Bleeding & Thrombosis in Practice Flashcards
1) 20 month old boy attends A&E with dad
Refused to walk for 2 days (Walked unsupported for 4 months prior)
Right swollen and warm
Blood aspirated from knee
Most likely diagnosis?
Haemophilia
1) How would you determine which kind of haemophilia?
Coagulation factor 8/9 Assay
1) Factor VIII = 0% and IX = 73%
Which type of haemophilia is it?
Haemophilia A
1) How is haemophilia inherited?
X-linked
1) Mum says her dad had haemophilia A, she want’s to know here odds of having another child with it?
1 in 4 (shes a carrier)
1) How do you treat the boy?
Recombinant Factor VIII
Atleast 3x per week
1) Which infections are a risk of Recombinant Factor VIII?
Hep B & C
HIV
1) Other than infections what’s the major complication of Factor 8 concentrates?
Inhibitory antibody development
2) 24yr old female student presents with 4 days of easy bruising & small red spots on her ankles
Recently been off colour with flu-like symptoms
Previous tonsillectomy with no bleeding and on OCP.
Which of these symptoms are unlikely?
- Menorrhagia
- Epistaxis
- Buccal Bleeding
- Swollen hot painful leg
Swollen hot painful leg
The rest are possible bleeds from an acquired bleeding disorder
2) What is most likely to cause her symtpoms?
Thrombocytopenia
2) What could cause her thrombocytopenia?
AML
Aplastic Anaemia
ITP
2) She’s bruising spontaneously, what’s her likely platelet count?
10 or less
2) What underlying illness could cause ITP?
SLE EBV HIV Lymphoma (Also use of quinines)
3) 70yr old man with excessive bleeds after colectomy for cancer
Bleed from abdo wound but not his drain or line.
He’s had surgery before without abnormal bleeds.
Whats the most likely cause?
LMWH prophylaxis
Not likely to be a bleeding disorder because its a single site
3) Why might that patient have been given LMWH prophylaxis?
For VTE because of his:
- Surgery
- Old Age
- Active Cancer
4) 65yr old man takes aspirin from h/o TIA.
How does it work?
Reduces platelet aggregation by inhibiting COX-1
4) Which of the following drugs are/aren't anti-platelets? Clopidogrel Dabigatran Abciximab Ticagrelor
Dabigatran is the only non anti-platelet. (its a DOAC)
C & T target binding of ATP to platelets, preventing activation of platelets
Abciximab inhibits platelet’s receptors for fibrinogen (GP2b/3a)
5) 21yr old med student uses cOCP. Which of these is true:
- Increased stroke risk?
- Reduced pulm embolism risk?
- Bleeds more easily from injuries?
- Could have a fh of mother or sisters suffering PE?
Only the increased risk of Stroke
Actually have an increased PE risk
More likely to have a thrombosis than a bleed
Wouldn’t prescribe OCP to someone with a 1st degree relative PE
5) Which of these could increase her risk of VTE?
- Hypercholesterolaemia
- Factor V Leiden
- Von Willebrand Factor Deficiency
- DM
Factor V Leiden
Hypercholesterolaemia & DM are arterial risk factors
vWF deficiency –> bleeding not thromboses
Which of these are risk factors for arterial thromboembolism?
- Smoking
- DM
- Factor V Leiden
- Atrial Fibrillation
All but Factor V leiden
Which of the follow are true of an arterial thrombus?
- Platelet rich
- Mostly on ruptured/ulcerated plagues
- Can –> PE
- Can –> Infarction
Is platelet rich
Is on plagues
Can cause infarction
Won’t cause PE
Which of the following are true of DIC?
- Spontaneous disorder of coagulation
- typically –> DVT in lower limbs
- –> Tissue infarction due to microvacular thrombosis
Tissue infarction due to microvascular thrombosis
Can cause DVT but not common
Not Spontaneous
Which of these can DIC be a complication of:
- Metastatic cancer
- Normal Pregnancy
- Severe burns
- Septic Shock
Any apart from normal pregnancy
Can occur in non-normal pregnancy
