Bleeding disorders

Question 1

Immediate bleeding

Nosebleeds, HMB, ptechiae, gum bleeding, prolonged bleeding after little scratches

Answer 1

Primary haemostatic disorder
(formation of unstable platelet plug problem)
E.g. VWD, platelet disorder

Question 2

Delayed bleeding

Bleeding into joints + muscles (haemarthroses), large deep bruises, ecchymoses

Answer 2

Secondary haemostatic disorder
(clotting cascade problem)
E.g. coagulation factor deficiency

Question 3

Primary haemostatic disorders

Answer 3

VWD
Platelet disorder (low or defect)

Question 4

Secondary haemostatic disorders

Answer 4

Coagulation factor deficiency

Question 5

3 causes of low platelets

Answer 5

Decreased production
Decreased survival (e.g. ITP)
Increased utilisation (e.g. DIC)

Thrombocytopenia may be immune-mediated (most idiopathic, drug-induced (lots of drugs e.g. quinine, anti-TB drugs like rifampicin, Abx e.g. vancomycin) as well as CT diseases like SLE and sarcoid, leukaemias / lymphomas, ITP– in all the platelets are recognised as foreign and destroyed). There are also non-immune-mediated causes like MAHA (HUS, TTP, DIC), HSP, pseudothrombocytopenia (clumping) and back-up in the spleen (splenomegaly)

Question 6

Platelets destroyed by antiplatelet antibodies
Preceding infection in child
Low platelets

Answer 6

ITP

Primary haemostatic disorder
Platelets destroyed by antiplatelet antibodies
2 syndromes - child + adult
Child = preceding infection, self-limiting in 2-6w, no treatment
Adult = women, lifelong condition, platelet count usually preserved

Question 7

AR condition
Raised bleeding time + raised APTT
Low factor 8 levels

Answer 7

VWD

Question 8

Factor VIII deficiency

Answer 8

Haemophilia A

Think Haemophilia Ate

Question 9

Factor IX deficiency

Christmas disease

Answer 9

Haemophilia B

Question 10

Prolonged APTT

Ecchymoses

Answer 10

Haemophilia

Question 11

Inheritance of Haemophilia

Answer 11

X-linked recessive

Question 12

Inheritance of VWD

Answer 12

Autosomal recessive

Question 13

Prolonged APTT + PT

Deficiency of factors 2, 7, 9 and 10, protein C + S

Answer 13

Vitamin K deficiency

Question 14

Mixed haemostatic disorders

Answer 14

DIC

Liver disease

Question 15

DIC

Answer 15

Systemic activation of coagulation = fibrin deposition + thrombosis in vessels = platelet + clotting consumption = resultant bleeding
Causes include sepsis, trauma, malignancy, placental abruption, amniotic fluid embolism, vascular disorders, toxin
Fragmented RBCs (schistocytes) on blood film as deposited fibrin breaks up RBCs

Question 16

Liver disease

Answer 16

Decreased clotting factor synthesis
Dietary vitamin K deficiency (inadequate intake or malabsorption)
Enhanced fibrinolysis
DIC
Thrombocytopenia due to hyposplenism

Question 17

VWD treatment

Answer 17

Desmopressin (increases VWF + factor VIII)

Question 18

Causes of vitamin K deficiency

Answer 18

Coeliac disease
Drugs (isoniazid, rifampacin, anti-convulsants, anti-coagulants)
Lack of vitamin K injection in baby

Question 19

MAHA
Jaundice, fever, worsening headache + renal impairment
Low platelets

Answer 19

TTP