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Y3 Haematology > Platelet Problems & Thrombosis > Flashcards

Platelet Problems & Thrombosis Flashcards

1
Q

Mucosal bleeding is a sign of ______

A

Primary haemostasis failure

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2
Q

Give 4 examples of mucosal bleeding

A

Epistaxis
Menorrhagia
GI
Conjunctiva

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3
Q

Purpura is a sign of _____

A

Primary haemostasis failure

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4
Q

What are the signs of primary haemostasis failure?

A

Easy bruising
Purpura
Mucosal bleeding
ICH

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5
Q

Primary haemostasis failure could be due to a promblem with which components?

A

Vascular problem
Thrombocytopenia
Platelet function
VWF problem

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6
Q

Name 3 vascular causes of primary haemostasis failure?

A

HSP
Vit C deficient
Marfan (interferes with endothelial collagen)

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7
Q

Vitamin C deficiency is seen is what group of people?

A

Alcoholic - easy bruising

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8
Q

HSP

  • Affects what age group?
  • Occurs following a recent what?
  • Has what effect on PLT count?
  • Can cause bleeding where?
A
  • Children
  • Recent infection
  • Normal PLT count
  • PR bleeding
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9
Q

Thrombocytopenia can be classified by cause as ….

A

Decreased production

Increased destruction

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10
Q

What causes decreased PLT production?

A

Bone marrow problem eg leukaemia, myeloma, met

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11
Q

What causes increased platelet destruction?

A

Hypersplenism (portal HTN)
ITP
HUS
DIC

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12
Q

What does ITP stand for?

A

Immune thrombocytopaenic purpura

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13
Q

What drug interfere with platelet function?

A

Antiplatelets and NSAIDs

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14
Q

How does chronic kidney disease cause primary haemostasis failure?

A

Raised urea interferes with platelet function

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15
Q

Von Willebrand Disease

  • Method of inheritance?
  • Gender effected?
A

AD

M=F

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16
Q

Von Willebrand Disease

-Common or rare?

A

-Common

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17
Q

Von Willebrand Disease

-Typical presentation?

A

Menorrhagia, epistaxis, easy bruising

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18
Q

Von Willebrand Disease

-Effect on PT and APTT?

A

Normal PT, raised APTT

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19
Q

Von Willebrand Disease

-Management?

A

IJ desmopressin DDAVP

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20
Q

ITP

  • What age range does it occur in?
  • Has what effect on PLT count?
A

Children or adults

Decreased PLTs

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21
Q

What is the management of ITP?

A

PO CCS

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22
Q

Secondary haemostasis failure:
A single factor deficiency is likely to due to a ______ cause.
Multiple factor deficiencies is likely due to an ______ cause.

A

Single hereditary

Multiple acquired

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23
Q

Name 3 causes of multiple clotting factor deficiencies

A

Cirrhosis
DIC
Vitamin K deficiency

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24
Q

Why can cirrhosis cause clotting factor deficiencies?

A

Clotting factors synthesised in liver hepatocyte

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25
What effect does cirrhosis have on D-dimers, PLT count, PT and APTT?
Normal D-dimers Low platelets Raised PT Raised APTT
26
Name causes of vitamin K deficiency
``` Diet Absorption Warfarin antagonist Obstructive jaundice eg gallstone Haemorrhagic disease of the newborn ```
27
What is given as prophylaxis against haemorrhagic disease of the newborn?
Vit K IJ
28
What is required for vitamin K absorption?
Bile salts | Also fat soluble
29
Vitamin K deficiency effects factors ......
II, VII, IX, X | Also protein C and S
30
What are the 2 types of haemophilia? Which is more common? Which factors are effect in each type?
A - VIII (80%) | B - IX
31
What is the inheritance pattern in haemophilia?
X linked
32
How does haemophilia present?
``` Recurrent haemarthrosis Easy bruising Haematuria Haematomas Prolonged bleeding after minor procedure ```
33
What is haemarthrosis? Which areas of the body are most effected? What is the pathological response?
Bleeding into a joint space Ankle, elbow, knee Neovascularisation
34
What is the complication of haemarthrosis in haemophilia?
Haemophilic arthropathy | Mx joint replacement
35
What effect does haemophilia have on platelet count, APTT and PT?
Normal PLT count Raised APTT Normal PT
36
What is the management of haemophilia?
IV infusion of factors every 2 days
37
What is DIC?
Disseminated intravascular coagulation Increased and inappropriate haemostasis activation
38
What stages of haemostasis are effected in DIC?
Primary + secondary + fibrinolysis
39
What leads to organ failure in DIC?
Microvascular thrombus formation
40
What is the aetiology of DIC? | DIC is not a diagnosis
``` Massive trauma eg RTA Septic/hypovolaemic shock ABO incompatible Obstetric emergency Cancer ```
41
What effect does DIC have on D-dimers, PLT count, PT and APTT?
Very raised D-dimers Decreases platelets Raised PT Raised APTT
42
What is the management of DIC?
Tx cause Replace fibrinogen Transfuse PLT + plasma
43
Where are common sites of arterial and venous thrombosis?
Arterial: coronary, cerebral, peripheral Venous: DVT, PE
44
Arterial thrombus is _____ rich and happens in a _____ pressure system. The drug class of choice is ______. Venous thrombus is _____ rich and happens in a _____ pressure system. The drug class of choice is ______.
Arterial thrombus is PLATELET rich and happens in a HIGH pressure system. The drug class of choice is ANTI-PLATELETS. Venous thrombus is FIBRIN rich and happens in a LOW pressure system. The drug class of choice is ANTI-COAGULANTS.
45
What are some risk factors for arterial thrombosis?
``` BP HTN Smoke Atherosclerosis DM ```
46
What are the components of Virchow's triad?
Hypercoagulability Stasis Valve damage
47
Venous thrombosis activates the _____
Coagulation cascade
48
Pulmonary embolisms cause ____ sided heart strain and knife like sharp pain on ____.
Right | Inhalation
49
Do DVTs cause pitting or non-pitting edema?
Pitting
50
What are some non-modifiable risk factors for VTE?
Age Family history PMH VTE Thrombophilia
51
What is the strongest RF for VTE?
PMH VTE (damages endothelium)
52
What are some modifiable RF for VTE?
``` Obesity Cancer Immobility Puerperium/pregnant Estrogen eg CHC Trauma Infections ```
53
Multiple risk factors for VTE have _____ effect
Synergistic
54
Why is infection a risk factor for VTE?
Some clotting factors are acute phase proteins
55
Thrombophilia increases the risk of ____
VENOUS thrombosis
56
What is a cause of acquired thrombophilia?
APS
57
What are some genetic causes of thrombophilia?
Factor V Leiden deficient Antithrombin deficient Prothrombin mutation Protein C/S deficient
58
What is the pathology of factor V Leiden deficiency?
Protein C and S less effectively switches off factor V
59
What are some red flags for factor V Leiden deficiency?
VTE under 45yr Recurrent VTE VTE in unusual place eg arm
60
What drug should be avoided in factor V Leiden deficiency?
CHC
61
What is the management of factor V Leiden deficiency in pregnancy?
Heparin
62
What is the management of factor V Leiden deficiency ONLY if VTE recurs?
PO long-term anticoagulant
63
APS causes ____ and ____ thrombosis
Arterial and venous
64
What stages of haemostasis are effected in APS?
Primary + secondary
65
What effect does APS have on PLT count, PT, APPT?
Mild decreased PLTs Normal PT Raised APTT (not deficient but interferes w test)
66
What autoantibodies are found in APS?
B2 glycoprotein Ab | Lupus anticoagulant
67
What are the 2 most common complications of APS?
Miscarriage | Stroke
68
What is the management of APS?
Aspirin, warfarin

Y3 Haematology (15 decks)

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