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3 Haematology > Bleeding Disorders > Flashcards

Bleeding Disorders Flashcards

1
Q

why are your blood vessels less efficient as you age?

A

lose collagen more easily

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2
Q

causes of vessel wall problems that affect platelet plug formation?

A 
steroids
ageing
vasculitis eg HSP (antibodies stick to vessel wall)
vitamin C deficiency
inherited eg marfans
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3
Q

why can aspirin cause failure of platelet plug formation?

A

it is an antiplatelet so causes a reduced number

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4
Q

VW disease is more commonly presented in women/men

A

women

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5
Q

main clinical sign of thrombocytopenia

A

petechial rash in the lower limbs

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6
Q

thromocytopenia is more commonly hereditary/acquired

A

acquired

autoimmune is most common

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7
Q

causes of platelet destruction in thrombocytopenia

A

coagulopathy eg DIC
ITP
hypersplenism

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8
Q

what is ITP?

A

making antibodies against your own platelets

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9
Q

1st line Tx ITP

A

prednisolone

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10
Q

platelets last for _ days

A

7

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11
Q

why do you get hypersplenism in portal HT

A

blood backs up from the liver and diverts to the spleen

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12
Q

is acquired or hereditary VWF disease more common?

A

hereditary

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13
Q

inheritance for hereditary VWF disease?

A

AD

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14
Q

commonest cause of primary haemostatic failure

A

thrombocytopenia

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15
Q

multiple clotting factor deficiencies are generally acquired/hereditary

A

acquired

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16
Q

4 clotting factors need vitamin K activated to form, what are they?

A

2
7
9
10

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17
Q

what step do the vitamin K dependent CFs need and why?

A

carboxylation

makes them negative

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18
Q

causes of multiple factor deficiencies?

A

warfarin therapy
liver failure
coagulopathy eg DIC

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19
Q

why does warfarin therapy cause CF deficiency?

A

reduces vit K levels which is required for some CF formation

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20
Q

what does vitamin K need to be absorbed?

A

bile salts

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21
Q

where is vit K absorbed?

A

jejeunum

ileum

22
Q

why can obstructive jaundice cause Vit K deficiency

A

gallstones block bile duct = reduced bile salt release = vit k deficiency

23
Q

causes of reduced vit k?

A 
poor diet
malabsorption
obstructive jaundice
vit k antagonists eg warfarin
haemorrhagic disease of newborn
24
Q

define DIC

A

excessive activation of the haemostatic system (primary, secondary, fibrinolysis)

25
Q

pathophysiology of DIC

A

TF expressed -> clotting -> more damage -> more clotting -> thrombus -> overuse of clotting factors = massive bleeding

26
Q

screening test for extrinsic pathway (TF)?

A

PT

play tennis - outside

27
Q

screening test for intrinsic pathway (8 etc)?

A

APTT

play table tennis - inside

28
Q

if PT and PTT are low, where is the problem?

A

problem with 5, 10 or

multiple clotting factor deficiency

29
Q

how are fibrin degradation products measured?

A

D dimers

30
Q

high D dimers means..

A

using up clotting fibres to cause fibrinolysis eg in DIC

31
Q

causes of DIC

A

sepsis eg meningitis/gram -ve
obstetric emergencies
malignancy
hypovolaemic shock

32
Q

what obstetric emergencies cause DIC and why?

A

placental abruption
infarction from PET
triggers TF release, inducing DIC

33
Q

Tx DIC

A

get a senior
treat cause eg antibiotics/delivery of placenta
REPLACE- platelets/plasma/fibrinogen transfusions

34
Q

FFP can be used to replace what?

A

blood clotting factors

CFs are present in plasma

35
Q

cryoprecipitate is good for replacing what?

A

fibrinogen (to make fibrin)

36
Q

inheritance of haemophilia

A

X linked so only affects boys

37
Q

where does bleeding most commonly present in haemophiliacs?

A
  1. ankle joint
  2. knee joint
  3. elbow joint
38
Q

haemophilia A/B is more common

A

A

39
Q

clinical features of haemophilia

A

haemarthrosis
recurrent soft tissue bleeds
bleeding after surgery/dental extractions

40
Q

complications of haemophilia?

A

iron inflames the synovium from haemarthrosis and causes neovascularisation of new vessels which are prone to bleeding

41
Q

haemophilia is a disruption of primary haemostasis T or F

A

F, secondary haemostasis as cant make factor 8/9 to form fibrin

42
Q

what screening test will be abnormal in haemophilia?

A

APTT

43
Q

medical term for a normal bruise

A

purpura

44
Q

people with thrombocytopenia get a __ rash

A

petechial

45
Q

thrombocytopenia means…

A

low platelets

46
Q

what initiates the extrinsic pathway

A

tissue thromboplastin

47
Q

what initiates the intrinsic pathway

A

contact activators

48
Q

how is warfarin screened and why?

A

PT as factor 7 is most sensitive

49
Q

how is heparin screened and why?

A

aPTT

50
Q

VWF is carried around on…

A

factor 8

51
Q

what age does VWF disease present?

A

adulthood

52
Q

ideal INR?

A

2-3

3 Haematology (30 decks)

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