Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CardioRespiratory 2 > Haemostasis 2 > Flashcards

Haemostasis 2 Flashcards

1
Q

What is the balance between coagulation and fibrinolysis when bleeding?

A

Coagulation factors decrease and platelets decrease

Fibrinolytic factors and anti coagulants increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why may coagulation factors be low?

A

ailure of production: congenital and acquired

defective function of a specific factor:
genetic or acquired from drugs, synthetic defects, inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do platelets adhere to collagen?

A

Directly via GLpIa or GLpIb indirectly via VWF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What may be disorders of primary haemostsis?

A

Platelet disorders

Von Willebrand factor

The vessel wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is thombocytopenia?

A

Low numbers of platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What may cause thombocytopenia?

A

Bone marrow failure due to Leukaemia or B12 defiency

Accelerated clearance e.g. immune, disseminated intravascular coagulation

Pooling and destruction in an enlarged spleen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What may cause an impared function of platelets?

A

Hereditary absence of glycoproteins or storage granules - this is rare

Acquired due to drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What impairment is found with Glenzmann’s thrombasthenia?

A

Absence of GpIIb/IIIa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What impairment is found with bernal soulier syndrome?

A

Absence of GpIb receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What impairments are found with storage pool disease?

A

reduction of dense granules in platelet e/g/
ADP
ATP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which drugs can cause impaired platelet function?

A

Aspirin
NSAIDs
Clopidogrel (common) - antiplatelet drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the common anti platelet drugs?

A

Aspirin and clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does aspirin work?

A

irreversibly blocks COX to stop prostoglandin thromboxane A2 from being produced by the arachidonic acid in platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does clopidogrel work?

A

irreversibly blocks ADP receptor on platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is von willebrand disease?

A

Hereditary decrease of quantity which can +/- function

could also be acquired due to an antibody but this is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the two functions of VWF?

A

Binding to collagen and capturing platelets

Stabalising Factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If VWF is low then?

A

Factor VIII may be low

  • because they travel as a complex of glycoproteins and both are involved with hemophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What mutations can cause VWF disorder?

A

Deficiency of VWF - type 1 + 3

VWF with abnormal function - type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can cause vessel wall disorders

A

inherited haemorrhagic telangiectasia Ehlers-Danlos and other connective tissue disorders - rare

Acquired is more common : steroid therpy, ageing, vasculitis, scurvy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the clinical features of disorders of primary haemostasis?

A

– imemdiate manifestation of bleeding
- prolonged bleeding from cuts
- nose and gum bleeding
- menorrhagia
- Eccyhmosis may be easy
prolonged bleeding after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Ecchymosis?

A

Bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can be seen on the skin due to bleeding under the skin due to thrombocytopenia

A

petechiae (<3mm) purpura 3-10mm) (these do not blanch when pressure is applied)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What can be seen on the skin due to bleeding under the skin due to vascula disorders?

A

Purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does severe VWF disorder present?

A

Haemophilia like bleeding due to low FVIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do we test for disorders of primary haemostasis?
- platelet count, morphology bleeding time- PFA100 assays of VWF clinical observation *coagulation screen, PT, APTT are both normal in these patients (except for severe VWF due to low V8)
26
What platelet count would result in spontaneous bleeding?
less than 40x10^9 / L if lower than 10x10^9/L then very severe spontaneous bleeding
27
How to treat failure of production / function that cayses primary haemotasis disorders?
replace : VWF, platelets - prophylactic - therapuetic stop aspirin/NSAIDS
28
How to stop immune destruction based primary haemostasis disorder?
immunosuppression - prednisolone splenectomy for ITP - Immune thrombocytopenic purpura
29
How to treat increased consumption causing primary disorders
treat cause | replace as necessary
30
What is Desmospressin used for?
Vasopressin analogue and can increase VWF from endogenous stores * only useful in mild disorders
31
What is tranexamic acid used for?
Antifibrinolytic * used in heavy periods
32
What other (non conventional) haemostatic treatments are there for primary disorders?
fibrin glues and sprays in theatre OCP - for menorrhagia
33
What is secondary haemostasis?
coagulation Platelet plug being stabilised by fibrin to stop blood loss
34
What is the role of coagulation?
generate thrombin = 2a converts fibrinogen to fibrin Deficiency of any coagulation factor can cause failure of thrombin generation an hence the fibrin plug
35
What can cause disorders of coagulation?
Coagulation factor production deficiency dilution increased consumption
36
What can cause dificiency of coagulation factor production?
Hereditary: factor V8 / 9 haemophilia a/b ``` acquired: liver disease anticoagulation drugs (warfarin and DOACs) ```
37
What is dilution?
From blood transfusion
38
what causes increased consumption disorders of coagulation?
Disseminated intravascular coagulation - common immune antibodies - rare
39
What is Haemophilia A and B?
a = factor 8 deficiency b = factor 9 sex linked
40
What is Haemarthrosis and what is this the hallmark of?
Spontaneous joint bleeding when factors 8/9 is low * can be avoided with propholaxis replacement therapy if is it chronic haemarthrosis it can cause muscle wasting and joint deformity
41
can you give a px with haemophilia intramuscular injection?
No
42
What are some examples of lethal coagulation factor deficiencies?
Prothrombin
43
What are the clinical bleeding signs of factor 11 deficiency?
bleed after trauma not spontaneously
44
What are the bleeding signs of factor XII deficiency?
no bleeding
45
Why does liver failure result in coagulation disorder?
Most factors are made in the liver
46
How to avoid a dilutional effect after haemorrhage?
When giving blood transfusion do not just give red blood cells require plasma and platelets to otherwise will lose coagulation factors
47
What occurs in dissemniated intravascular coagulation?
general activation of coagulation - tissue factor associated with SEPSIS or cancer, major tissue damage and inflammation depletes factors thrombocytopenia too activation of fibrinolysis depletes fibrinogen == raised D dimer
48
What is the D-dimer?
A breakdown product of fibrin
49
What does the deposition of fibrin in vessels following increased consumption cause?
Organ failure and sheering of red blood cells = fragmentation
50
What are the clinical features of coagulation disorders?
Superficial cuts do not bleed as platelets are fine bruising common spontaneous bleeding is deep into muscles of joints bleeding after trauma may be delayed and is prolonged bleeding frequently restarts after stopping
51
What tests are done for coagulation disorders?
Screening tests : PT APTT full blood count Coagulation factor assays for factor VIII tests for inhibitors
52
What could cause these results: PT = 10.6s (normal) APTT = 85s (high)
- haemophilia A/B - factor XI, XII deficiency intrinsic pathway
53
What could cause these results: PT = 26s (high) APTT = 29s (normal)
Factor VII deficiency in extrinsic pathway
54
What could cause these results: | both PT and APTT are high?
- liver disease - anti coagulation drug - DIC - dilution
55
How can we replace factors?
Factor replacement therapy --> plasma FPP with all coagulation Factors --> cryoprecipitate with fibrinogen, 8, 13, VWF --> factor concentrates, available for all except factor 5 Prothrombin complex concentrates include factor 2, 7, 9, 10 Recombinant forms of Factor 8 and 9 are available on demand for bleed and on prophylaxis
56
How was haemophilia first treated?
plasma derived clotting factors, however this was an issue to due to widespread viral contamination then changes to recombinant clotting factors recent developments to modify the half lives of the factors to less frequent injections
57
What novel agents are being looked into for haemophilia treatment?
Bispecific antibody- Emicizumab binds to F8a and 10 to mimic function of F8 for Haem 8 Anti TFPI antibody Antithrombin RNAi
58
What novel treatments are being looked into for haemophilia?
Gene therapy RNA silencing : targets natural anticoagulant antithrombin
59
How do disorders of thrombosis present?
pulmonary embolism Deep vein thrombosis
60
How does pulmonary embolism present?
heart racing palpitations hypoxia chest pain haemoptysis sudden death
61
How may deep vein thrombosis - DVT present?
painful leg swelling red warm may embolise to lungs post thrombotic syndrome * px may just say feels like pulled calf muscle * can cause post thrombotic syndrome
62
what is thrombosis?
intravacular, inappropriate coagulation venous or arterial obstructs flow may embolise to lung
63
what is virchows triad?
3 factors contributing to thrombosis - blood - vessel wall - blood flow
64
What is changes in blood a risk factor for?
venous thrombosis
65
What is changes in vessel wall a risk factor for?
arterial thrombosis
66
What is changes in blood flow a risk factor for?
both arterial and venous thrombosis
67
What is thrombophilia?
increased risk of venous thrombosis
68
How may thrombophilia present?
thrombosis at young spontaneous thrombosis multiple times thrombosis whilst anticoagulated
69
What happens to fibrinolytic factors and anticoagulant proteins during thrombosis?
decrease antithrombin protein C protein S
70
What happens to coagulation factors during thrombosis?
Increase F 8, 2, 5 (due to activated protein C resistance) myeloproliferative disorders can increase platelets
71
what are the risk factors for venous thrombosis?
- increasing age - inherited thrombophilic traits: anticoagulant deficiency (antithrombin, protein C/S) ``` procoagulant excess (factor 5 Leiden Factor 8, 2) ```
72
How does the vessel wall changes cause arterial thrombosis?
Inflammatory endothelial cell changes can express coagulation proteins
73
How does blood flow changes affect thrombosis?
travel e.g. flight surgery pregnancy
74
How is venous thrombosis prevented?
assess and prevent prophylactic anticoagulant therpay
75
How to reduce risk of recurrence of venous thrombosis?
lower procoagulant factors e.g. warfarin, DOACs increase anticoagulant activity e.g. heparin

CardioRespiratory 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions