Haemostasis

Question 1

Disorders of primary

Answer 1

Autoimmune thrombocytopenia purpura
B12 def
DIC
Hereditary disease (Glanzmann, Bernard Soulier) or acquired (aspirin, NSAIDs, clopidogrel)

Hereditary or acquired

Hereditary (Ehlers Dahlos and connective tissue disorders) or acquired (steroid, ageing, vasculitis)

Question 2

Primary Features

Answer 2

Petechiae - thrombocytopenia
Purpura - platelet or vascular
Haem like bleeding - severe VWD
Heavy and immediate, prolonged bleeding

Question 3

Primary test

Answer 3

Platelet count - <100x10^9, <40, <10
PFA100
Assay of VWF
APTT and PT normal unless severe VWD

Question 4

Primary treatment

Answer 4

Replace
Immunosuppressant
Consumption - as appropriate

Desmopressin - vwf and F8
Tranexamic acid - antifib

Question 5

Secondary

Answer 5

Lack thrombin 2a

Question 6

DIC

Answer 6

Generalised activation
Sepsis, tissue damage, inflammation
Thrombocytopenia
Decreased fibrinogen

Question 7

Secondary test

Answer 7

APTT - haemophilia A or B, factor 11 and 12
PT - factor 7
Both - liver disease, DIC, dilution

Question 8

Secondary replacement

Answer 8

Plasma
Cryoprecipitate - 8, 13, VWF
Factor concentrate - 2, 7, 9, 10 not 5

Question 9

Venous thrombosis

Answer 9

Virchow’s triad
Blood - venous
Vessel wall - arterial
Blood flow - both

Question 10

Anticoagulant proteins

Answer 10

C and S for 5a and 8a

Antithrombin for 2a and 10a