patients often have a history of bleeding?

Answer 84

It's inherited, so family history is common. Symptoms like excessive bleeding usually start early in life and has been seen before.

Question 85

A 12-year-old boy with a past medical history of Haemophilia A is about to undergo dental extraction. To prevent excessive bleeding, a subcutaneous injection of desmopressin was given immediately before the procedure. What is the mechanism of action of desmopressin when used to prevent bleeding in Haemophilia A?

Answer 85

Releases von Willebrand factor from its storage sites in endothelial cells

Question 86

A 72-year-old man has just undergone an emergency repair for a ruptured abdominal aortic aneurysm. Preoperatively he was taking aspirin, clopidogrel and warfarin. Intraoperatively he received 5000 units of unfractionated heparin before application of the aortic cross clamp. His blood results on admission to the critical care unit are as follows: Full blood count Hb 8 g/dl Platelets 40 * 109/l WBC 7.1 * 109/l His fibrin degradation products are measured and found to be markedly elevated. What accounts for these results?

Answer 86

DIC

Question 87

A 34-year-old man presents to his GP with a 6-month history of foul-smelling, fatty stools and weight loss. On examination of the patient's abdomen, no masses or organomegaly are felt. The GP does notice several bruises on the patient's abdomen, yet the patient denies any trauma. The patient's sister has coeliac disease. He reports playing rugby as a child and did not notice unusual bruising. The GP orders several blood tests, shown below: Hb 138 g/L Male: (135-180) Female: (115 - 160) Platelets 260 * 109/L (150 - 400) WBC 6.0 * 109/L (4.0 - 11.0) Prothrombin time (PT) 19 secs (10-14 secs) Activated partial thromboplastin time (APTT) 36 secs (25-35 secs) What is the most likely cause of the patient's bruising?

Answer 87

Vitamin K deficiency

Question 88

A 48-year-old man presents to the hospital complaining of easy bruising. He was recently discharged from the hospital after recovering from community-acquired pneumonia requiring prolonged intravenous and later oral broad-spectrum antibiotics. His vital signs are normal. Laboratory tests are significant for a prolonged prothrombin time, a prolonged partial thromboplastin time, and a normal platelet count. Which is the most likely underlying cause of his condition?

Answer 88

Vitamin k Deficiency

Question 89

prolonged prothrombin and prolonged partial thromboplastin + normal platelet = what disease

Answer 89

Vitamin K deficiency

Question 90

A 40-year-old female is referred to medical assessment unit by her physician for querying thrombotic thrombocytopenic purpura (TTP) after she presented with a temperature of 38.9ºC. Her subsequent urea and electrolytes showed deteriorating renal function with a creatinine 3 times greater than her baseline. What is the underlying pathophysiology of TTP?

Answer 90

TTP is caused by the failure to cleave vWF normally

Question 91

Idiopathic thrombocytopenic purpura (ITP) is a condition characterised by autoimmune destruction of platelets. What type of hypersensitivity is this defined as?

Answer 91

2