Bleeding disorders Flashcards
what is DIC?
an acquired syndrome that is characterised by activation of coagulation pathways, resulting in formation of intrvascular thrombi, which depletes platelets and clotting factors, predisposing to consequent bleeding risk
what are the causes of DIC?
sepsis
major trauma or burns
some malignancies e.g AML
Severe organ destruction e.g severe pancreatitis or acute liver failure
what are the S&S of DIC?
underlying cause present
oliguria, hypotension or tachycardia
- signs of circulatory collapse
Purpura fulminans, gangrene or acral cyanosis
- systemic micro/macrovascular thrombosis
Delirium or coma
Petechiae, eccymosis, oozing or haematuria
- generalised bleeding
what would investigations show in DIC?
Decreased platelets
Decreased fibrinogen
Elevated D-Dimer
Prolonged prothrombin time
2 up 2 down
what are the treatments for DIC?
treat underlying cause
Platelets, FFP or cyroprecipitates in bleeding
heparin in thrombosis
what is immune thrombocytopenic purpura (ITP). It can be primary but what are some secondary causes?
haematological disorder characterised by isolated thrombocytopenia in the absence of an indentifiable cause
- causes petechiae
Secondary causes
- HIV
- Hep C
- H. Pylori
- Autoimmune disorders
how does ITP present and how is it diagnosed?
signs of bleeding i.e petechiae, bruising etc
absence of systemic symptoms
decreased platelets on FBC
increased megakaryocytes on BM biopsy
how is ITP treated?
observation if mild Pred IVIG rituximab splenectomy
what is the deficiency in Haemophilia A and which clotting marker is prolonged?
Factor VIII
aPTT prolonged
what is the deficiency in Haemophilia B and which clotting marker is prolonged?
factor IX
aPTT prolonged
what are the S&S and inv for von willebrand disease?
excessive bleeding post op bleeding Fhx Easy and excessive bruising menorrhagia
aPTT prolonged
Von willebrand factor antigen
platelet aggregometry
how is VWD treated?
platelets, cryoprecipiate
VWF recombinant
Desmopressin
what are causes of thrombophilia?
Antithrombin deficiency Antiphospholipid syndrome Protein C deficiency Protein S deficiency Factor V leidin Prothrombin mutation
antiphosholipid syndrome can be investigated via which test?
aPTT 50:50 dilution
- only partial correction of aPTT
what is the MOA of heparin?
increased action of antithrombin (esp anti IIa and anti Xa)
