Lecture 9: Bleeding and Clotting Disorders Flashcards

1
Q

When should we be worried about bleeding disorders with epistaxis, cutaneous bruising, or oozing from minor wounds?

A

E - > 5 per year

C - 5 visible bruises at least 1 cm

M - > 10 min

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2
Q

What is the difference between a Primary Hemostatic Disorder and a Secondary Hemostatic Disorder?

A

Primary - platelet disorder

Secondary - coagulation factor deficiency/inhibitor

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3
Q

What 3 things can we test for if we suspect Von Willebrand Disease?

A

test the amount of vWF antigen, the amount of cofactor, and amount of Factor VIII

  • will see an increased PTT time
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4
Q

What can we give to a patient that has Von Willebrand Disease that can help treat them?

A

DESMOPRESSION

  • helps release vWF from endothelial cells/platelets
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5
Q

What types of Von Willebrand Disease are autosomal dominant?

A

types 1, 2A, and 2B

  • harder to detect in males than females
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6
Q

What is considered “heavy menstrual bleeding”?

A
  • changing pad/tampon every hour

- passing clots that are larger that 1 cm

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7
Q

What factor deficiencies would show elevated PTT and PT times?

A

PTT - factors VIII, IX, and XI

PT - factor VII

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8
Q

Why is genetic testing important for Hemophilia A? How is Hemophilia A passed on?

A
  • can predict the disease severity
  • eliminates other diseases from differential (such as Von Willebrand Disease
  • Hemophilia A is X-linked recessive
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9
Q

What is the most standard therapy for Hemophilia A treatment? How should pts manage their condition?

A

give pt Recombinant Factor VIII

avoid bleeding in acute/chronic situations –> disease can progress to Hemophilic Arthropathy (bleeding in sinovial joint that can cause arthritis overtime)

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10
Q

Acquired Hemophilia A and Mixed Study PTT

A
  • pts. with prolonged PTT (as in a factor deficiency) should fully correct with 50% of normal factor lvls
  • failure of PTT to correct with study could indicate ANTIBODIES are present (extra Abs would bind to normal blood)

if antibodies are suspected, check for family history of autoimmune disease

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11
Q

What is Acquired Hemophilia A (Factor VIII Inhibitor)?

A
  • often seen in adults (50+) but can occur postpartum or during pregnancy (<50)
  • associated with autoimmune diseases (SLE/RA)
  • treat mainly by suppressing the inhibitor

pts with CONGENITAL Hemophilia A can develop Abs to FVIII over the course of their disease

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12
Q

Where does DVT usually appear at?

A

typically originates in the calf (painful, cramping sensation)

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13
Q

How do we diagnose a thromboembolism if we suspect a patient may have one?

A

GENEVA criteria (score for risk factors)

  • PT/DVT before?, cancer?, recent medical problem?, hemoptysis?, tachycardia?, >65?
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14
Q

How is a thromboembolism diagnosed?

A

Labs –> check for D-dimer

Radiography –> Ultrasound (DVT) or CT angio (PE)

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15
Q

Why is D-dimer important for diagnosing a Thromboembolic event?

A

has HIGH NEGATIVE predictive value

  • if D-dimer isn’t found (normally a degradation product of cross-linked fibrin) you are NOT dealing with a TEV
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16
Q

How are ultrasounds and CT angiograms helpful in diagnosing DVT and PE?

A

US - lumen of occluded vein will NOT collapse during compression

CT - show normally white vessels, but if there is an occlusion it will appear dark

17
Q

How is Ventilation/Perfusion Scanning helpful in PE diagnosis?

A

breath a radiotracer dye to measure ventilation, then get injected with a radiotracer dye to measure perfusion

  • any difference between the two patterns is a mismatch and can indicate PE
18
Q

What is the difference between a Red and White thrombus?

A

Red - VENOUS (red cells, stasis, lower extremity)

White - ARTERIAL (platelet, high shear stress, atherosclerosis, coronary/cerebral arteries)

19
Q

What is a Paradoxial Embolism and what is the most common route of transmission?

A
  • passage of embolus from venous circulation to arterial circulation
  • commonly travels through patent foramen ovale
    • found in 50-60% of pts <55 who have had stroke
    • normally only in 15-20% of the population
20
Q

For a patient with “provoked” thromboembolism with NO underlying conditions or risk factors, how long should they be on anticoagulants?

A

3-6 months

  • for pts. with life-threatening, unusual, or underlying risk factor –> probably wanna anticoagulate indefinitely
21
Q

What is a non-pharmacological option for coagulation problems?

A

Inferior Vena Cava Filters