Bleeding tendency

Question 1

Stages of haemostasis?

Answer 1

Vasoconstriction
Platelet plugging
Coag cascade to create fibrin clot

Question 2

What are factors 1a and 2a

Answer 2

fibrin (from fibronogen 1) and thrombin (from prothrombin 2)

Question 3

Causes of excessive bleeding

Answer 3

Von Willebrand (APTT prolonged, prolonged bleeding time)
Haemophilia  (APTT prolonged)
Thrombocytopaenia (platelets down)
Warfarin (PT prolonged)
DIC (everything off)
Liver failure (PT prolonged then APTT in late)

Question 4

What does vonWillebrand factor do?

Answer 4

• promotes platelet adhesion to damaged endothelium

* carrier molecule for factor VIII

Question 5

Management for vonWillebrand?

Answer 5

□ tranexamic acid for mild bleeding

desmopressin

factor VIII concentrate

Question 6

ITP explain and Sx:

Answer 6

ITP: • Idioiopathic thrombocytopenic purpura
• Autoimmune

• Children - acute, follows virus, self-limiting
• Adults - insidious & chronic
• Immune (or idiopathic) thrombocytopenic purpura (ITP) is an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.

Sx: • Mucosal petechiae
• Purpura
• Epistaxis
* Well

Question 7

TTP explain and Sx:

Answer 7

Thrombotic thrombocytopaenic purpura (TTP) and HUS are both acute illnesses that present with thrombocytopaenia and anaemia. However, renal complications are more common in HUS whereas TTP generally presents with neurological signs (e.g. headaches, fevers, confusion).

Pentad of Sx:
Fever
Neuro Sx
Thrombocytopaenia
Anaemia
AKI

On Blood film: Schistocytes due to platelet aggregation

Definition
• Rare massive destruction of platelets, high mortality

Question 8

Signs and causes and Mx of HUS

Answer 8

Haemolytic uraemic syndrome is generally seen in young children and produces a triad of:
	• acute renal failure
	• microangiopathic haemolytic anaemia
	• thrombocytopenia
Causes
post-dysentery - classically E coli 0157

• treatment is supportive e.g. Fluids, blood transfusion and dialysis if required

Question 9

define haemophilia

Answer 9

• Bleeding disorder (usually inherited) characterised by deficiency of Factor 8 or 9
Intrinsic pathway thrombin generation affected, thus unstable clot

X-linked recessive

Question 10

Sx of haemophilia

Answer 10

SEVERE - diagnosed in infancy
• Joint swelling and pain in infants
• Haematomas at immunisation sites
• Intracranial haemorrhage in neonate

MILD/MODERATE
• Prolonged bleeding after dental work

Question 11

Ix haemophilia:

Answer 11

APTT prolonged

Question 12

Mx haemophilia

Answer 12

• Factor 8 or 9 concentrate infusion
  
  • Desmopression in mild haemophilia or as prophylaxis to minor surgery
  • Tranexamic acid

Question 13

Sx of von Willebrand disease?

Answer 13

• Mucosal bleeding 
• Menorrhagia 
• Epistaxis 
• Bruising
• Prolonged bleeding from cuts 
GI bleeding

Question 14

Ix VW disease?

Answer 14

normal clotting studies

Question 15

Mx vW disease?

Answer 15

• vWF concentrate
• Tranexamic acid
Desmopressin