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LHT2 > Disorders of clotting DSA > Flashcards

Disorders of clotting DSA Flashcards

1
Q

possible bleeding disorder- characteristics

A
  • hemorrhage after surgery or trauma
  • systemic dz?
  • drug ingestions
  • FH
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2
Q

suspected coagulopathy- lab testing?

A
  • platelet count
  • bleeding time
  • PT, aPTT
  • thrombin time
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3
Q

possible clotting disorder- characteristics

A
  • venous thromboembolism (>90% of cases)
  • DVT or PE
  • FH of thrombosis
  • first episode of thrombosis in young adulthood
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4
Q

congenital disorders of coagulation

A
  • Hemophilia A (def of factor 8)
  • hemophilia B (def of factor 9)
  • von willebran dz
  • factor 11 def
  • less common heritable disorders of coagulation
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5
Q

Hemophilia A and B- essentials of dx

A

(X-linked recessive)

  • recurrent hemarthroses and arthropathy
  • risk of development of inhibitory ab’s to factor 8 or 9
  • older pts- infection with HIV or HCV in the 1980s due to exposure of contaminated blood products
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6
Q

Hemophilia A and B- sx and signs

A

severe- factor 8 activity < 1%- early childhood- bleeding into joints, soft tissues

  • mild (activity > 5%)- spontaneous bleeding is rare, but occurs after surgery, trauma
  • moderate (activity 1-5%)
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7
Q

Hemophilia A and B- tx

A
  • recombinant factor 8 or 9 products

- mild bleeding- DDAVP

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8
Q

Von Willebrand disease- essentials of diagnosis

A
  • most common inherited bleeding disorder

- VWf binds platelets to subendo surfaces, aggregates platelets, and prolongs the half-life of factor 8

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9
Q

Von Willebrand disease- types

A
  • 1- quantitative abnormality- 80% of pts
  • 2- qualitative defect- dec binding to factor 8 or to platelets
  • 3- rare- severe bleeding in infancy
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10
Q

Von willebrand disease- signs and sx

A

-type 1- mild/moderate bleeding
-2- moderate to severe
3- severe

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11
Q

von willebrand dz- tx

A
  • DDAVP

- vWF product

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12
Q

factor 9 deficiency

A
  • autosomal recessive
  • Ashkenazi Jews
  • mild bleeding
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13
Q

less common heritable disorders of coagulation

A
  • def of clotting factors 2, 5, 7, 10

- autosomal recessive

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14
Q

Acquired disorders of coagulation

A
  • acquired ab’s to factor 8, 2, or 5
  • vit K def
  • coagulopathy of liver dz
  • warfarin ingestion
  • DIC
  • heparin/fondaparinux/direct-acting oral anticoagulant use
  • lupus anticoagulants
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15
Q

Vit K def- caused by?

A
  • def dietary intake, malabs, or dec production by intestinal bacteria
  • assists in the coag factors 2, 7, 9, 10
  • prolonged PT
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16
Q

Vit K def- tx

A

-vit K1 (phytonadione)

17
Q

Coagulopathy of liver dz

A
  • dec syn of clotting factors- 2, 5, 7, 9
  • prolonged PT
  • normal factor 5 level indicates vit K def!!!
  • also def of fibrinogen
18
Q

Severe DIC due to acute promyelocytic leukemia

A
  • dec in the activity of clotting factors
  • aPTT and PT prolonged
  • platelets and fibrinogen levels are reduced
19
Q

Acquired factor 8 inhibitor

A
  • extensive soft-tissue ecchymoses, hematomas, mucosal bleeding
  • aPTT prolonged
  • Bethesda assay- titer of the inhibtor
20
Q

thrombotic disorders- most common?

A
  • factor V leiden

- prothrombin gene mutation

21
Q

primary hypercoagulable states

A
  • Antithrombin III def
  • protein C def
  • protein S def
  • act protein C resistance (factor V leiden)
  • prothrombin gene mutation
22
Q

antithrombin III def- path

A
  • leads to inc fibrin accum and propensity to thrombosis!!!
  • antithrombin is a inhibitor of thrombin and other act coag factors- its def leads to unreg protease activity and fibrin formation
23
Q

antithrombin III- in who? types?

A
  • in 1% of pts with venous thromboembolism
  • 2.5% of pts with recurrent thrombosis
  • type 1- quantitative deficiency
  • type 2- fxnally defective
  • type 3- dysfxnal protein (due to specific point mutations)
  • autosomal dominant!
  • most pts affected are heterozygous
24
Q

protein C def- path

A
  • unregulated fibrin generation b/c of impaired inactivation of factors 8a and Va
  • type 1- quantitative def
  • type 2- abnormalities in prot C act or fxn
  • autosomal dominant!!!
  • most pts affected are heterozygotes
25
Q

protein S def- path

A
  • principal cofactor of activated protein C (APC)
  • its def mimics that of protein C- loss of regulation of fibrin generation by impaired inactivation of factors 8a and 5a
26
Q

Activated protein C resistance (Factor V Leiden)

A
  • mutation is in 3-8% of white populations of European ancestry
  • causes APC resistance!!
  • point mutation in the gene for factor V
27
Q

Prothrombin Gene mutation (prothrombin G20210A)

A
  • assoc with elevated levels of prothrombin and an inc risk of venous thrombosis
  • more common in white populations
28
Q

primary hypercoagulable states- clinical manifestations

A

venous thromboembolic (VTE) complications!

  • DVT and PE- most common!
  • recurrent pregnancy loss
  • VTE usually occurs in early adulthood
29
Q

venous vs arterial thromboses

A

-venous- unusual sites- superficial thrombophlebitis and mesenteric and cerebral venous thrombosis
-arterial thrombosis involving the
coronary, cerebrovascular, and peripheral circulations is not linked to any primary hypercoag states!

30
Q

secondary hypercoagulable states

A
  • hyperhomocysteinemia
  • malignant dz
  • myeloproliferative neoplasms and PNH
  • antiphospholipid syndrome
  • pregnancy, oral contraceptives, hormone replacement therapy
  • systemic infl
  • postop state, immoblization, trauma
31
Q

malignant dz- what type of cancer?

A
  • thrombotoc complications in cancer pts depends in part on the type of malignant dz
  • hypercoagulability most prominent in pancreatic cancer, adenocarcinoma of GI tract, lung, ovarian cancer, hematologic malignant neoplasms
32
Q

myeloproliferative neoplasms and PNH- clinical?

A
  • thrombosis and bleeding!!
  • PV- inc whole blood viscosity- thrombosis
  • hepatic v thrombosis and other intra-abd venous thromboses- assoc with these!!
33
Q

Antiphospholipid syndrome- characterized by? clinical?

A
  • characterized by- venous and arterial thrombosis, recurrent spontaneous pregnancy loss, thrombocytopenia, and neuropsychiatric manifestations
  • autoab’s bind to phospholipid-protein complexes
  • positive tests that detect diff plasma antiphospholipid-protein ab’s!!
  • DVT and PE most common

LHT2 (17 decks)

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