Lecture 9: Bleeding and Clotting Disorders Flashcards
When should we be worried about bleeding disorders with epistaxis, cutaneous bruising, or oozing from minor wounds?
E - > 5 per year
C - 5 visible bruises at least 1 cm
M - > 10 min
What is the difference between a Primary Hemostatic Disorder and a Secondary Hemostatic Disorder?
Primary - platelet disorder
Secondary - coagulation factor deficiency/inhibitor
What 3 things can we test for if we suspect Von Willebrand Disease?
test the amount of vWF antigen, the amount of cofactor, and amount of Factor VIII
- will see an increased PTT time
What can we give to a patient that has Von Willebrand Disease that can help treat them?
DESMOPRESSION
- helps release vWF from endothelial cells/platelets
What types of Von Willebrand Disease are autosomal dominant?
types 1, 2A, and 2B
- harder to detect in males than females
What is considered “heavy menstrual bleeding”?
- changing pad/tampon every hour
- passing clots that are larger that 1 cm
What factor deficiencies would show elevated PTT and PT times?
PTT - factors VIII, IX, and XI
PT - factor VII
Why is genetic testing important for Hemophilia A? How is Hemophilia A passed on?
- can predict the disease severity
- eliminates other diseases from differential (such as Von Willebrand Disease
- Hemophilia A is X-linked recessive
What is the most standard therapy for Hemophilia A treatment? How should pts manage their condition?
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)
Acquired Hemophilia A and Mixed Study PTT
- 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
What is Acquired Hemophilia A (Factor VIII Inhibitor)?
- 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
Where does DVT usually appear at?
typically originates in the calf (painful, cramping sensation)
How do we diagnose a thromboembolism if we suspect a patient may have one?
GENEVA criteria (score for risk factors)
- PT/DVT before?, cancer?, recent medical problem?, hemoptysis?, tachycardia?, >65?
How is a thromboembolism diagnosed?
Labs –> check for D-dimer
Radiography –> Ultrasound (DVT) or CT angio (PE)
Why is D-dimer important for diagnosing a Thromboembolic event?
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
How are ultrasounds and CT angiograms helpful in diagnosing DVT and PE?
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
How is Ventilation/Perfusion Scanning helpful in PE diagnosis?
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
What is the difference between a Red and White thrombus?
Red - VENOUS (red cells, stasis, lower extremity)
White - ARTERIAL (platelet, high shear stress, atherosclerosis, coronary/cerebral arteries)
What is a Paradoxial Embolism and what is the most common route of transmission?
- 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
For a patient with “provoked” thromboembolism with NO underlying conditions or risk factors, how long should they be on anticoagulants?
3-6 months
- for pts. with life-threatening, unusual, or underlying risk factor –> probably wanna anticoagulate indefinitely
What is a non-pharmacological option for coagulation problems?
Inferior Vena Cava Filters
