Bleeding Disorders Flashcards

1
Q

Normal haemostastic response

A

Primary- Platelet Plug formation, platelets, vWF, endothelial wall

Secondary- Fibrin plug formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is haemorrhagic diathesis?

A

Unusual susceptibility to bleed

  • Any quantitative or qualitative abnormality inhibition of function
  • Due to platelets, vWF, coagulation factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Points to ask in bleeding disorders bleeding history?

A
Has patient got a bleeding disorder, 
How severe is it?,
pattern of bleeding, 
Congenital or acquired, 
Mode of inheritance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Key points to ask about with suspected bleeding disorder to ascertain how severe?

A
How appropriate? 
Bruising, 
Epistaxis, 
Post surgical bleeding (how long? Outcome? Dental surgery, tonsillectomy?)
Menorrhagia,
Post-partum haemorrhage, 
Post-trauma,
Spontaneously?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If due to platelets what types of bleeds are you likely to see?

A
Mucosal 
Epistaxis 
Purpura 
Menorrhagia 
GI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If due to coagulation factors what types of bleeds are you likely to see?

A

Articular
Muscle haematoma
CNS (intracranial bleed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Questions to ask to assess if bleeding disorder is congenital or acquired

A

Previous episodes ?
Age at first visit for bleed ?
Previous surgical challenges ?
Associated history ?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of inheritance of haemophilia

A

X-linked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is haemophilia?

A

Genetic disorder impairing body’s function to make clots

Severity of bleeding depends on the residual coagulation factors activity:
<1% severe
1-5% moderate
5-30% mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Presentation of haemophilia

A

Haemoarthrosis: Bleeding into joint

Muscle Haematoma: Bleeding into muscle

CNS bleeding: Less commonly seen

Retroperitoneal bleeding

Post-surgical bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Difference between haemophilia A and B

A

A=deficiency in factor 8

B=deficiency in factor 9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Haemophilia clinical complications

A

Synovitis,
Chronic haemophilic arthropathy,
Neurovascular compression (eg compartment syndromes),
Other sequelae of bleeding (eg stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Haemophilia diagnosis

A
Clinical, 
Prolonged APTT,
Normal PT, 
Reduced factor 8 or 9,
Genetic analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Haemophilia treatment of bleeding diathesis

A
Coagulation factor replacement, 
DDAVP (causes release of vWF)
Tranexamic acid, 
Prophylaxis,
Gene therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of haemophilia to prevent bleeds

A
Splints, 
Physiotherapy, 
Analgesia, 
Synovectomy, 
Joint replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Haemophilia treatment complications

A

Viral infection- HIV, HBV, HCV
Inhibitors- anti FVIII antibodies
DDAVP- MI, hyponatraemia

17
Q

Typical clinical picture of haemophilia

A

Male
6mnts-1yr
Bleeding into joint

18
Q

What is the inheritance type of Von Willebrand Disease

A

Autosomal dominant

19
Q

Presentation of Von Willebrand Disease

A
Mucosal pattern of bleeding:
Easily bruising,
Large bruises,
Frequent/prolonged epistaxis,
Bleeding gums,
Heavy/prolonged bleeding from cuts,
Menorrhagia,
Post partum haemorrhage
20
Q

Von Willebrand Disease types

A

Type I:
Mildest and most common form
Quantitative defect
Don’t make enough

Type II (A,B,M,N):
Qualitative deficiency
Quality of the protein is not good enough
Doesn’t work properly

Type III:
Severe
Complete deficiency

21
Q

Treatment of Von Willebrand Disease?

A

vWF concentrate or DDAVP
Tranexamic acid
Topical applications
OCP

22
Q

Causes of acquired bleeding disorders

A
Thrombocytopenia,
Liver failure, 
Renal failure, 
DIC, 
Drugs- warfarin, heparin, aspirin, clopidogrel, rivaroxaban, apixaban, dabigatran, bivalirudin
23
Q

Causes of thrombocytopenia

A

Decreased production of platelets:

  • marrow failure
  • aplasia
  • infiltration

Increased consumption of platelets:

  • immune ITP
  • non immune DIC
  • hypersplenism
24
Q

Thrombocytopenia clinical presentation

A

Petechia,
Ecchymosis,
mucosal bleeding,
Rare CNS bleeding

25
What does ITP stand for
Immune Thrombocytopenic purpura
26
What is Immune thrombocytopenia purpura?
Defined as low platelet count with normal bone marrow And absence of other causes of thrombocytopenia 2 distinct patterns: Acute and Chronic
27
Describe immune ITP
Caused by antiplatelet antibodies Acute: Children Following acute infection Self-limiting purpura Chronic: Adults Mainly women Fluctuating course
28
What is associated with ITP
Infection esp. EBV, HIV Collagenosis Lymphoma Drug induced esp quinine
29
Treatement for ITP
Steroids, IV IgG, Splenectomy, Thrombopoietin analogues (Eltrombopag, romiplostim)
30
What coagulation factors are associated with liver | And diagnostic findings of liver failure with regards to bleeding?
Factor I, II, VII, IX, X, XI Prolonged PT and APTT Reduced fibrinogen
31
Treatment of bleeding in liver failure
FFP, | Vitamin K
32
Treatment of haemorrhagic disease of newborn
Vitamin K !!