Bleeding Disorders

Question 1

Causes of thrombocytopenia?

Answer 1

Production failure due to loss of megakaryocytes (aplastic anemia) or marrow suppression (drugs)

Reduced life-span due to antibodies (ITP), consumption (DIC, HIT, TTP), hypersplenism

Question 2

What types of bleeding are associated with thrombocytopenia?

Answer 2

Bruising
Petechiae
Mucosal bleeding (nose, gums)
(Infrequently) brain, GI tract

Question 3

2 causes of acquired thrombasthenia:

Answer 3

Drugs (ASA, NSAIDS)

Metabolic (renal failure, liver failure)

Question 4

2 causes of congenital thrombasthenia:

Answer 4

Bernard Soulier (Ib)
Glanzman’s thrombasthenia (IIb IIIa)

Question 5

How do you treat thrombocytopenia or thrombasthenia locally?

Answer 5

pressure, gelfoam and topical thrombin

Question 6

How do you treat thrombocytopenia or thrombasthenia systemically?

Answer 6

Prednisone (ITP)/Rituximab
Platelet transfusion
Eltrombopag
Stop all non-essential drugs

(*treat the cause)

Question 7

Causes of acquired coag disorders:

Answer 7

Iatrogenic – heparins, warfarin
Secondary to liver disease
Disseminated intravascular coagulation (DIC)
Antibodies – acquired hemophilia

*usually multiple deficiencies

Question 8

Causes of inherited coag disorders:

Answer 8

Absence/lack of a single factor
Bleed into deep structures

*usually single deficiency

Question 9

Hemophilia A is due to a factor ___ deficiency

Answer 9

VIII

*1 out of every 10,000 male births

Question 10

Hemophilia B is due to a factor ___ deficiency

Answer 10

IX

*1 for every 9 Hemophilia A’s

Question 11

What is a “very common” inherited coag disease?

Answer 11

von Willebrand disease

Question 12

How are Hemophilia A and B inherited?

Answer 12

sex-linked

Question 13

How do you treat acute Hemophilia bleeding systemically?

Answer 13

replace deficient factor
desmopressin (DDAVP; Stimate) = intranasal
E-aminocaproic acid (Amicar) = used for cuts around nose and mouth

Question 14

How do you treat acute Hemophilia bleeding locally?

Answer 14

immobilize

topical thrombin/Gelfoam/pressure

Question 15

What supplement should be given to patients with Hemophilia?

Answer 15

Iron

Question 16

What are symptoms of von Willebrand type 1?

Answer 16

bruising

mucosal bleeding (nosebleeds, menorrhagia)

Question 17

What are treatments for von Willebrand type 1?

Answer 17

DDAVP

E. aminocaproic acid

Question 18

Three causes of fibrinolysis?

Answer 18

Only common cause: cirrhosis of liver

Occasionally: prostatic cancer or prostate surgery

Question 19

What is symptomatic of Hemophilia, in terms of spontaneous bleeding?

Answer 19

Bleeding/swelling at joints

*i think this is what the pictures were saying?

Question 20

What is the major difference between thrombocytopenias and coagulation dysfunction?

Answer 20

Thrombocyopenia = superficial bleeding
Coagulation = bleed into deep structures (joints and retroperitoneal spaces)