Bleeding Disorders Flashcards
Most common bleeding disorder?
von Willenbrand disease
Without adequate von Willenbrand factor you end up this?
bleeding
Common symptoms of von Willenbrand disease
mucosal bleeding
severe: deep joint bleeding
Abnormal lab tests with von Willebrand disease
Bleeding time
PTT
vWF (normal with type 2)
Some ways von Willenbrand disease is treated
DDVAP(spray)
cryoprecipitate
Factor VIII
Describe the different types of von Willenbrand disease
Type 1 - decreased vWF - 70%
TYpe 2 - abnormal vWF - 25%
Type 3 - no vWF - 5%
Hereditary pattern for Hemophillia
x-linked recessive
Describe factor bleeding
Deep joint bleeding
Big bleeds
trauma
Abnormal lab tests found in Hemophillia
Factor VIII assay
DNA studies
Difference between Hemophillia A and B
Factor decreased - A = 8, B = 9
Name some hereditary platelet disorders
Bernard-Soulier Syndrome
Glanzmann Thrombasthemia
Gray Platelet Syndrome
Delta granule Deficiency
Bernard soulier syndrome is caused by this abnormality
1b problems leading to abnormal adhesion
Lack of IIb/IIIa prevent aggregation and cause this problem
Glanzmann Thrombastehmia
Acquired bleeding disorders are described by acronyms - name some
DIC
ITP
TTP/HUS
Causes of DIC?
Dumpers - obstetric complications, AML
Rippers - Sepsis, Trauma
Abnormal lab tests with DIC
INR, PTT, TT - prolonged
FDP - increased
Fibrinogen decreased
Idiopathic Thrombocytopneina Purpura is caused by antibodies to tehse proteins
GP IIb/IIIa or GP Ib
How do you diagnose ITP?
Diagnosis of exclusion
Biggest danger of chronic ITP?
Bleeding in the brain
Treatment for ITP
Steroids
Splenectomy
IV immunoglobin
Some things you would see on a blood smear of a patient with ITP
large megakaryocytes
thrombocytopenia
What does TTP stand for?
Thrombotic Thrombocytopenia Purpura
TTP is caused by a deficiency in this
ADAMTS13
ADAMTS13 cleaves vWF, without ADAMTS13 around you get this problem
uncleaved vWF multimers trap platelets
Pentad of symptoms for TTP
MAHA Thrombocytopenia fever neuro problems renal problems
Some causes of Hemolytic Uremic Syndrome
E. coli
defect in complement H
Epidemic HUS can be caused by E. coli which causes this progression of symptoms in kids and old ones
bloody diarrhea then renal failure - fatal 5% of time
Treatment for HUS
Supportive care and dialysis
Antibiotics could increase toxin release
Treatment for TTP differs depending on the type of TTP. Describe treatement for both acquired and hereditary TTP
Acquired - daily plasmapharesis
Hereditary - plasma infusions every 3 weeks
Some causes of Vitamin K deficiency
Factor deficienecies - II, VII, IX, X, protein C and S Coumadin Poor diet malabsorption vit. K defiencey of newborn
Problems with these organs can also cause bleeding problems
Liver - disease and biliary obstruction
Spleen - portal hypertension
