Bleeding Disorders Flashcards
What are causes of Peripheral Platelet Destruction?
Coagulopathy - Disseminated intravascular coagulation
Autoimmune - Immune thrombocytopenic Purpura (ITP)
Hypersplenism
What vascular abnormalities can cause platelet problems?
Vasculitis
What are other causes of acquired platelet dysfunction?
Drugs - Aspirin + NSAIDs
Renal failure
Describe Von Willebrand Factor deficiency?
Acquired or Hereditary
Autosomal dominant
Common
Variable severity
Name a type of multiple clotting factor deficiencies?
Disseminated Intravascular Coagulation (DIC)
Name a single clotting factor deficiency?
Haemophilia
What multiple factor deficiencies can cause bleeding issues?
Liver failure
Vit K deficiency, warfarin therapy
Complex coagulopathy - (DIC)
Where are all coagulation factors synthesised?
In hepatocytes
What factors does vit K carboxylate?
Factors II, VII, IX & X
How is Vit K sourced?
Diet
Intestinal synthesis
Absorbed in upper intestine
Required bile salts for absorption
What are causes for Vit K deficiency? (5)
Poor dietary intake Malabsorption Obstructive jaundice Vit K antagonists (warfarin) Haemorrhagic disease of the newborn
Describe Disseminated Intravascular Coagulation (DIC)?
Excessive and inappropriate activation of the haemostatic system - Primary, Secondary, Fibrinolysis
Microvascular thrombus formation - end organ failure
Clotting factor consumption - bruising, purpura and generalised bleeding
Describe Fibrinolysis?
Fibrinogen becomes fibrin
Plasminogen becomes plasmin
Plasmin converts fibrin into FDPs (Fibrin Degradation Products) e.g. D-Dimers
What are causes of DIC?
Sepsis
Obstetric emergencies
Malignancy
Hypovalaemic shock
How do you treat DIC?
Treat underlying cause Replacement therapy: - Platelet transfusion - Plasma transfusion - Fibrinogen replacement
Describe Haemophilia
X-linked hereditary
Abnormally prolonged bleeding recurs episodically
What causes Haemophila A?
Factor VIII deficiency
What causes Haemophila B?
Factor IX deficiency
What are clinical features of severe haemophilia?
Recurrent haemarthroses
Recurrent soft tissue bleeds - bruising in toddlers
Prolonged bleeding after dental extractions, surgery and invasive procedures
What is seen in single factor deficiency?
Isolated prolonged APTT
What else can haemophilia cause?
Joint problems
Arthropathy (caused by multiple events of bleeding into the joint, fusion occurs)
What else can prolong the APTT?
Heparin therapy
