Bleeding Disorders Flashcards
What can lead to failure of primary haemostasis
Vessel wall abnormalities - vasculitis or collagen disorders
Platelet abnormalities: reduced number (affects bone marrow), reduced function (immune thrombocytopaenia)
VWF: usually reduced amount of VWF but can also be due to abnormal VWF (hereditary)
What acquired vascular abnormalities can lead to bleeding disorders
Vasculitis - leads to leaky vessel walls
e.g. Henoch-schonlein purpura seen in kids after a viral infection
How does Henoch-schonlein purpura present
PR bleeding
Pupura on the lower limbs
Common in paeds
Seen after viral infection
When might you see scurvy
Alcoholics with a poor diet
ED
What can cause a thrombocytopaenia
Hereditary causes - rare
Marrow disorder - reduced production
Autoimmune conditions - increased platelet destruction
List causes of peripheral platelet destruction
DIC - used up
Autoimmune destruction - Immune thrombocytopenic purpura
Hypersplenism
What can cause functional deficits in platelets
Hereditary causes - very rare
Drugs most common (often deliberately – antiplatelets)
Renal failure - uraemia interferes with their function
What type of inheritance is vWF deficiency
Autosomal dominant
It is a common condition
What bleeding pattern does vWF deficiency have
Primary haemostatic problems such as mucosal bleeding – menorrhagia, nosebleeds, mouth
How can you treat peripheral platelet destruction due ot ITP
Suppress the antibody with steroids
How do you treat thrombocytopaenia caused by marrow failure
Platelet transfusion
It is a failure of production so would replace it
Are single clotting factor deficiencies usually hereditary or acquired
Usually hereditary
e.g. haemophilia
Are multiple clotting factor deficiencies usually hereditary or acquired
Generally acquired
e.g. DIC
What can lead to multiple factor deficiencies
Liver failure
Vitamin K deficiency or warfarin therapy
Where are clotting factors produced
All are made in the liver
Which clotting factors are dependent on vitamin K
2, 7, 9 and 10
What can cause vitamin K deficiency
Poor dietary intake Malabsorption Obstructive jaundice Vitamin K antagonists (warfarin) Haemorrhagic disease of the newborn
How does DIC present
End organ failure - caused by microvascular thrombi
Bruising, purpura and generalised bleeding - occur as the clotting factors are used up
What can cause DIC
Sepsis
Obstetric emergencies
Malignancy
Hypovolaemic shock
How do you treat DIC
Treat the underlying cause
Replacement therapy= Platelet transfusions
Plasma transfusions
Fibrinogen replacement
What pattern of inheritance does haemophilia follow
X-linked
Therefore much more common in men a
Females are carriers
Which type of haemophilia is more common
A
What are the clinical features of severe haemophilia
Recurrent Hemarthroses - joint bleeds
If repeated can lead to arthritis and needs replacement
Recurrent soft tissue bleeds
Bruising in toddlers
Prolonged bleeding after dental extractions, surgery and invasive procedures
What is the definition of massive haemorrhage by clinical situation
Bleeding that leads to a HR of over 110 and/or systolic of less than 90
Bleeding which has already prompted use of emergency O Rh(D) negative red cells
