Haematology (clotting) Risk Factors And Complications

Question 1

Which other condition is the most highly correlated with pulmonary embolism?

Answer 1

Deep vein thrombosis

Most people with a PE will have a DVT as well

Question 2

What proportion of patients with a DVT will have a silent pulmonary embolism as well?

Answer 2

50%

Question 3

What is Virchow’s triad of risk factors for thrombosis?

Answer 3

1. Turbulence or stasis (of blood flow)
   e. g. immobility
2. Endothelial injury
   e. g. operation or immobility
3. Hypercoagulability
   - when ill, your acute phase reactants concentration increases: fibrinogen, factor 8 and VwF

Virchow’s triad is effectively saying that hospitalisation and illness are the biggest risk factor for VTE.

Question 4

What is the major complication of disseminated intravascular coagulation?

Answer 4

DIC means widespread thrombus formation throughout the body.

Major complication is thrombocytopenia with bleeds throughout the body (organs, skin, tissue)

Question 5

What are the complications of DVT?

Answer 5

1. Pulmonary embolism

2. Cardiac arrest (big enough to block Right atrium/ventricle)

Question 6

What are the complications of Von willebrands disease?

Answer 6

Haemorrhage
Anemia

Treatment reactions:

VwF disease type 2B can develop thrombocytopenia (due to increased clearance of VwF-bound platelets)

Antibody to VwF concentrate

Question 7

What are the complications of a massive pulmonary embolism?

Answer 7

Pulmonary hypertension

Right-sided heart failure

Cardiac arrest

Cardiogenic shock

Pulmonary infarct

Treatment complication:
Heparin-associated thrombocytopenia

Question 8

What are the potential complications of blood transfusion following a major haemorrhage?

Answer 8

Acute lung injury

Renal dysfunction

Disseminated intravascular coagulation

Infection (unlikely, due to screening)

Type 2 hypersensitivity reaction (IgG/IgM mediated cell-bound antigen recognition)

Readmission/morbidity