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3 HAEM > BLEEDING DISORDERS > Flashcards

BLEEDING DISORDERS Flashcards

1
Q

what can cause reduced collagen

A

old age

steroid use

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2
Q

why can vitamin C deficiency cause failure of primary Haemostasis

A

its needed to make collagen

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3
Q

what are the four main mechanisms of bleeding disorder

A

failure of primary Haemostasis (platelet plug)
failure of secondary Haemostasis (fibrin clot)
excess fibrinolysis
excess anticoagulant defences

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4
Q

what are the three main reasons for failure of platelet plug formation

A

vascular
platelets
von willebrand factor

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5
Q

reasons for thrombocytopaenia

A

coagulopathy
autoimmune disorders
hypersplenism
marrow pathology

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6
Q

which drugs can cause problems with platelet function

A

NSAIDs
aspirin
warfarin

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7
Q

why can renal failure cause failure of primary Haemostasis

A

uraemia interferes with platelet function

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8
Q

what is the commonest cause of primary haemostatic failure

A

thrombocytopenia

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9
Q

describe the extrinsic pathway

A

TF > VIIa > V > Xa > thrombin > fibrin

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10
Q

describe the intrinsic pathway

A

thrombin > VIII/IXa > V > Xa > thrombin > fibrin

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11
Q

causes of multiple clotting factor deficiencies

A 
liver failure (clotting factors are made in the liver)
vitamin K deficiency 
complex coagulopathy
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12
Q

what can cause vitamin K deficiency

A 
poor dietary intake 
malabsorption 
obstructive jaundice (bile salts needed to absorb vitamin K)
vitamin K antagonists 
haemorrhage disease of the newborn
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13
Q

what is the function of vitamin K in the clotting cascade

A

it is needed to carboxylate factors II, VII, IX and X

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14
Q

as well as diet, how else is vitamin K obtained by the body

A

it is produced by gut bacteria

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15
Q

causes of DIC

A

sepsis
obstetric emergencies
malignancy
trauma

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16
Q

management of DIC

A

treat the underlying cause

supportive therapy

17
Q

which coagulation pathway does prothrombin time reflect

A

extrinsic

18
Q

which factors are measured by prothrombin time

A 
fibrinogen 
prothrombin
V
VII
X
19
Q

which pathway does APTT reflect

A

intrinsic

20
Q

which factors does APTT measure

A 
fibrinogen 
prothrombin
V
VIII
IX
X
XI
XII
21
Q

prolongation of both PT and APTT suggests….

A

general deficiency of both pathways

22
Q

prolongation of PT suggests….

A

deficiency in the extrinsic pathway

23
Q

prolongation of the APTT suggests…

A

deficiency in the intrinsic pathway

24
Q

which substance breaks down fibrin

A

plasmin

25
Q

give an example of a fibrin breakdown product the can be measured

A

D-dimer

26
Q

why is D-dimer high in DIC but low in liver disease

A

it is high in DIC because there are high rate of fibrinolysis (lots of fibrin is being broken down)

it is low in liver disease because the liver is unable to produce the clotting factors in the first place

27
Q

why is haemophilia rare in girls

A

it is X-linked

28
Q

which part of the body is most commonly affected by haemophilia

A

joints eg ankle, knee, elbow

29
Q

how does haemophilia cause joint damage

A

general activity causes bleeding in the joints (haemoarthosis)
iron in blood irritates the synovial leading to inflammation
inflammation causes neovascularisation with fragile blood vessels
fragile blood vessels are more likely to bleed, starting the cycle again

30
Q

why does bleeding tend to occur from medium to large blood vessels in haemophilia

A

they still have platelets so small, minor bleeds can be healed, but large vessels would need a fibrin clot

31
Q

clinical features of haemophilia

A

recurrent haemoarthroses
recurrent soft tissue bleeds
prolonged bleeding after dental extraction and invasive procedures

32
Q

what is the difference between haemophilia A and B

A 
A = factor VIII deficiency 
B = factor IX deficiency

3 HAEM (20 decks)

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