Bleeding disorders Flashcards
What pattern of bleeding may thrombocytopaenia give?
Mucosal (GI bleeding, petechiae)
What are some important factors in a history of bleeding?
Bruising Epistaxis Post-surgical bleeding Menorrhagia PPH Post-trauma
What does spontaneous bleeding suggest?
Severe coagulopathic disorder
Into key joints
What are some different kinds of platelet type bleeding?
Mucosal Episatxis Purpura Menorrhagia GI
What are some different kinds of coagulation factor bleeding?
Articular
Muscle haematoma
CNS
What is articular haemarthrosis?
Bleeding into joint
Iron released by red blood cells taken up by macrophages in the joint which causes inflammation in synovium
Inflammation prevents normal repair of cartilage
What are some consideration for inherited disorders?
Carriers/affected family members
Sex of affected family members
Is haemophilia x linked?
Yes
What determines the severity of bleeding in haemophilia
Residual coagulation factor activity
<1% = severe
1-5% = moderate
What are some clinical complications of haemophilia?
Synovitis
Chronic haemophilic arthropathy
Neurovascular compression
Haemorrhagic stroke
How is haemophilia diagnosed?
Clinical Prolonged APTT Normal PT Reduced FVIII Genetic analysis
How is haemophilia treated?
Coagulation factor replacement (FVIII/IX)
DDAVP
Tranexamic acid
Emphasis on prophylaxis in sever cases
What are some viral complications of haemophilia treatment?
HIV, HBV, HCV
What are some possible consequences of DDAVP?
MI
Hyponatraemia
Why is immune response important to consider in haemophilia?
If patients are treated with FVIII but have never been able to produce it then they may recognise it as a foreign molecule and produce antibodies against it
