Bleeding Disorders

Question 1

Most common bleeding disorder?

Answer 1

von Willenbrand disease

Question 2

Without adequate von Willenbrand factor you end up this?

Answer 2

bleeding

Question 3

Common symptoms of von Willenbrand disease

Answer 3

mucosal bleeding

severe: deep joint bleeding

Question 4

Abnormal lab tests with von Willebrand disease

Answer 4

Bleeding time
PTT
vWF (normal with type 2)

Question 5

Some ways von Willenbrand disease is treated

Answer 5

DDVAP(spray)
cryoprecipitate
Factor VIII

Question 6

Describe the different types of von Willenbrand disease

Answer 6

Type 1 - decreased vWF - 70%
TYpe 2 - abnormal vWF - 25%
Type 3 - no vWF - 5%

Question 7

Hereditary pattern for Hemophillia

Answer 7

x-linked recessive

Question 8

Describe factor bleeding

Answer 8

Deep joint bleeding
Big bleeds
trauma

Question 9

Abnormal lab tests found in Hemophillia

Answer 9

Factor VIII assay

DNA studies

Question 10

Difference between Hemophillia A and B

Answer 10

Factor decreased - A = 8, B = 9

Question 11

Name some hereditary platelet disorders

Answer 11

Bernard-Soulier Syndrome
Glanzmann Thrombasthemia
Gray Platelet Syndrome
Delta granule Deficiency

Question 12

Bernard soulier syndrome is caused by this abnormality

Answer 12

1b problems leading to abnormal adhesion

Question 13

Lack of IIb/IIIa prevent aggregation and cause this problem

Answer 13

Glanzmann Thrombastehmia

Question 14

Acquired bleeding disorders are described by acronyms - name some

Answer 14

DIC
ITP
TTP/HUS

Question 15

Causes of DIC?

Answer 15

Dumpers - obstetric complications, AML

Rippers - Sepsis, Trauma

Question 16

Abnormal lab tests with DIC

Answer 16

INR, PTT, TT - prolonged
FDP - increased
Fibrinogen decreased

Question 17

Idiopathic Thrombocytopneina Purpura is caused by antibodies to tehse proteins

Answer 17

GP IIb/IIIa or GP Ib

Question 18

How do you diagnose ITP?

Answer 18

Diagnosis of exclusion

Question 19

Biggest danger of chronic ITP?

Answer 19

Bleeding in the brain

Question 20

Treatment for ITP

Answer 20

Steroids
Splenectomy
IV immunoglobin

Question 21

Some things you would see on a blood smear of a patient with ITP

Answer 21

large megakaryocytes

thrombocytopenia

Question 22

What does TTP stand for?

Answer 22

Thrombotic Thrombocytopenia Purpura

Question 23

TTP is caused by a deficiency in this

Answer 23

ADAMTS13

Question 24

ADAMTS13 cleaves vWF, without ADAMTS13 around you get this problem

Answer 24

uncleaved vWF multimers trap platelets

Question 25

Pentad of symptoms for TTP

Answer 25

MAHA
Thrombocytopenia
fever
neuro problems
renal problems

Question 26

Some causes of Hemolytic Uremic Syndrome

Answer 26

E. coli

defect in complement H

Question 27

Epidemic HUS can be caused by E. coli which causes this progression of symptoms in kids and old ones

Answer 27

bloody diarrhea then renal failure - fatal 5% of time

Question 28

Treatment for HUS

Answer 28

Supportive care and dialysis

Antibiotics could increase toxin release

Question 29

Treatment for TTP differs depending on the type of TTP. Describe treatement for both acquired and hereditary TTP

Answer 29

Acquired - daily plasmapharesis

Hereditary - plasma infusions every 3 weeks

Question 30

Some causes of Vitamin K deficiency

Answer 30

Factor deficienecies - II, VII, IX, X, protein C and S
Coumadin
Poor diet
malabsorption
vit. K defiencey of newborn

Question 31

Problems with these organs can also cause bleeding problems

Answer 31

Liver - disease and biliary obstruction

Spleen - portal hypertension