Haematology (DVT)

Question 1

What is a deep vein thrombosis?

Answer 1

a clot that develops in a deep vein, usually the leg

Question 2

What are the signs and symptoms of a deep vein thrombosis?

Answer 2

asymptomatic, pain, oedema, erythema, discolouration, increased temperature in leg, engorgement of the surface veins, tenderness

Question 3

What are the causes of deep vein thrombosis?

Answer 3

hypercoagulability - from malignancy, surgery, trauma, oral contraceptive pill, clotting abnormalities
venous stasis - immobility, pregnancy, heart failure
trauma - inflammation, previous thrombosis

Question 4

DD of deep vein thrombosis?

Answer 4

musculoskeletal injury, bakers cyst rupture, cellulitis

Question 5

Complications of deep vein thrombosis?

Answer 5

pulmonary emobolism, post thrombotic syndrome

Question 6

What investigations should be done in deep vein thrombosis?

Answer 6

D dimer, B mode venous compression US, modified wells score, PT, APPT, blood films show evidence or myeloproliferative disorders

Question 7

What does the modified wells score do?

Answer 7

calculates deep vein thrombosis probability

Question 8

When is a B mode venous compression US used?

Answer 8

in deep vein thrombosis above the knee

Question 9

What does it rule out it a d dimer is normal?

Answer 9

it excludes deep vein thrombosis

Question 10

What can cause an abnormal d dimer?

Answer 10

deep vein thrombosis, pregnancy, surgery, infection

Question 11

What is the treatment of deep vein thrombosis?

Answer 11

anticoagulation therapy with unfractional heparin e.g. telteparin
vit k antagonist e.g. warfarin
compression stockings
treat cause
hydration, early mobilisation

Question 12

What classification is used for bleeding risk in DVT?

Answer 12

HAS-BLED
hypertension 1
abnormal liver or renal function 1 or 2
stroke 1
bleeding 1
labile INR 1
elder >65 1
drugs or alcohols 1 or 2

Question 13

what do LMWH and warfarin inhibit

Answer 13

L - inhibits Xa and IIa

W- inhibits vit K dependent factors

Question 14

What should be kept between for LMWH and warfarin?

Answer 14

2-3INR

Question 15

What clinical features are in the two level DVT Wells Score?

Answer 15

active cancer, paralysis, paresis, recent bedridden or major surgery, local tenderness in deep venous system, entire swollen leg, calf swelling, pitting oedema, colateral superficial veins, previously docuented DVT

Question 16

What is PT?

Answer 16

a measure of how quickly the blood clots, standardized by the INR

Question 17

What does a d dimer detect?

Answer 17

small protein fragments released following the breakdown of a clot

Question 18

How does warfarin treat DVT and what is its risk?

Answer 18

inhibits vit k synthesis, but before of over coagulation

Question 19

SE of LMWH?

Answer 19

bleeding, osteoporosis, heparin induced thrombocytopenia

Question 20

When is LMWH contraindicated?

Answer 20

in bleeding disorders, low platelets and HTN

Question 21

When is warfarin contraindicated?

Answer 21

pregnancy and peptic ulcer

Question 22

examples of other anticoagulants?

Answer 22

apixaban, rivaroxaban (xa inhibitors), dabigatran (direct thrombin inhibitor)

Question 23

What does TPA do?

Answer 23

generates plasmin and degrades fibrin

Question 24

What is thrombolytic therapy?

Answer 24

streptokinase tissue plasminogen activator

Question 25

What causes venous thrombosis?

Answer 25

antithrombin deficiency, protein c deficiency, protein s deficiency, PT20210A, Factor V Leiden, anti phospholipid syndrome, lupus anticoagulant, hyperhomocysteinaemia

Question 26

What is the initial and after anticoagulant treatment for DVT?

Answer 26

LMW sc od initial and then oral warfarin 3-6 months after

Question 27

How does heparin treat DVT?

Answer 27

glycoaminoglycan, binds to antithrombin and increases its activity

Question 28

Does LMWH or warfarin have a longer half life?

Answer 28

warfarin