Bleeding disorders Flashcards
What history should be taken if a bleeding disorder us suspected?
Types of bruising
Severity
Pattern
Congenital vs acquired
What types of bleeding may be reported?
Bruising Epistaxis Post surgical Menorrhagia Post partum haemorrhage Post trauma
What is the pattern of platelet type bleeding?
Mucosal Epistaxis Purpura Menorrhagia GI
What is the pattern gf coagulation factor bleeding?
Articular
Muscle haematoma
CNS
What history should be taken to establish congenital vs acquired?
Previous episodes
Age at first event
Previous surgical challenges
Associated history
What is the genetic basis of haemophilia?
X linked
What is distinctive about severe haemophilia?
Spontaneous bleeding
What are the clinical features of haemophilia?
Haemarthrosis- esp in hinge and weight bearing joints Muscle haematoma CNS bleeding Retroperitoneal bleeding Post surgical bleed
How is haemophilia diagnosed?
Clinical Genetic analysis Prolonged APTT Normal prothrombin time Reduced factor VIII or IX
What is the pharm treatment of haemophilia?
Coagulation factor replacement- given as prophylaxis in severe
Demopressin
Tranexemic acid
Analgesia
What is the general management of haemophilia?
Splints
Physio
What is the surgical management of haemophilia?
Synovectomy
Joint replacement
What are the complications of haemophilia?
Synovitis
Chronic haemophilic arthropathy
neuromuscular compression
Other sequelae of bleeding- stroke
What are the complications of demopressin?
MI
Hyponatraemia in babies
What is common in those recieving factor VIII?
Development of inhibitors
What are the types of von Willebrand disease?
Type 1= quantitive deficiency
Type 2= mutation causing poor function
Type 3= complete deficiency
What is the genetic basis of von Willebrand disease?
Autosomal
What is the treatment of von Willebrand?
vWF concentrate or demopressin
Tranexemic acid
OCP for women- prevent menorrhagia
What are the 2 types of causes of thrombocytopenia?
Decreased production
Increased consumption
What are the causes of decreased production thrombocytopenia?
Marrow failure
Aplasia
Infiltration
What are the causes of increased consumption thrombocytopenia?
Immune ITP
Non immune DIC
Hypersplenism
What are the clinical features of thrombocytopenia?
Petechia
Ecchymosis
Mucosal bleeding
Rarely CNS bleeding
What is ITP associated with?
Infection
Lymphoma
Collagenosis
Drug induced
What is the treatment of ITP?
Steroids
IV IgG
Splenectomy
Thrombopoietin analogues
Why does liver failure cause bleeding?
Failure to produce factors I, II, V, VII, VIII, IX, X, XI
what are the clinical features of bleeding caused by liver failure?
Bleeding from structural lesions
how is bleeding due to liver failure diagnosed?
Prolonged prothrombin time and APTT
Reduced fibrinogen
What are the acquired causes of bleeding disorders?
Thrombocytopenia Liver failure Renal failure DIC Drugs
What drugs can cause bleeding disorders?
Warfarin
Heparin
Aspirin
Clopidogrel etc
What causes haemorrhage disease of the newborn?
Vit K deficiency
