haematology

Question 1

how is it dynamic?

Answer 1

establishes an equilibrium

Question 2

warfarin dose

Answer 2

1-15mg

Question 3

warfarin mechanism

Answer 3

inhibits synthesis of vit K dependent clotting factors

- 2, 7, 9, 10 (also protein C and S - decrease rate of fibrin formation)

Question 4

major disadvantage of warfarin

Answer 4

interactions

Question 5

danger of warfarin

Answer 5

haemorrhage (1%)

Question 6

what type of anticoagulant is warfarin?

Answer 6

coumarin

Question 7

phenindione

Answer 7

vit K antagonist

indanediones

Question 8

indications for anticoagulants

Answer 8

AF
DVT
heart valve disease
mechanical valves
thrombophilia
pulmonary embolism

Question 9

INR

Answer 9

prothrombin time ratio corrected for the Warfarin sensitivity of the thromboplastin reagent

Question 10

risks of adjusting INR

Answer 10

fatal thromboembolic events
non-fatal thromboembolic events
rebound hyper coagulable state?

Question 11

NOACs

Answer 11

no monitoring

shorter acting time

Question 12

dabigatran

Answer 12

direct thrombin inhibitor

Question 13

apixaban

Answer 13

FXa inhibitor

Question 14

rivaroxaban

Answer 14

FXa inhibitor

Question 15

unfractionated heparins

Answer 15

IV, hospital
makes you bleed more
short 1/2 life - controllable

Question 16

low molecular weight heparins

Answer 16

doesn’t make you bleed more
SC injection
no monitoring

Question 17

heparin mechanism

Answer 17

make blood not clot as well

inhibit FX and thrombin formation, by activating AT3

Question 18

antiplatelets

Answer 18

aspirin, clopidogrel, dipyridamole, prasugrel

inhibit platelet aggregation and thrombus formation in arterial circulation

Question 19

thrombophilia

Answer 19

increased risk of clots developing

Question 20

inherited thrombophilia

Answer 20

protein C/S deficiency
F5 leiden
AT3 deficiency

Question 21

acquired thrombophilia

Answer 21

antiphospholipid syndrome
OCP
surgery
cancer
pregnancy
trauma 
smoking

Question 22

platelet abnormalities

Answer 22

thrombocytopenia
qualitative disorders
thrombocythaemia

Question 23

thrombocytopenia

Answer 23

idiopathic
drug related
secondary to e.g. leukaemia

Question 24

qualitative disorders

Answer 24

rare
normal number but abnormal function
inherited/acquired e.g. cirrhosis

Question 25

thrombocythaemia

Answer 25

often pre-malignant

Question 26

what would platelet abnormalities vs a coagulation problem cause?

Answer 26

platelet abnormalities - immediate haemorrhage

coagulation problem - delayed haemorrhage

Question 27

haemophilia B

Answer 27

F9 deficiency/Christmas disease
NO IDB
females carriers (sex linked recessive)

Question 28

haemophilia A

Answer 28

F8 deficiency
NO IDB
F carriers (sex linked recessive)

Question 29

haemophilia A tx

Answer 29

severe - recombinant F8
mild - DDAVP
v mild - TXA (antifibrinolytic)

Question 30

inhibitors

Answer 30

antibodies which develop after being given factor concs

takes a while to dissipate

Question 31

VW disease

Answer 31

most common
reduced F8 and reduced platelet aggregation 
autosomal dominant
T1 and 2 - dominant mild
T3 - recessive severe

Question 32

VW tx

Answer 32

DDAVP
TXA
severe - VW factor conc

Question 33

F11 deficiency

Answer 33

less common

common in Ashkenazy Jew pop

Question 34

haemophilia B tx

Answer 34

doesn’t respond to DDAVP
TXA
recombinant F9

Question 35

blood tests

Answer 35

bleeding (platelets - FBC, bleeding time)
Clotting (INR), (APPT)
factor assay (only if above abnormal)

Question 36

rare bleeding disorders

Answer 36

inherited

• defects of other factors
• defects of platelet no/fct

lack of clear correlation between bleeding and level of factor

Question 37

DDAVP/Desmopressin

Answer 37

nasal
causes F8 stuck to blood vessels to be released into bloodstream
own factor so no inhibitors

Question 38

txing pts with bleeding disorders

Answer 38

severe/mod - hospital except pros

mild/carriers - refer for ext, surgery, IDB, lingual infiltration