Hubbard: Bleeding and Clotting DSA Flashcards
__________ = most important predictor of bleeding
risk.
History of bleeding risk
________= hallmark of moderate and severe factor 8 and 9 deficiency
Spontaneous hemarthroses
Disorders due to ABNL platelets vs coagulation facts cause WHAT findings
- ABNL platelets = Mucosal/skin bleeding => peteechiae
2. ABNL coagulation factors = JOINT bleeding, deep tissue bleeding
How does bleeding due to clotting factor abnormalities differ from those seen with platelet deficiencies?
- Spontaneous petechiae/purpura = uncommon
- Bleeding manifests as large excxymoses or hematomas after injury or prolonged bleeding after laceration/surgery.
- Often occurs into the GI/GU tracts and into weight-bearing joints (hemarthrosis)
_______ = suggestive of underlying
platelet disorders or Von Willebrand disease (VWD), also called disorders of primary hemostasis or platelet plug formation.
Mucosal bleeding symptoms
Bleeding symptoms that appear to be more common in patients with
bleeding disorders include …
- Prolonged bleeding with surgery
- Dental procedures and extractions, and/or trauma
- Heavy menstrual
bleeding (HMB) - Postpartum hemorrhage (PPH)
- Large bruises (often described with lumps).
\_\_\_\_\_\_ = MC symptom in hereditary hemorrhagic telangiectasia (HHT) and in boys with VWD
Epistaxis
Bleeding with eruption of primary teeth = common in _________
Kids with severe bleeding disorders (moderate - severe hemophilia)
Heavy menstrual bleeding = loss of ______ of blood per cycle, based on the quantity of blood loss required to produce iron-deficiency anemia
> 80 mL
Complaint of heavy menses is subjective and poorly correlates with excessive
blood loss. Predictors of HMB include bleeding resulting in: (4)
- Iron-deficiency anemia
- Need for blood transfusion
- Passage of clots >1 in. in diameter,
- Changing a pad or tampon more than hourly
HMB is a common symptom in women with underlying
bleeding disorders and is reported in the majority of women with
- VWD
- Factor XI deficiency, and symptomatic carriers
of hemophilia.
_________
has been associated with angiodysplasia of the bowel and GI bleeding.
VWD, particularly types 2 and 3
Hemarthroses and spontaneous muscle hematomas are
characteristic of __________
Moderate - severe congenital factor 8 or 9
deficiency
Muscle and soft tissue bleeds are also common in ______
factor 8 deficiency
Life-threatening sites
of bleeding include bleeding into the
- Oropharynx
- CNS
- Retroperitoneum
_________ bleeding is the
major cause of bleeding-related deaths in patients with severe congenital factor deficiencies
CNS
What medications and dietary supplements have pro-hemorrhagic effects
- ASA and NSAIDS that inhibit COX-1 => impair primary hemostasis
- ADP P2Y12 inhibitors (-grel drugs) = inhibit platelet aggregation & have higher risk of bleeding
- Fish oil/omega3 FA = INC PGI3, which impair platelet function
- Vitamin E = inhibits PKC-mediated platelet aggregation and NO production
UNDERLYING SYSTEMIC
DISEASES THAT may be present with bruising/mucosal bleeding
- Liver disease
- Severe renal impairment
- Hypothyroidism
- Paraproteineimias
- Amyloidosis
- Conditions causing BM failure.
What factors are dependent on Vit. K?
Vitamin K deficiency results in?
Factors 2, 7, 9, and 10, as well as protein C and protein S
-Bleeding
NL blood platelet count is _______
150,000–450,000/μL.
What platelet count does spontaneous bleeding occur?
<10,000–20,000/μL
At what platelet count can most surgical procedures be performed at?
50,000/μL, but preferably ~80,000/μL.
What are the major RF for arterial vs venous thrombosis?
- Arterial = atherosclerosis
- Venous = immobility, surgery, underlying medical conditions like hormonal therapy, obesity and genetic predispositions
Most important point in a history related to venous
thrombosis is determining whether the thrombotic event was …
Idiopathic (no clear precipitating factor) or
was a precipitated event.
In patients without underlying
malignancy, ___________ = strongest predictor of
recurrence of VT
Having an idiopathic event
Routine pre-op and pre-procedure testing, an abnormal prothrombin time (PT) may detect…
- Liver disease
2. Vitamin K deficiency
The most commonly used screening tests are the _________
- PT
- aPTT
- Platelet count
INR is used for what?
- Assess stable anticoagulation due to reduction of vitamin K–dependent co-ag factors;
- Liver disease.
Allows comparison between laboratories.
Mixing studies are used for what?
Evaluate a prolonged aPTT or, less commonly PT, to distinguish between a factor deficiency and an
inhibitor.
If isolated factor deficiencies => the aPTT will correct. with mixing and stay corrected with incubation. With aPTT
prolongation due to a lupus anticoagulant, the mixing and
incubation will show no correction. In acquired neutralizing factor
antibodies, notably an acquired factor VIII inhibitor, the initial assay
may or may not correct immediately after mixing but will prolong
or remain prolonged with incubation at 37°C.
How is a mixing study performed?
NL plasma and patient plasma are mixed
in a 1:1 ratio => determine aPTT or PT .
If isolated factor deficiencies => aPTT will correct.
aPTT
prolongation due to a lupus anticoagulant => aPTT will not correct.
In acquired neutralizing factor
Ab, notably an acquired factor 8-inhibitor => the initial assay may or may not correct immediately after mixing but will prolong
or remain prolonged with incubation at 37°C.
