Lecture - Blood (Haemostasis #4)

Question 1

1. When assessing a person with a possible bleeding disorder, what four things are important to look at?
2. For assessing the person with the possible bleeding disorder - what three ‘screens’ do you do?

Answer 1

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Question 2

1. What are the four basic causes of bleeding?

Okay, so have a vascular disease is important for the bleeding disorder - what causes these four:

• easy bruising
• purpura of old age ‘senile purpura’
• purpura from prolonged steroid medication
• scurvy

More acquired vascular disorders:

1. What does severe atherosclerosis do?
2. What is telangiectasis?

Even more acquired vascular disorders:

1. Why get purpura from infection?
2. What is Henoch-Schonlein purpura?

Answer 2

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Question 3

What are clinical factors that affect bleeding time and PFA-100 test? (4)

Answer 3

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Question 4

Drugs and disorders that affect platelets:

1. Anti-platelet drugs that are long-acting agents, what are they?
2. What are other sorta drugs that are short acting? Not really any names but yeah
3. Do paracetamol, opiates and tramadol affect platelets?
4. Why does renal failure (and liver failure) affect platelet function?

Answer 4

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Question 5

What does a mild platelet defect cause? (3)

Answer 5

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Question 6

What’re the 4 overall causes of thrombocytopenia>

Answer 6

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Question 7

Bleeding and Liver disease (acute and chronic severe liver disease)

The main effect is that you’ll have a reduction in Vit-K dependent factors so

• What happens to the PT and APTT? Because reduced _____ burst
• Since anti-thrombin and protein C & S are produced by liver, what happens to them? What does this reduction mean a correction in?
• In real severe cases, what happens to fibrinogen (since it is also produced by liver)
• the liver clears t-PA so what would extra t-PA mean?

Another effect of Liver disease is that thrombocytopenia is common - there is reduced production of platelets, shortened survival and some can be sequestered in spleen

How do you diagnose liver disease and bleeding?

How do you treat liver disease for acute bleeding in the presence of prolonged PT and APTT? (4)

How does tranexamic acid inhibit fibrinolysis?

Answer 7

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Question 8

vWF disease and the platelet response to vascular injury

1. What does reduced plasma and platelet vWF levels cause?
2. What sort of hereditary pattern?

vWF disease:

1. Low levels of vWF function - what two types?
2. There will be a mild reduction in what factor and why?
3. What are the three key issues with vWF?
4. What is the three types of clinical presentation of vWF?
5. What 4 diagnostic tests to do?
6. What are the two treatments?

Answer 8

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Question 9

Haemophilias:

1. They are inherited but are they recessive or dominant and autosomal or nah?
2. What’s haemophilia A or B? Are females usually affected?
3. Mutations may affect ____ _____ _____ in the F8 or F9 genes causing reduced functional activity (is that allelic heterogeneity?)
4. Why get joint bleeding problems with haemophilia?
5. Where do you get the bleeding in haemophiliacs?
6. Increased bleeding is caused by what? What happens to the fibrin strands?

Answer 9

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Question 10

Compare Haemo A and B with vWF Disease:

• Inhertiance
• bleeding time/PFA-100
• Defect in
• Platelet aggregation?
• where are the main bleeding sites?

Answer 10

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Question 11

Heprain - what is it?

What’s its half life?

What does it bind to and increase activity of? So it neutralises what? Read slide 36

Answer 11

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