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Haematology > Bleeding Disorders > Flashcards

Bleeding Disorders Flashcards

1
Q

What to remember when taking a bleeding Hx

A
  • Has the patient really got a bleeding disorder?
  • How severe is the disorder? (ie how appropriate is the bleeding)
  • Pattern of bleeding
  • Cognenital or acquired
  • Mode of inheritance
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2
Q

Types of bleeding

A
  • Bruising
  • Epistaxis
  • Post-surgical bleeding
  • Menorrhagia
  • Post-partum haemorrhage
  • Post-trauma
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3
Q

How to categorise the pattern of bleeding

A

Platelet type of coagulation factor

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4
Q

If the platelets were at fault in a bleeding disorder what kind of bleeding would occur

A
  • Mucosal
  • Epistaxis
  • Purpura
  • Menorrhagia
  • GI
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5
Q

If the coagulation factors were at fault in a bleeding disorder what kind of bleeding would occur

A
  • Articular
  • Muscle haematoma
  • CNS
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6
Q

3 types of hereditary bleeding disorders

A
  • Haemophilia A
  • Hamophilia B
  • Von Willebrand Disease
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7
Q

Difference between Haemophilia A + B

A
  • Both X-linked
  • With identical phenotype
  • Just slightly different mutation
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8
Q

Haemophilia clinical features

A
  • Haemarthrosis
  • Muscle haematoma
  • CNS bleeding
  • Retroperitoneal bleeding
  • Post surgical bleeding
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9
Q

Complications of haemophilia

A
  • Synovitis
  • Chronic haemophilic arthropathy
  • Neurovascular compression ( compartment syndrome)
  • Other bleeding issues like stroke
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10
Q

What investigations diagnose Haemophilia

A
  • Prolonged APTT (activated partial thromboplastin time)
  • Normal PT and BT
  • Reduced factor VII or FIX
  • Genetic analysis
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11
Q

Rx for bleeding diathesis in Haemophilia

A
  • Coagulation factor replacement
  • Tranexamic acid
  • Desmopressin IV, PO or sublingual (DDAVP) [only in mild haemophilia A, no use if severe or haemophilia B]
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12
Q

How does desmopressin treat haemophilia

A

Stimulates the release of Von Willebrand factor + coagulant factor VIII

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13
Q

Management of haemophilia (no the bleeding diathesis)

A
  • Splints
  • Physiotherapy
  • Analgesia
  • Synovectomy
  • Joint replacement
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14
Q

What is bleeding diathesis

A

Unusual succeptibility to bleed

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15
Q

What is bleeding diathesis

A

Unusual susceptibility to bleed

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16
Q

Complication of Desmopressin (DDAVP)

A
  • MI

- Hyponatraemia in babies

17
Q

What type of bleeding does Von Willebrand Brand disease cause

A

Platelet type (mucosal e.g. mouth, lips, tongue)

18
Q

2 types of abnormalites of the VWF in von willebrand disease

A
  • Quantitative

- Qualitative

19
Q

3 types of Von Willebrand Disease

A
  • Type 1 = Quantitative deficiency
  • Type 2 = Qualitative deficiency
  • Type 3 = severe (complete) deficiency
20
Q

What investigations diagnose Von Willebrand disease

A
  • Prolonged APTT (activated partial thromboplastin time)
  • Increased BT
  • Reduced factor VIII
  • Reduced vWF Ag
21
Q

What does vWF do

A
  • Brings platelets into contact with exposed subendothelium
  • Makes platelets bind to each other
  • Binds platelets to factor VIII (protecting it from destruction in circulation)
22
Q

Rx for Von Willebrand Disease

A
  • vWF concentrate or Desmopressin (DDAVP)

- Tranexamic acid

23
Q

5 types of acquired bleeding disorders

A
  • Thrombocytopenia
  • Liver failure
  • Renal failure
  • DIC
  • Drugs (warfarin, heparin, aspirin, clopidogrel, rivaroxaban etc)
24
Q

Causes of thrombocytopenia

A
  • Decreased production (marrow failure)

- Increased consumption (DIC, hypersplenism, ITP)

25
Q

How does ITP present and what cuases it

A

Immune Thrombocytopenia Purpura

  • Usually in children
  • Low platelet count, normal bone marrow, absence of other causes of thrombocytopenia
  • Purpuric rash + increased tendency to bleed
  • Caused by antiplatelet autoantibodies
26
Q

4 types of bleeding seen in thrombocytopenia

A
  • Petechia
  • Ecchymosis (discoloration of skin due to bleeding underneath)
  • Mucosal bleeding
  • Rare CNS bleeding
27
Q

What is Ecchymosis

A

Discoloration of skin due to bleeding underneath

28
Q

What is Immune Thrombocytopenia Purpura (ITP) associated with

A
  • Infection (esp. EBV, HIV)
  • Collagenosis
  • Lymphoma
  • Drug induced
29
Q

Who is mainly affected by chronic ITP and what are the symptoms

A
  • Women

- Epistaxis + Menorrhagia

30
Q

Rx of ITP

A

Only if symptomatic

  • Prednisolone
  • Thrombopoietin analohues (Eltrombopag)
  • IV IgG
  • Splenectomy (cures =80%)
  • Immnosuppression if splenectomy fails (azathioprine)
31
Q

Investigations to diagnose ITP

A
  • Megakarocytes in marrow (?marrow biopsy?)

- Serum anitplatelet autoantibodies (?ELISA procedure?)

32
Q

Changes related to bleeding in liver failure

A
  • Reduced Factor I, II, V, VII, VIII, IX, X, XI
  • Prolonged PT + APTT
  • Reduced fibrinogen
33
Q

Rx bledding disorders in liver failure

A
  • Replacement FFP

- Vit K

34
Q

Cause of haemorrhagic disease of the newborn (HDN)

A

Vitamin K deficient diet

35
Q

Complication of HDN

A

Fatal or incapacitating haemorrhage

36
Q

How to prevent HDN

A

Vitamin K IM/PO at birth

Haematology (24 decks)

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