L29, 30 Inherited and Acquired Bleeding Disorders

Question 1

What are the usual diagnostic test for coagulation disorder

Answer 1

APTT
PT
TT
Fibrinogen level

Question 2

Which pathway(s) does APTT measure
List diseases where involves the disorder with this pathway(s)

Answer 2

Intrinsic pathway & final common pathway
Haemophilia, VWF disease 
Factor XII deficiency 
Factor X deficiency 
Fibrinogen deficiency 
Vitamin K deficiency 
haemorrhagic disease of the new bornn 
Vitamin K antagonsim 
Liver disease 
DIC

Question 3

What pathway(s) does PT measure

Answer 3

Extrinsic and final common pathway

Question 4

A patient is taking a drug which he can’t recall and he is having a prolonged TT, what is he likely to be taking

Answer 4

Heparin, due to the inhibition of thrombin

Question 5

How is the test TT carried out and what does it evaluate

Answer 5

Carry out by adding thrombin and evaluate on the amount of fibrinogen

Question 6

What are the systemic disease that might link to a bleeding disorder

Answer 6

Renal disease, chronic liver disease, autoimmune diseases

Question 7

In a clinical setting, is acquired and inherited bleeding disorder more common

Answer 7

Acquired is more common

Question 8

Is thrombocytopenia or platelet disfunction more common in clinical settings

Answer 8

Thrombocytopenia

Question 9

When autoimmune thrombocytopenia is secondary to other systemic disease, what are the likely disease

Answer 9

Autoimmune diseases

Acute post-viral event (typically yong children)

Question 10

What are the usual clinical presentation of haemophilia A

Answer 10

Haemarthrosis and soft tissue bleeding

Question 11

Which chromosome is the gene coding for VWF located

Answer 11

Chromosome 12

Question 12

What is the function of VWF

Answer 12

Protein carrier for factor 8 because it degrades easily in plasma
Mediating platelet adhesion to collagen in the sub-endothelial matrix

Question 13

Why would there be vitamin K deficiency in obstructive jaundice

Answer 13

Bile salt secretion decreases
Absorption of fat decreases
Since vitamin K is a fat soluble vitamin
Hence …

Question 14

What are the clotting factors that depend on the vitamin K

Answer 14

2, 7, 9, 10

Question 15

What is the route of intake of vitamin K

Answer 15

Absorbed from food in the upper part of the small intestine in the presence of bile
Intestine flora

Question 16

If a patient has acquired bleeding disorder with the route cause of liver disease, what may be the possible treatment? (except treating liver? )

Answer 16

Parenteral vitamin K replacement

Clotting factor replacement

Question 17

What is disseminated intravascular coagulation (DIC)?

Answer 17

Inappropriate and excessive activation of the haemostatic system

Question 18

What are the causes of DIC

Answer 18

Infection: sepsis 
Malignancies 
Obsteric conditions 
Massive tissue trauma 
Extensive intravascular haemolysis

Question 19

For a patient with DIC, what is the expected PT, APTT, TT and reduced fibrinogen level?

Answer 19

PT, APTT, TT and fibrinogen level will be reduced

Question 20

What is the plan of treatment for DIC

Answer 20

Treat the precipitating trigger

Transfusion of platelet and fresh frozen plasma

Question 21

What is the PT, APTT and TT for haemophilia

Answer 21

APTT, PT increases

TT normal

Question 22

For a patient with a bleeding disorder, what is the likely cause when APTT, PT and TT are normal

Answer 22

Platelet disoder

Question 23

What will be the level of APTT, PT and TT for a patient with liver disease

Answer 23

Prolongation of PT and APTT, probably a prolonged TT –>WHY ?!! @@