Bruising And Bleeding Flashcards
Major causes of bleeding disorders
. Structural
. Platelet-related
. Clotting factor-related (platelet plug not stable)
Leukemia
. Group of neoplasticism disorders affecting leukopoietic tissues in body
. Characterized by leukocytosis, immature leukocytes in peripheral blood
. Proliferation of immature cells in marrow suppressing normal cell growth (like MK cells)
Idiopathic thrombocytopenic purpura
. Platelet destruction inc. from circulating antiplatelet antibodies in plasma
. Platelet survival is shortened
Hemophilia A/B
. Genetic defect x-linked recessive
. Inc. bleeding from clotting disturbance
. 70% people are inherited, others from spontaneous mutation
. A is deficiency in factor VIII, b from IX deficiency
Disseminated intramuscular coagulopathy
. Systemic activation of blood coag resulting in generation and deposition of fibrin
. Leads to microvascular thrombi in organs causing dysfunction
. Possible consumption and subsequence exhaustion of coag proteins and platelets may cause severe bleeding
Diascopy
. Test for blanchability by applying pressure w/ finger and observing color change
Normal platelet count
. 150,000-400,000
. Thrombocytopenic: less than 150,000
. Thrombocytosis: over 400,000
Partial thromboplastin time
.blood test evaluating integrity of intrinsic and common coag pathway and to monitor patients on Heparin
. Normal 25-37 s.
Prothrombin time
. Blood test that measures how quickly blood clots
. Normal 10-14 s.
International normalized ratio (INR)
. 1.1 or below is normal
. 2-3 is therapeutic range when taking blood thinners
Bleeding time (BT)
. Standard filter paper should be every 30 s. Until blood completely stops
. Normal: 2-9 minutes
. Risk of bleeding inc. w/ time over 10 min.
Unexplained nosebleeds suggest ___
. Platelet defects
5 causes of dec. platelet production
. Meds . Bone marrow replacement by malignancy, fibrosis, or granulomas . Bone marrow aplasia . Alcohol . B12 deficiency
5 causes of inc. platelet consumption
. Splenic sequestration . Autoimmune thrombocytopenia (idiopathic, HIV, lupus, lymphoproliferative issues, meds) . Disseminated intravascular coag. . Thrombotic thrombocytopenic pupura . Sepsis
Evaluation of bleeding patient
. Clinical context (post-surgical, sepsis, exposure to anticoags)
. Personal history (onset in infancy = heritable condition, as adults = milder heritable condition or acquired cause)
. Family history
. Location (mucocutaneous bleeding = suggests qualitative/quantitative platelet defects, joint/soft tissue= disorders of coag factors
Platelets
. Critical role in hemostasis
. Functions: adhesion, activation, aggregation
Bernard-soulier syndrome
. Deficiency in GpIb platelet Factor
Glanzmann thrombasthenia
. Deficiency in GpIIb-IIIa complex in platelet clotting
Von willebrand Disease
. Most common inherited bleeding disorder, most cases autosomal dominant
. Due to issues w/ Von willebrand factor (glycoprotein that binds platelets to subendothelium and is a carrier of factor VIII)
Type I Von willebrand disease
. Type i: 75-80% pts, mild to moderate bleeding, don’t bleed spontaneously, involves skin and mucous membranes
. Keep in mind for teen patients
. Normally diagnosed when excessive bleeding occurs after procedure, heavy or long menstrual bleeding (changing of pad once an hour)
Type II Von willebrand disease
. 15-20% patients
. Moderate to severe bleeding
. Usually present in childhood or adolescence
Type 3 Von willebrand disease
. Severe bleeding in infancy and childhood
. Autosomal recessive inheritance
Bernard-Soulier syndrome
. Autosomal recessive inheritance
. Reduced or abnormal platelet membrane expression of GIb/IX
. Failure of adhesion
. Severity of symptoms vary
. Clinical features: petechia, ecchymosis, recurrent epistaxis
Glanszmann’s thrombasthenia
. Autosomal recessive
. Platelets contain low or defective glycoprotein GpIIb/IIa (fibrinogen receptor)
. Platelets aggregation impaired os no thrombus formation
. Clinical features: petechia, ecchymosis, recurrent epistaxis