Bleeding disorders

Question 1

What is the diagnostic triad of bleeding?

Answer 1

1. Personal Hx of bleeding
2. Family Hx of bleeding
3. Supportive laboratory test

Question 2

What do you look for in a personal Hx when looking to diagnose bleeding disorders?

Answer 2

• Bruising
• Epistaxis (nosebleed)
• GI tract
• Menses
• Urine (Haematuria)
• Surgical Hx
• Dental Hx
• Cuts and injuries

Question 3

What do you look for in a family Hx when looking to diagnose bleeding disorders?

Answer 3

• Known bleeding disorders

* Bleeding in family members especially after surgery or dentistry

Question 4

What blood tests would you order for a suspected bleeding disorder?

Answer 4

Platelets:

• FBC
• Microscopy
• Platelet function assay
• Specialist tests

Coagulation:

• Prothrombin time (PT)
• Activated partial thromboplastin time (APTT)
• Thrombin time (TT)
• Clauss Fibrinogen
• 50/50 mixture test

Test of clot stability

• Euglobin clot lysis
• Factor XIII assay
• PAI-D

Question 5

What is the normal range for Prothrombin time?

Answer 5

10-14s

Question 6

What does the Prothrombin time measure?

Answer 6

The extrinsic system in the coagulation pathway – factors II, V, VII and X

Question 7

What is the normal range of INR?

Answer 7

0.9-1.2

Question 8

What is the normal range for Activated partial thromboplastin time

Answer 8

22-36s

Question 9

What does the Activated partial thromboplastin time measure?

Answer 9

The intrinsic system in the coagulation pathway – factors VIII, IX, XI, XII and Von Willebrand factor

Question 10

What does a quick Activated partial thromboplastin time mean?

Answer 10

Increased thrombus formation

Question 11

What does a slow Activated partial thromboplastin time mean?

Answer 11

Increases bleeding

Question 12

When is the Activated partial thromboplastin time usually ordered?

Answer 12

When a patient is on heparin

Question 13

What does the thrombin time measure?

Answer 13

The rate of conversion of fibrinogen to fibrin when thrombin has been introduced

Question 14

What is a 50/50 mixture test?

Answer 14

Mix 50% of patient’s plasma with 50% normal plasma

Question 15

In a 50/50 mixture test, what does it show if the PT and APTT correct?

Answer 15

There is a factor deficiency

Question 16

In a 50/50 mixture test, what does it show if the PT and APTT are still prolonged?

Answer 16

There is a factor inhibitor

Question 17

What can cause prolonged PT?

Answer 17

- Warfarin
      Most common
- VII
      Second most common
- II
- V
- X

Question 18

What can cause prolonged APTT?

Answer 18

• Heparin
• VIII
• IX
• XI
• XII
• Von Willebrand’s disease
  In types I and II, APTT is often normal

Question 19

What are the vitamin K dependent factors?

Answer 19

• Factor II
• Factor VII
• Factor IX
• Factor X
• Protein C
• Protein S

Question 20

What can cause a prolonged PT and APTT?

Answer 20

•	Vitamin K deficiency 
•	DIC = Disseminated Intravascular Coagulation
•	Heparin toxicity 
•	Deficiencies of Factor V or Factor X 
o	Rare

Question 21

What can cause vitamin K deficiency?

Answer 21

Liver disease or malabsorption

Question 22

What test would you order if the clotting tests came back as negative, but there is still a history of bleeding?

Answer 22

Von Willebrand’s tests:

• VIII
• vWF antigen
• vWF activity

Question 23

What is DIC (Disseminated Intravascular Coagulation)?

Answer 23

Processes of coagulation and fibrinolysis are dysregulated causing widespread clotting with resultant bleeding

Question 24

What can cause DIC (Disseminated Intravascular Coagulation)?

Answer 24

• Sepsis
• Trauma
• Obstetric complications
• Malignancy

Question 25

How do you diagnose DIC (Disseminated Intravascular Coagulation)?

Answer 25

• Low platelets
• Prolonged PT, APTT
• Fibrin degradation products raised
• Schistocytes due to microangiopathic haemolytic anaemia