Bleeding disorders

Question 1

Over-anticoagulation

Cause

Answer 1

Warfarin

Question 2

Over-anticoagulation

Treatment

Answer 2

Major bleeding from orifices - life-threatening:

• Stop warfarin
• Give Vit K by slow IV injection (antidote)
• FFP

INR > 8, no/minor bleeding:

• Stop warfarin
• Give Vit K by slow IV injection

Any other INR > target range:

• Stop warfarin
• Restart when INR < 5

Question 3

Haemophilia A

Patho (3)

Answer 3

• X-linked recessive inheritance
• Factor VIII deficiency
• Impairs body’s ability to make blood clots

Question 4

Haemophilia A

Symptoms (2)

Answer 4

• Bleeds into joints -> crippling arthropathy

- Bleeds into muscle -> haematomas

Question 5

Haemophilia A

Diagnosis (2)

Answer 5

• Raised APTT

- Reduced factor VIII plasma levels

Question 6

Haemophilia A

Treatment (3)

Answer 6

• Avoid NSAIDs and IM injections
• DESMOPRESSIN - raises factor VIII
• IV infusion of recombinant factor VIII

Question 7

Haemophilia B

Answer 7

‘Christmas disease’

• Behaves clinically like Haemophilia A
• However, is due to factor IX deficiency
• Treat with factor IX concentrates

Question 8

Von Willebrand’s Disease

VW’s roles in clotting

Answer 8

1. Brings platelets into contact with exposed sub-endo
2. Makes platelets bind to each other
3. Binds factor VIII, protecting it from destruction in circulation

Deficiency -> Defective platelet function and VIII deficiency

Question 9

Von Willebrand’s Disease

Clinical presentation

Answer 9

Bruising
Epistaxis
Menorrhagia
Increased bleeding post tooth extraction

Question 10

Von Willebrand’s Disease

Mild

Answer 10

(Types 1 and 2)

• Autosomal dominant inheritance
• Mucosal bleeding (GI and epistaxis)
• Prolonged bleeding after dental treatment/surgery

Question 11

Von Willebrand’s Disease

Severe

Answer 11

(Type 3)

• Recessive inheritance
• More severe bleeding and symptoms

Question 12

Von Willebrand’s Disease

Diagnosis

Answer 12

• Raised APTT and bleeding time
• Decreased factor VIII clotting activity
• Decreased vWf
• Normal INR and platelets

Question 13

Von Willebrand’s Disease

Treatment

Answer 13

• DESMOPRESSIN

- vWf-containing factor VIII concentrate

Question 14

Vitamin K deficiency

Needed for

Answer 14

Vit K = needed for formation for active factors II, VII, IX and C

Question 15

Vitamin K deficiency

Causes

Answer 15

• Malnutrition
• Malabsorption
• Warfarin treatment (inhibits Vit K synthesis)

Question 16

Vitamin K deficiency

Diagnosis

Answer 16

Increased PT and APTT

Question 17

Vitamin K deficiency

Treatment

Answer 17

Phytomenadione (vit K)