Bleeding disorders Flashcards
Primary hemostasis
Platelet plug
Secondary Hemostasis
coagulation cascade
Epistaxis with gingival bleeding, easy bruising and menorrhagia is hallmark
primary hemostasis failure
Delayed bleeding, or bleeding into muscles and joints is consistent with
secondary hemostasis failure
Identifies platelet disorders and vessel-wall integrity
Bleeding time
Tests conversion of fibrinogen to fibrin
Thrombin time
Used to identify excessive fibrinolysis
Fibrinogen, fibrinogen degradation products, d-dimer
Common acquired bleeding disorders
Liver Disease
Vit K def
Factor inhibitors
DIC
Bleeding due to Vit K def should be treated with
FFP
Bleeding due to factor inhibitor should be treated with
Activated factor concentrate (kcentra?)
Immunosuppression
Peripheral smear in DIC
Schistocytes
Treatment for bleeding in DIC
platelets and coag factory replacement
Treat underlying disorder
Serious bleeding at any INR in patient on warfarin
Kcentra/ 4f=PCC or 3fPCC with FFP or rfVIIa
Differentials for Prolonged PT and normal aPTT
Factor VII deficiency or inhibitor
Liver disease
Vit K def
Warfarin ingestion
Differentials for normal PT, prolonged aPTT
Deficiency of Factors VIII, IX, XI or XII
vWD (if factor VIII is low)
Heparin exposure
Differentials for Prolonged PT and aPTT
Deficiency of factors V, X, II or fibrinogen
Severe liver disease, DIC, Vit K def, warfarin toxicity
Heparin overdose
Differentials for Normal PT and aPTT in a patient who is bleeding
Platelet dysfunction vWD (if mild bleeding and FVIII is not too low) Scurvy Ehlers-Danlos Hereditary hemorrhagic telangiectasia Factory XIII deficiency
Factor associated with Hemophilia A
Factor VIII
Factor associated with Hemophilia B
Factor IX
Factor XI deficiency is rare and mild. It is found in
Ashkenazi Jews
Prolonged PTT, normal PT, thrombin time and bleeding time
PT and PTT findings in hemophilia
PT normal, PTT prolonged
What should mild Hemophilia A patients receive for acute bleeding and before minimally invasive procedures
Desmopressin
How to differentiate Liver disease labs from DIC
Factor VIII
Made by endothelial cells
Most common inherited bleeding disorder
vWD
Normal function of vWF
vWF adheres platelets to injured vessels and carries VIII
Lab findings in vWB
elevated bleeding time, normal PT, normal or prolonged PTT
Treatment for vWD
Estrogen- can regulate menstrual cycle and increase vWF
DDAVP before minor procedures
Pure factor VIII (contains vWF)
Cryo should not be used to treat vWD because of its
increased transfusion infection risk
