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Finals > Coagulation disorders > Flashcards

Coagulation disorders Flashcards

1
Q

Warfarin Major bleed T

A

Stop W
Cit K IV 5mg (phytomenodione K1)
Prothrombin Complex Bereplex 50u/kg

(cant: FFP)

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2
Q

Warfarin Minor bleed T

A

Stop W
Vit K IV 1-3mg (phytomenodion K1)
Repeat in 24hr if INR still high
Restart warfarin INR

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3
Q

INR 5-8 (no bleed)

A

Omit 1-2 doses

Adjust after

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4
Q

INR 8+ (no bleed)

A

Stop W
Vit K oral 1-5mg (swallow IV prep phytomenodione K1)
Repeat in 24hr if INR still high

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5
Q

Warfarin mechanism

A

Vit K dependent factors
2,7,9,10
Protein C + S

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6
Q

Warfarin half life

A

> 40hr

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7
Q

INR aim post 1st VTE

A

provoked: 2-3 for 3m
unprovoked: 2-3 for 6m

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8
Q

INR aim post recurrent VTEs no treatment

A

2-3 for life

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9
Q

INR aim recurrent VTEs ON treatment

A

3-4 for life

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10
Q

INR aim on HEART VALVES

A

Mechanical Aortic 2-3

Mechanical mitral 2.5-3.5

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11
Q

Describe Intrinsic pathway

A 
Eposed collagen
12a hageman
11a
9a + 8a
10a + 5a
2a thrombin
1a + 13a
fibrin clot
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12
Q

Describe extrinsic pathway

A 
tissue damage
7a + tissue factor thromboplastin 3
10a + 5a
2a thombin
1a + 13a
Fibrin clot
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13
Q

Vit K factors

A

7, 9, 10, 2

protein C + S

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14
Q

Thrombomodulin

A

+ 2a thrombin + Protein S
causes Protein C -> Active protein C
INHIBITs 5a + 8a

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15
Q

Antithrombin 3

A

Binds heparin
HMWH/ unfractionated: 2,9,10,11,12 (IV)
LMWH: 10a only (SC)

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16
Q

Tissue Factor Pathway inhibitor

A

Inhibts 7aTF

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17
Q

Fibrinolysis (tPa)

A

tPa
Plaminogen to Plasmin
Fibrin to Fibrinogen

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18
Q

Measuring intrinsic

A

aPPT

19
Q

Measuring extrinsic

A

PT

20
Q

Thrombin functions

A

Activates 11, 8, 5 and 13

+thrombomodulin & protein S -> activate Protein C

21
Q

Haemophilia A

A

Low Factor 8

A8

22
Q

Haemophilia B

A

Low Factor 9

B9

23
Q

Haemophilia inheritence

A 
X linked (male only)
female carry
24
Q

Haemarthrosis

A

haemophilia

25
Q

Christmas disease

A

Haemophilia B9

26
Q

Haemophilia bloods

A 
High APPT (intrinsic)
normal PT (extrinsic)
normal vWF
Low 8 (A) or 9(B)
27
Q

haemophilia A T

A

Replace A8

Demopression increases 8

28
Q

haemophilia B T

A

Replace B9

29
Q

Variant CJD risk

A

Haemophilia

30
Q

Chronic arthropathies

A

Haemophilia

31
Q 
High APPT (intrinsic)
normal PT (extrinsic)
normal vWF
Low 8 (A) or 9(B)
A

Haemophilia

32
Q

High APPT,
normal PT
low vWF
Low 8

A

vW disease

33
Q

No 1 bleeding disorder

A

vW disease

34
Q

vW disease types

A

1-partial drop in vWF
2-abnormal vWF
3-NovWF

35
Q

vW disease inheritence

A 
Autosomal dominant
(type 3-no vWF is AR)
36
Q

vW disease T

A

Desmopression inreases vWF + 8
vW rich factor 8/ vWF concentrate
TRANEXAMIC ACID

37
Q

Thrombophilia primary causes

A 
LOW
Protein C
Protein S
Antithrombin 3
Factor 5 Leiden (active protein C cant break 5a down)
38
Q

commonest heritable thrombophilia

A

Factor 5 Leiden (active protein C cant break 5a down)

39
Q

Virchows triad

A

Venous stasis
Hypercoagulation
Vascular injury

40
Q

Homan’s sign

A

Pain dorsiflexion in calf DVT

risk of dislodgeing

41
Q

VTE treatment

A
  1. LMWH/ Fondaparinux for 5d+ AND INR >2.0 for 24hr
    2, within 24hr start WARFARIN
    -Provoked 3month
    -Unprovoked 6months

CANCER
- LMWH 6months + compression stocking 2yrs

Unprovoked = screen for cancer
-exam, CXR, FBC, Ca2+, LFTs, urinalysis
+/- >40yr CTCAP/ mammography

Unprovoked = screen for thrombophilia + antiphospholipid if their on gna be on lifelong warfarin

USS review in 1 week

42
Q

Thrombophilia secondary cuases

A

Immobility, surgery, malignany, smoking, pregnancy
ANTI-PHOSPHOLIPID SYNDROME
Oestrogens (COCP)

43
Q

Prophylaxis on flights

A

Aisle seat
Ankle exercises
Stockings

44
Q

VTE investigations

A

Two level Wells score

2+ = USS

Finals (23 decks)

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