Hematology lec 3 : Coagulation and bleeding disorders (Hemostasis) Flashcards

1
Q

A 32-year old woman observes the presence of multiple petechiae, purpura and ecchymosis rashes when she wakes up in the morning . She had a history of epistaxis requiring cauterization.

  • Platelet count 50 x 109/L (RI 150-400 x 109/L)
  • Bleeding time 10 min (RI 2-7 min)
    This woman might be suffering from???????
A

Immune thrombocytopenic purpura

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2
Q

Components of hemostasis

A
  • normal blood vessels
  • clotting cascade
  • platelets
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3
Q

Hemostasis depends on a delicate balance between ………………….and …………… mechanisms

A

procoagulant , anticoagulant

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4
Q

Mechanismm of intrinsic pathway of blood coagulation

A

XIIa + XIa + lXa + Xa

اتناشر حداشر تسعة بمساعدة تمانية يبدأ الكومن باثوي ب عشرة

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5
Q

Mechanism of Extrinsic pathway of blood coagulation

A

Tissue factor + VIIa + Xa

باثوي قصير وكل حاجة فيه بسيطة

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6
Q

Mechanism of coagulation common pathway

A

Xa + (prothrombin) II to (thrombin) IIa , then Fibrinogen to Fibrin
نووتتسس عشرة محتاج مساعدة من خمسة(نصه التاني) والكالسيوم

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7
Q

Test of intrinsic pathway :

A

PTT

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8
Q

Test of Extrinsic pathway :

A

PT

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9
Q

Screening tests: done for all suspected patients

A
⚫Bleeding time
⚫Platelet count
⚫Prothombin time (PT)
⚫Partial thromboplastin time (PTT)
⚫Thrombin time (TT)
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10
Q

Specific tests : done according to results of……………….

A

screening tests

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11
Q

Bleeding time Affected by

A

�Platelet count
�Platelet function
�Vessel wall

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12
Q

Normal range OF Bleeding time

A

Ivy’s method: up to 7 min

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13
Q

Causes of prolonged bleeding time:

A
1-Thrombocytopenia 
(moderate or severe). 
2-Disorders of platelet function: 
Thrombasthenia
3-Vascular abnormalities
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14
Q

Normal platelet count =

A

150-400 x109/L

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15
Q

Investigation of a case of thrombocytopenia

A

⚫ History
⚫ CBC
⚫ Bone Marrow
⚫ ANA

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16
Q

QUALITATIVE PLATELET
DEFECT (Thrombasthenia)
In a case presenting with …………….. and
……………………………….

A

purpura , normal platelet count

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17
Q

PROTHROMBIN TIME (PT) Test for ……………….

A
extrinsic pathway (FVII, FX, FV , FII, FI)
- [majority are vitamin K dependent factor].
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18
Q

Normal range of PROTHROMBIN TIME (PT):

A

10-14 sec

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19
Q

Causes of prolonged PT

A
�Oral anticoagulants 
�Liver disease
�Vit K deficiency (FII, VII , IX and X )
�Congenital deficiency of factors 
involved in extrinsic pathway.
�DIC
�inhibitors
20
Q

PARTIAL THROMBOPLASTIN TIME (PTT) It is a test for

A

intrinsic pathway of blood coagulation (FVIII, FIX, FXI, FXII, FII, FV, X).

21
Q

PARTIAL THROMBOPLASTIN TIME (PTT) It is a test Used for patients receiving……………. therapy

A

heparin

22
Q

Normal range of PARTIAL THROMBOPLASTIN TIME (PTT): ……………………..

A

30-40 sec

23
Q

Causes of prolonged PTT

A
�Heparin 
�Deficiency of factors involved in intrinsic 
pathway, usually congenital: 
Hemophilia A Hemophilia B and von 
Willebrand disease)
�DIC
�Massive transfusion (labile FV, FVIII)
�Inhibitors
24
Q

Prolonged (BT) + Prolonged APTT+ Normal PT

A

Von Willebrand Disease

25
Q

Prolonged (BT) + Prolonged APTT+ Prolonged PT

A

Massive Liver Disease , DIC

26
Q
  • ↑ BT
  • ↓Platelet count
  • normal (PTT , PT)
A

immune thrombocytopenic purpura

27
Q
  • ↑PTT

- normal( PT , BT , Platelet count)

A

Hemophilia A

28
Q
  • ↑PTT

- normal (PT , BT , Platelet count)

A

Hemophilia B

29
Q
  • ↓Platelet count

- ↑( PT , BT , PTT)

A

DIC

30
Q

Group of disorders that predispose to venous thrombosis

A

thrombophilia

31
Q
INHERETED THROMBOPHILIA (Heritable 
thrombophilia)
A
  • Anti-thrombin deficiency
  • Protein C deficiency
  • Protein S deficiency
  • Factor V leiden (FV R 506 Q)
  • Prothrombin G20210A mutation
  • MTHFR
32
Q

Acquired thrombophilia

A

Iatrogenic: surgery -hormonal therapy - chemo/radiotherapy – drugs
Environmental: Age - obesity - pregnancy – trauma –Immobility
Disease related: APS –Neoplasia – MPN – PNH – TTP–
Inflammation – stroke -SCD

33
Q

DIAGNOSIS of HEREDITARY THROMBOPHILIA

A
Assays for:
 AT-III, 
Protein C 
Protein S
Molecular studies for:
 FV leiden
 Prothrombin G20210A
Homocysteinaemia
34
Q

DIAGNOSIS of ACQUIRED THROMBOPHILIA:

A

• Tests for APS, Lupus Anti-coagulant

35
Q

Procoagulant

A

PAI-I
Antiplasmin
Tissue Factor
Clotting Factors

36
Q

Anticoagulant

A
Protein S
Protein C
TFPI
Fibrinolytic system
AT III
37
Q

Hemostatic Balance between

A

1-platelet
2-clotting factors (procoagulant)
3- fibrinolytic system (anticoagulant)

38
Q

Types of bleeding disorders

A
  • Disorders of Blood vessels e.g. Scurvy, senile purpura
  • Disorders of Platelets decrease count (Thrombocytopenia) or impaired function Thrombasthenia
  • Disorders of Coagulation e.g decrease amount of clotting factor
39
Q

◦ Decrease platelet count less than 150.000 may be due to

A

◦ Decrease production like in aplastic anemia

◦ Increase destruction like ITP immune thrombocytopenic purpura

40
Q

Thrombasthenia Impaired platelet function may be congenital like ………………………….. or acquired e.g. …………….

A

von Willebrand disease , Aspirin therapy

41
Q

von Willebrand factor: Carrier of factor……………..Anchors platelets to subendothelium

A

VIII

42
Q

Inheritance of von Willebrand disease

A

Autosomal dominant

43
Q

Bleeding in Liver Disease
Decreased synthesis of………………………….
Prolongation of …………………………

A

II, VII, IX, X, XI, and fibrinogen,

PT, aPTT and Thrombin Time

44
Q

(bone marrow disorder lead to increase platelet productions from megakaryocyte ) we call it ……………………

A

essential thrombocytosis

45
Q

A 31 years old previously healthy man noticed some mild swelling in his left forearm following
his daily workout, which involved doing pushups and lifting weights. Two weeks later he
developed left shoulder pain and some bluish discoloration of the arm. A Doppler ultrasound
showed a DVT in the left subclavian and proximal internal jugular veins. He was treated with
low molecular weight heparin and transitioned to warfarin. 3 days later he is developing
irregular heartbeat and dyspnea , what is the most probable ?

A

PULMONARY EMBOLISM