Haematology- Bleeding Disorders Flashcards
What would you want o ask about in bleeding history?
Bruising
Menorrhagia
Epistaxis
Post-partum haemorrhage
Post-trauma
Response to surgery/dental extraction
->basically trying to out if they have ever bled normally or always extreme
Which types of bleeding are ‘platelet type bleeding’ causes?
Mucosal bleeding e.g. bleeding, menorrhagia, GI, epistaxis
How may you determine if a patient has a congenital or acquired bleeding condition?
Previous episodes?
Age at first event
Previous surgical challenges
Associated history e.g. new cancer diagnosis suggesting acquired rather than congenital
Family members with similar symptoms
What type of genetic condition are Haemophilia A and B?
X-linked
->present the same
What are the features of haemophilia A/B?
Hemarthrosis
Muscle haematoma
CNS bleed
Retroperitoneal bleeding
Postsurgical bleeding
What are some of the clinical complications of haemophilia?
Synovitis
Chronic Haemophilic Arthropathy
Neurovascular compression (compartment syndrome)
Other sequelae of bleeding (stroke)
->a lot less common now with modern treatment
Treatment of mild haemophilia?
On demand treatment- bleeding episodes and peri-operatively
Recombinant factor concentrate
DDAVP (haem A)
Tranexamic acid
Treatment of severe haemophilia?
Prophylaxis: recombinant factor concentrates
EHL or SHL
Emicizumab for haemophilia A
On demand factor for bleeding episodes
Which drugs can be used for prophylactic treatment in haemophilia?
Emicizumab
As well as treatment for the actual haemophilia, what else is given in terms of management?
Physio
Analgesia
Synovectomy/joint replacement if required
Which type of bleeding occurs in von Willebrand disease?
Platelet bleeding (mucosal)
What is the inheritance pattern for von Willebrand disease?
Usually autosomal dominant
How is a diagnosis of von Willebrand disease made?
vWF level <30%
What are the three types of von Willebrand disease?
Type 1- most common
Type 2
Type 3- rarest, complete deficiency of vWF
Management of von Willebrand disease?
Majority only require on demand treatment, prophylactic if type 3
vWF concentrate +/- Factor VIII
Tranexamic acid
What are some of the causes of acquired bleeding disorders?
Thrombocytopenia
Liver failure
Renal failure
DIC
Drugs
Acquired clotting factor deficiencies- rare
Symptoms of thrombocytopenia?
Petechia- rash of tiny blood spots, google
Bruising
Mucosal bleeding
List some of the drugs which can cause acquired bleeding disorders.
Warfarin
Heparin
Aspirin
Clopidogrel
Rivaroxaban
Apixaban
What are some of the causes of thrombocytopenia?
Decreased production e.g. marrow failure, aplasia, infiltration
Increased consumption e.g. immune ITP, DIC, hypersplenism
What can ITP (immune thrombocytopenia) be associated with?
Infection, especially EBV, HIV
lymphoma
Drug induced
Management of ITP?
If rescue/acute= steroids, IVIg
Longer term= thrombopoietin analogues, immunosuppression
