Bleeding disorders Flashcards
Important questions in bleeding history
is this a bleeding disorder? severity? pattern of bleeding congenital or acquired mode of inheritance
History of bleeding
epistaxis bruising menorrhagia previous surgeries eg appendicectomy, dental PPH post trauma
Platelet type bleeding
mucosal GI menorrhagia pupura epistaxis
Coagulation factor type bleeding
haemarthrosis
muscle haematoma
CNS
haemophilia A and B factor
A = 8, B=9
Is haemophilia A or B more common?
A
inheritance of haemophilia
x-linked
residual coagulation factor activity and severity in haemophilia
<1% = severe 1-5% = moderate 5-30% = mild
Clinical signs of haemophilia
post surgical bleeding haemarthrosis - weight bearing, hinge joints muscle haematoma retroperitoneal bleed CNS bleed
Complications of haemophilia
synovitis
chronic haemophilic arthropathy
stroke
neurovascular compression - compartment syndrome
diagnosing haemophilia
genetics
factor 8/9 low
clinical
prolonged APTT, normal PT
treating of bleeding - haemophilia
factor 8/9 replacement
desmopressin
tranexamic acid
Complications of haemophilia treatment
viruses! eg HIV, HPC - not anymore
desmopressin = MI, hyponatraemia
Haemophilia - other treatment
synovectomy joint replacement splints physio analgesia
vW disease prevalence and inheritance
1 in 200
autosomal dominant
What pattern of bleeding does vW disease follow - platelet or coagulation?
platelet
Treatment of vW disease
vW concentrate
desmopressin
tranexaminc acid
OCP
Acquired bleeding disorders
renal/liver failure, thrombocytopenia, DIC, drugs etc
drugs - acquired bleeding disorders
aspirin
clopidogrel
warfarin etc
thrombocytopenia causes
increased consumption
decreased production
increased - DIC, immune ITP, hypersplenism
decreased - infiltration, marrow failure, aplasia
clinical picture of thrombocytopenia
ecchymosis
petechiae
mucosal bleeding
rare CNS bleeding
ITP associations
infection (HBV, HIV), lymphoma, drug induced
treating ITP
steroids, IV IgG, splenectomy, thrombopoietin analogues
Liver failure - acquired bleeding and treatment
produce clotting factors
vitamin K clotting factors
give vitamin K and replacement fresh frozen plasma
What precipitates bleeding in liver failure?
infection, renal failure etc
Haemorrhagic disease of newborn
immature coagulation system
vit K deficienct diet (breast milk)
Give vit K at birth
