Inherited Coagulation Disorders Flashcards

1
Q

Haemophilia A

➢Haemophilia A is an _________
bleeding disorder caused by
__________ or ________ factor _____ molecules or a combination of both

A

X-linked

defective synthesis

synthesis of dysfunctional

VIII

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2
Q

____________ is the commonest inherited
bleeding disorder after ______

A

Haemophilia A

vWD

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3
Q

Haemophilia A

➢F8 gene is located on ________

➢ pathophysiology is based on
insufficient generation of _______
by the ______ complex of the
_______ pathway

A

Xq28

thrombin

IXa/VIIIa

intrinsic

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4
Q

Haemophilia A
➢All sons of haemophilic males
with non-carrier wives are _____
➢All daughters of haemophilic males
with non-carrier wives are _______

A

normal

obligatory carriers

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5
Q

Haemophilia A

➢Sons of carriers have ____%
chance of being affected

➢Daughters of carriers have 50%
chance of being ______ if ________

A

50

carriers

father is normal.

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6
Q

Haemophilia A
✓Can result from multiple
alterations in the ____ gene:

✓Over _____ mutations noted

A

F8

142

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7
Q

Haemophilia A

Carrier detection can be as below:
•Family history
•Carriers usually have _____% or (more or less?) of _______ levels

•________ technique to detect
the ____________

•Prenatal diagnosis through ________

A

50; less

factor VIII

Southern blot

intron 22 inversion

DNA analysis

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8
Q

Haemophilia A: Carrier detection

vWF:FVIII is (lower or higher?) in carriers

A

Higher

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9
Q

Clinical classification of haemophilia A

  1. Mild: factor level is _____% of normal
    (0.06-0.3 U/ml); _______ spontaneous bleeds, secondary to _____ or ____
  2. Moderate: factor level is ___-___% of
    normal (0.01-0.05 U/ml); ____
    spontaneous bleeds, secondary to ______ or _______
  3. Severe: factor level is ____% of
    normal (≤ 0.01 U/ml); spontaneous
    bleeds from _______, requires
    factor replacement
A

6-30; extremely rare ; trauma or surgery

1-5; occasional; trauma or surgery

≤ 1; early infancy

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10
Q

Haemarthrosis in Haemophilia A:

➢Accounts for approximately ____% of
bleeding episodes
➢_______ beneath the _____ easily damaged

A

75

Numerous capillaries; synovium

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11
Q

Haemarthrosis in Haemophilia A:

Affects which joint more?
Hinge or ball and socket

A

Hinge joints > ball & socket joints

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12
Q

Haemarthrosis in Haemophilia A:

Hips, knees, shoulder, elbows, wrists, ankles

➢arrange the joints in order of deacresing frequency:___,______,_____,______ ,_____,_____

A

knees, elbows, ankles,
shoulders, wrists and hips

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13
Q

Haemarthrosis in Haemophilia A:

➢Occurs when affected child ___________

A

begins
to walk

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14
Q

Haemarthrosis

➢Heralded by aura of ____ discomfort which progresses in _____-____ to _____ pains

➢Joint ———, (cold or warm?) , ____ motion

➢May experience (mild, moderate, severe?) fever

A

mild; minutes-hours ; severe

swells; warm; limited ; limited

Mild

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15
Q

Haemarthrosis

➢Repeated bleeds destroys the ———- and leads to ____________

A

articular cartilage ; synovial hyperplasia

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16
Q

Haemarthrosis

➢A major complication is ____________, associated ________ and ____________ and —————-

A

joint deformity

muscle atrophy

soft tissue contractures and chronic
synovitis

17
Q

Haematomas

✓Characteristic of __________

✓Bleeding into ________ is not
common

A

clotting factor deficiencies

myocardium

18
Q

Haematomas

occurs only with known traumas

T/F

A

F

May occur with or without known
traumas

19
Q

Haematomas

✓May stabilize and __________

Or

✓May ____________ and ______________, thereby ___________

A

slowly resorb

enlarge progressively

dissect in all planes

compressing vital organs

20
Q

____________ is the most dangerous haemorrhagic event

A

Intracranial bleeds

21
Q

Neurologic complications of Haemophilia A

Spontaneous or following trivial
trauma in _________ patients

A

severely deficient

22
Q

Neurologic complications of Haemophilia A

➢Suspect if _________ persists

➢ Immediate __________ following suspicion (before or after?) CT scan
or MRI

A

unusual headaches

factor replacement

Even before

23
Q

Neurologic complications of Haemophilia A

Bleeding into the spinal canal is
(Common or uncommon?)

Bleeding into the spinal canal may produce _________

A

uncommon

paraplegia

24
Q

Lab features of Haemophilia A

✓APTT: ———-
✓PT: ________
✓BT: ________
✓TT: is ________

A

prolonged

normal

normal

normal

25
Q

Lab features of Haemophilia A

✓__________ assay: definitive
diagnosis

A

Factor VIII

26
Q

Lab features of Haemophilia A

FVIII antigen is measured by _________.

A

immunologic assays

27
Q

If FVIII antigen level is normal and APTT is prolonged then the patient has _____________

A

dysfunctional FVIII molecule

28
Q

Treatment of Haemophilia A

✓Avoid ____,_____

✓May use ______,______,________ in moderate doses

✓__________ with caution
✓_____ injections should be avoided
✓Replacement therapy ASP
✓Home treatment facilities
✓________ for the severely deficient

A

ASA, NSAIDs,

acetaminophen, celecoxib,
rofecoxib

Addictive narcotics

IM; Prophylaxis

29
Q

Factor VIII replacement

Several plasma products are available for use to raise VIII levels
➢_______
➢ __________
➢_____________ from pooled donors
➢Plasma-derived VIII produced by ______ techniques
➢VIII produced by _______ techniques
e.g ______
➢______ VIII is useful in patients with VIII
_________

A

FFP

Cryoprecipitate

Lyophilized VIII

monoclonal antibody

recombinant DNA ; ADVATE

Porcine; antibodies

30
Q

VIII replacement
✓____ U per ml of plasma is considered 100% of normal

✓Required dose depends on patient’s _________ and _________

✓½ life of VIII is _____-______

A

1

plasma volume (approx 5% wt in kg) and the desired level

8-12 hrs

31
Q

_________
• Commonest inherited bleeding disorder

A

vWD

32
Q

vWD

•approx 1 in _____

•Types ________
•__________ pattern of inheritance

A

100

1, 2 and 3

Autosomal recessive

33
Q

vWF is a central component of haemostasis

T/F

A

T

34
Q

Relationship between VWF and F8

A

VWF is a carrier protein for VIII in circulation

35
Q

VWF

•Provides ______ interphase between _____ and _______

A

adhesive

platelets and
injured vessel wall

36
Q

vWF produced exclusively in ______
and ________

A

endothelial cells

Mgks

37
Q

Treatment of VWD is by _______, DDAVP

A

replacement