Management of Acquired Bleeding Disorders

Question 1

Causes of bleeding with normal clotting screen

Question 2

Causes of bleeding with abnormal clotting screen

Question 3

chronology of blood changes in DIC

Answer 3

Early:
pro thrombotic

Established:
pro-haemorrhage
low platelets, low fibrinogen, coagulation factors

microvascular thrombosis –> Consumptive coagulopathy –> bleeding

Question 4

what is critical molecule ingoing frorm thrombosis to haemorrhage in DIC

Answer 4

Fibrinogen

Question 5

why do gram -ve agents particurlar cause DIC

Answer 5

Lipopolysaccharide release from dead gram-ve cells (especially bacteriacidal agents)

LPS - potent vasodilator + inducer of DIC

Question 6

Causes of DIC

Answer 6

• Sepsis -especially gram -ve bacteria, viral (especially COVID), malaria
• Pregnancy - HELLP, pre-eclampsia
• Trauma - burns
• Tumours
  *

Question 7

How is DIC assessed?

Answer 7

<4 = early
4-6 = established
>6 = late

Question 8

Why does COVID have

Answer 8

maintain platelets levels

due to long viral prodrome - able to compensate

have high thrombotic risk as well as high bleeding risk

Question 9

How is DIC managed?

Answer 9

Treat underlying cause

Maintain fibrinogen - FFP, Cryo, Fibrinogen concentrate

Question 10

How many clotting factors does the liver make

Answer 10

All of them

Some are also made elsewhere

Question 11

what are the vitamin K factors

Answer 11

2,7,9,10

Question 12

what does TEG do

Answer 12

assess hemostasis in vivo (POCT not lab)

Question 13

VWF is associated with what factor

why is this relevant