Clinical cases in thrombosis and haemostasis

Question 1

A 65 year old man takes aspirin because of a previous history of TIA.

Answer 1

…

Question 2

How does asprin work?

Answer 2

REDUCES PLATLET AGGREGATION - inhibits cyclooxygenase from working, inhibits arachadonic acid from turning into thrmoboxane A2.

Question 3

which drugs prevent pletlet funciton?

Answer 3

clopidogrel, adciximab, ticagrelor.

Question 4

how does dabigatran work?

Answer 4

small molecule whichh bind to and inactivates thrombin

Question 5

A 21-year old medical student uses the combined oral contraceptive. She is clinically well

Answer 5

…

Question 6

what is true?

Answer 6

she has an increased risk of stroke and VTE

Question 7

what increases VTE risk?

Answer 7

Fcator V leiden in combination with COCP and fhx of VTE.

Question 8

what is given to prevent blood clot formation in hospital?

Answer 8

thromboprophylaxis

Question 9

what are rf’s for arterial thromboembolism?

Answer 9

smoking, dm, af

Question 10

A 20 month old boy attends accident and emergency with his father, The child has refused to walk for the past 2 days having been walking unsupported for 4 months, The right knee is slightly swollen and feels warm to touch. Blood is aspirated from the knee.

Answer 10

ponder…

Question 11

differentiate between haemophilia a and b

Answer 11

measure APTT then measure factor 8 and 9 levels

Question 12

how is heamophilia a inherited?

Answer 12

x linked

Question 13

tx for haemophilia a

Answer 13

recominant factor 8

Question 14

complicaition of factor 8 tx

Answer 14

hapatitis a and development of inhibitory antibodies

Question 15

what is the best tx regimen for the pt?

Answer 15

give factor 8 at least 3 times a week or small amounts every day. Gene therapy,

Question 16

A 24 year old female student presents with a 4 day history of easy bruising and small red spots on her ankles
She has no previous history of abnormal bleeding
Previous tonsillectomy with no bleeding
Recently been off colour with flu like symptoms
Only medication COCP

Answer 16

ponder…

Question 17

hwat is seen oin the skin as a sx

Answer 17

unblanching petichiae

Question 18

which sy is she likely to have

Answer 18

menorrhagia, epistaxis, busccal bleeding

Question 19

what is the likely cause of her sy?

Answer 19

thrombocytopenia, vitamin k deficiency (obstruction of the biliary tree

Question 20

what are common causes of thrombocytopenia?

Answer 20

AML, anaplastic anaemia, ITP, (VIT K. deficiency does not)

Question 21

what is her platelt count most likely to be?

Answer 21

10

Question 22

which underlying illness is associated with ITP?

Answer 22

HIV, SLE, EBV (glandular fever) - all of thhe autoimmune mediated diseases.

Question 23

A 70 year old man has excessive bleeding after a colectomy for cancer
He has bleeding from his abdominal wound but not from his drain or his indwelling line
He has had surgery in the past but had no abnormal bleeding

Answer 23

ponder…

Question 24

Which is the most likely cause of this?

Answer 24

poor surgical technique (single site does not suggest coagulopathic bleeding).

Question 25

rf’s for VT

Answer 25

surgery, age, cancer