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Haematology and Immunology > Bleeding Disorders > Flashcards

Bleeding Disorders Flashcards

1
Q

What is arterial thrombosis

A

When a blod clot forms in the arterial system

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2
Q

Risk factors for arterial thrombosis

A 
Increasing age 
Smoking 
Sedentary lifestyle 
Hypertension 
DM 
Obesity 
Hypercholesterolemia
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3
Q

Describe the clot in arterial thrombosis

A

Platelets and fibrin

White clot

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4
Q

Pathology of arterial thrombosis

A

Results in infarction and ischaemia

Decrease in O2 supply

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5
Q

Example of arterial thrombosis

A

Coronary thrombosis disease:
MI
Angina

Cerebrovascular disease:
Stroke
TIA

Peripheral Disease:
Acute limb ischaemia
Chronic limb ischaemia

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6
Q

Acute presentation Rx for arterial thrombosis

A

Thrombolysis
Anti-platelet/anti-coagulant therapy
Interventional techniques e.g PCI

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7
Q

Primary Rx for arterial thrombosis

A

Lifestyle modification
Smoking cessation
Exercise
Diet ect..

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8
Q

What is a venous thrombosis

A

Thrombus arising in the venous system

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9
Q

Risk factors for venous thrombosis

A 
Increasing age 
Pregnancy
Hormonal therapy (COCP/HRT)
Depoprovera (injection) higher risk than the other progesterone only methods) 
Tissue trauma 
Immobility 
Surgery 
Obesity 
Systemic disease
FH (mainly related to 1st degree relatives
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10
Q

Describe the clot in venous thrombosis

A

Fibrin and red cells

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11
Q

Which aspects of Virchow’s triad tend to be most affected in venous disease

A

Blood flow

Blood constituents

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12
Q

What are the 2 main clinical manifestations of venous thrombosis disease

A

Limb DVT

PE

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13
Q

Rarer clinical manifestations of venous thrombosis disease

A

Visceral venous thrombosis
Intracranial venous thrombosis
Superficial thrombophlebitis

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14
Q

Which Pre-test scores can be used in venous thrombosis disease

A

Wells Score

Geneva Score

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15
Q

If probability score is low what is the next Ix

A

D-dimer

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16
Q

If probability score is high what is the next Ix

A

D-dimer skipped

Go straight to imaging

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17
Q

What is D-dimer a breakdown product of?

A

Fibrinolysis

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18
Q

Imaging Ix for venous thrombosis

A

Doppler USS
V/Q scan
CT Pulmonary Angiogram

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19
Q

Drug Rx for venous thrombosis

A

Anti-coagulants
LMWH
Warfarin
DOACs

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20
Q

Example of case where thrombolysis would be used

A

Massive PE

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21
Q

What is heritable thrombophilia

A

Inherited predisposition to venous thrombosis

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22
Q

Most common type of heritable thrombophilia

A

Factor V Leiden

Prothrombin G20210A

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23
Q

Rare types of heritable thrombophilia

A

Anti-thrombin deficiency
Protein C deficiency
Protein S deficiency

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24
Q

Common type of Acquired haemophilia

A

Anti-phospholipid syndrome

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25
What conditions are most associated with heritable thrombophilia
DVT | PE
26
Ix for thrombophilia
FBC Blood film ``` Clotting: PT Thrombin time APTT Fibrinogen ```
27
Rx for thrombophilia
No specific Rx
28
Who is thrombophilia prophylaxis not required for
Absence of VTE | But advise about risk with COCP or HRT
29
Who is prophylaxis required for in thrombophilia
Long term anticoagulation in those with recurrent episodes with no other risk factors
30
Who should be tested for thrombophilia
``` Arterial thrombus or MI <50yrs Unprovoked VTE <40yrs with no risk factors VTE with oral contraceptive/pregnancy Unusual site thrombosis e.g mesenteric Recurrent fetal loss Neonatal thrombosis ```
31
Pathology of prothrombin G20210A
Produce too much prothrombin Increased tendency to clot Increased risk of thrombosis
32
Pathology of anti-thrombin defiency
Deficit in anti-thrombin | Anti-thrombin is a naturally occurring anti-coagulant
33
Pathology of Protein C deficiency
Protein C is naturally occurring anti-coagulant | => deficiency leads to increased risk of clots
34
What is protein S
Naturally occurring anti-coagulant
35
What does DIC stand for
Diffuse systemic coagulation activation
36
When can DIC typically occur
Septicaemia Malignancy Eclampsia Severe burns
37
Pathology of DIC
Platelet and/or fibrin | Results in diffuse ischaemia affecting extremities
38
Rx for DIC
Mainly directed towards underlying conditions
39
Pathology of Factor V Leiden Syndrome
Hypercoagulable state Prone to thrombosis Mutated factor 5 is resistant to action of Protein C Protein C is a natural anti-coagulant Increased risk of developing DVT (PE) at some point
40
Rx for Factor V Leiden Syndrome
No cure | Prevention of thrombotic complications using medication
41
Miscarriage risk in Factor V Leiden Syndrome
Women with Factor V Leiden 2-3x risk of miscarriage
42
What is deficient in Haemophilia A
Factor 8
43
What is deficient in Haemophilia B
Factor 9
44
Inheritance pattern Haemophili
X-linked
45
What does the severity of bleeding in haemophilia depend on
Residual coagulation factor activity
46
What is common in haemophilia with factor level <1%
severe | Common to have spontaneous bleeding
47
Clinical features of haemophilia
``` Haemoarthrosis Muscle haematoma Post surgical bleeding Typically M 6mnth to 1yr ```
48
Which gender is affected by haemophilia
M
49
Ix for haemophilia
Clinical Prolonged APTT Normal PT Normal BT Reduced Factor 8 or 9 depending
50
Rx for haemophilia
F VIII F IX Injections
51
Prevention Rx for haemophilia
``` Aim to prevent spontaneous bleeding Splints Physio. Analgesia Synovectomy Joint replacement ```
52
Complications of bleeding into muscles
Increased pressure can cause: Nerve palsies Compartment syndrome
53
What blood cell does Von Willebrand Disease affect
Platelets
54
What is the commonest inheritable bleeding disorder
Von Willebrand Disease
55
Inheritance pattern of Von-Willebrand disease
Autosomal dominant
56
What pattern of bleeding is seen in Von-Willebrand disease
Mucosal pattern of bleeding
57
What are the 3 types of Von-Willebrand Disease
Type I, II, III
58
Describe Type I Von Willebrand disease
Mildest from Quantitative defect Don’t make enough
59
Describe Type II Von Willebrand Disease
Qualitative deficiency Quality of the protein is not good enough Doesn’t work properly
60
Describe Type III Von Willebrand disease
Severe (complete deficiency) Most severe Rarest
61
Clinical features of Von willebrand isease
``` Mucosal pattern of bleeding Easily bruising Large bruises Frequent/prolonged epistaxis Bleeding gums Heavy/prolonged bleeding from cuts Menorrhagia PPH (obs) ```
62
Rx for Von Willebrand disease
``` wVF concenrate DDAVP Tranexamic acid Topical applicaitons OCP ```
63
What is thrombocytopenia
Low platelet count
64
what are the causes of thrombocytopenia
Decreased production | Increased consumption
65
Decreased production causes of thrombocytopenia
Marrow failure Aplasia Infiltration
66
Increased consumption causes of thrombocytopenia
Immune ITP Non-immune DIC Hypersplenism
67
Clinical features of thrombocytopenia
Petechia Ecchymosis Mucosal pattern bleeding Rare CNS bleeding
68
What is Immune ITP
Defined as low platelet count with normal bone marrow | And absence of other causes of thrombocytopenia
69
What causes immune ITP
Anti-platelet antibodies | Autoimmune
70
Associations of Immune ITP
Infection esp. EBV, HIV Colagenosis Lymphoma Drug induced (quinine esp.)
71
2 distinct patterns of Immune ITP
Actue | Chronic
72
Typical picture of acute immune ITP
Children Following acute infection Self-limiting purpura
73
Typical picture of chronic immune ITP
``` Adults Mainly women Fluctuating course Bleeding Epistaxis Menorrhagia ```
74
Clinical picture of immune ITP
``` Increased tendency to bleed Petechiae Purpura Menorrhagia Epistaxis Bleeding from gums ```
75
Ix for Immune ITP
Isolated thrombocytopenia Only abnormality = > easy to Dx Diagnosis of exclusion Bone marrow? Very rarely need to do tis to Dx
76
Rx for Immune ITP
Steroids: Dexamethasone Prednisolone IgG transfusion Thrombopoietin analogous: Romiplostim Oral thrombopoietin receptor agonist: Eltrombopag
77
What is Immune ITP a Dx of
Dx of exclusion

Haematology and Immunology (7 decks)

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