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Case 4: Infective Endocarditis > Haematology: Coagulation > Flashcards

Haematology: Coagulation Flashcards

1
Q

What 3 components are part of primary haemostasis

A

Pt, VWF & vessel wall contribution to haemostasis

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2
Q

What is 2 components of secondary haemostasis

A

Clotting factors & formation of fibrin clot contribution to haemostasis

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3
Q

What is the 2 abnormalities in haemostasis

A
  1. Bleeding
  2. Thrombosis
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4
Q

What does Virchow’s triad refer to

A

Relationship between
1. Vessel wall damage
2. Stasis of blood flow
3. Hypercoagulable state

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5
Q

What is 5 common causes of bleeding

A
  1. Secondary to trauma
  2. Thrombocytopenia
  3. Coagulation factor deficiency
  4. Increased fibrinolysis
  5. Reduced or dysfunctional VWF
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6
Q

What is the 3 component in diagnosing a patient w/ bleeding disorder

A
  1. Thorough family & personal history
  2. Physical examination
  3. Laboratory testing
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7
Q

What 4 categories are important under history collection

A
  1. Family history of bleeding
  2. Drugs, food & herbal preparation (over the counter, excessive consumption of some foods, anticoagulant therapy or drugs that weaken vascular wall)
  3. Previous history of excessive bleeding, anaemia, iron deficiency or previous blood transfusion
  4. Medical conditions that predispose to bleeding (liver disease, renal failure, autoimmune disorders, connective tissue disorders)
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8
Q

What is 3 clinical feature of primary haemostasis disorder

A

Mucocutaneous bleeding
Petechiae
Persistent bleeding from cut skin

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9
Q

What is 2 clinical features of secondary haemostasis

A

Haemarthrosis
Deep seated soft tissue haematomas

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10
Q

What is the 2 common laboratory test for diagnosis of bleeding disorders

A
  1. Pt testing
  2. Coagulation (PT & INR for extrinsic pathway & aPTT for intrinsic pathway)
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11
Q

What is thrombocytopenia

A

Low platelets

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12
Q

What is the 2 main causes of thrombocytopenia w/ examples

A
  1. Failure of pt production in bone marrow: infection, drug toxicity, bone marrow infiltration
  2. Increased peripheral pt consumption: immune thrombocytopenia, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation & infection
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13
Q

What is 5 clinical presentation of immune thrombocytopenia (ITP)

A

Mucosal & nose bleeds
Heavy menses
Bleeding from gums
Skin petechiae
Bleeding from bowel/intracranial is dangerous

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14
Q

What is the 2 diagnostic test for ITP

A

FBC & peripheral smear to confirm true thrombocytopenia
BMAT that shows increased megakaryocytes that indicate increased peripheral platelet consumption

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15
Q

What is the treatment for ITP

A

Treat underlying cause
1 line prednisone
2 line rituximab & splenectomy

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16
Q

What is clinical presentation of disseminated intravascular disease (DIC)

A

Widespread endothelial damage, platelet activation & entry of procoagulant material into circulation

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17
Q

What is the 4 diagnostics test for DIC

A
  1. Low platelet count
  2. PT & aPTT prolonged
  3. D-diners increased
  4. Fibrinogen is low
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18
Q

What is the 3 treatments for DIC

A
  1. Treat underlying cause
  2. Supportive treatment
  3. Replacement of consumed clotting factors & pt
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19
Q

What is 3 clinical presentation of thrombotic thrombocytopenia purpura (TTP)

A

Renal impairment
Fever
CNS disturbance

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20
Q

What is the 4 diagnostic test for TPP

A
  1. Blood smear
  2. Negative DIC screen
  3. Biochemical evidence of haemolysis (low haptoglobin, raised LDH & unconjugated bilirubin)
  4. Low ADAMTS13 activity level
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21
Q

What is the treatment of TTP

A

Daily fresh frozen plasma or plasma exchange

22
Q

When is VWF released

A

Vascular injury released from platelets & endothelial cells

23
Q

What is the 2 major roles of VWF

A
  1. Mediate platelet adhesion at site of injury
  2. Binds & stablise factor VIII to prevent rapid degradation §
24
Q

What is ADAMST13

A

An enzyme that prevent blood from forming clots normally

25
Q

What is VWFD

A

Inherited disorders w/ subtypes depending on quantitative & qualitative problems

26
Q

What is the 3 clinical symptoms of VWFD

A

Easy brushing
Skin bleeding
Prolonged bleeding from mucosal surfaces

27
Q

What is the abnormal laboratory findings in VWFD

A

VWF antigen & activity influenced

28
Q

What is the clinical presentation of haemophillia

A

Bleeding episodes at joint called haemarthrosis that is painful swollen joint w/ reduced motility resulting in destructive athropathy

29
Q

In which joints does haemophillia occur

A

Knee, elbow & ankles
Shoulders, wrist & hips

30
Q

What is the 2 types of haemophillia

A
  1. Haemophillia A due to factor VIII deficiency
  2. Haemophillia B due to factor IX deficiency
31
Q

What is the 4 diagnostic tests for haemophillia

A

Platelet & PT normal
aPPT prolonged
Specific assay factor

32
Q

What is the treatment for haemophillia

A

A treated w/ factor VIII concentrate but specialized care is required

33
Q

What is the 3 types of anti-coagulation therapies

A
  1. Vitamin K antagonist
  2. Heparin
  3. Direct oral anticoagulant
34
Q

What is the mechanism of warfarin

A

Prevent vitamin K recycling that is required for factors II, VII, IX & X
Monitored w/ INR

35
Q

What is the 2 indication for warfarin

A
  1. Treat & prevent extension of excising thrombus
  2. Prevent recurrent thromboembolism
36
Q

What is the 3 side effects of warfarin

A
  1. Bleeding
  2. Fetal warfarin syndrome
  3. Warfarin skin necrosis
37
Q

What is the 3 advantages of warfarin use

A
  1. Cheap
  2. Good oral absorption
  3. INR monitoring widely available
38
Q

What is 3 disadvantages of warfarin use

A
  1. Monitoring required
  2. Interfere w/ other drugs, medication & diet
  3. Narrow therapeutic index so at risk for toxicity
39
Q

What is the 2 types of heparin

A
  1. Low molecular weight heparin
  2. Unfractionated heparin
40
Q

What is the mechanism of action of heparin

A

Binds & increase anti-thrombin action by inhibiting factor IIa & Xa

41
Q

What is the 3 indication for heparin

A
  1. Treat & prevent extension of excising thrombus
  2. Prevent recurrent thromboembolism
  3. Prophylaxis for at high risk
42
Q

What is the 3 side effects of heparin

A
  1. Bleeding
  2. Osteoporosis in long term use
  3. Heparin induced thrombotic thrombocytopenia
43
Q

What is the mechanism of action of DOAC

A

Directly inhibits thrombin I or anti-Xa

44
Q

What is the 3 indications for DOAC

A
  1. Treat & prevent extension of excising thrombus
  2. Prevent recurrent thromboembolism
  3. Prophylaxis for at high risk
45
Q

What is the 4 treatment steps for DVT

A
  1. Warfarin & LMWH in hospital
  2. Measure INR after 3 days & adjust dose
  3. LMWH is first given at therapeutic dose & then at prophylactic dose until INR is stable & in range
  4. INR monitoring out of hospital
46
Q

What is thrombolytic drugs

A

Dissolves blood clots by activating plasminogen that stimulation formation of plasminogen that breaks the cross links between fibrin molecules that affect structural integrity of clot

47
Q

What is anti-platelet drugs used for

A

Prevent thrombosis on arterial side

48
Q

What is the 5 indication of aspirin

A
  1. Prevention of recurrent acute coronary syndrome
  2. Prevention of recurrent pre-eclampsia in pregnancy
  3. Coronary artery stoning to prevent stent thrombosis
  4. Stable PAD or carotid artery disease
  5. Acute occlusive stroke
49
Q

What is the effect of aspirin at low dosage

A

Inhibits COX-1 that prevent biosynthesis of adequate TxA2 that decrease platelet recruitment & activation & reduce MI mortality

50
Q

What is the effect of aspirin at high dosage

A

Also inhibits COX 2
COX 2 initiates synthesis of prostacyclin that is responsible for vasodilation & inhibits platelet aggregation

51
Q

What is the 5 side effects of aspirin

A
  1. Bleeding
  2. Peptic ulcers
  3. Aspirin resistance & treatment failure
  4. Hypersensitivity
  5. Hearing loss

Case 4: Infective Endocarditis (10 decks)

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