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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
Q

What effect does cirrhosis have on D-dimers, PLT count, PT and APTT?

A

Normal D-dimers
Low platelets
Raised PT
Raised APTT

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26
Q

Name causes of vitamin K deficiency

A 
Diet
Absorption
Warfarin antagonist
Obstructive jaundice eg gallstone
Haemorrhagic disease of the newborn
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27
Q

What is given as prophylaxis against haemorrhagic disease of the newborn?

A

Vit K IJ

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28
Q

What is required for vitamin K absorption?

A

Bile salts

Also fat soluble

29
Q

Vitamin K deficiency effects factors ……

A

II, VII, IX, X

Also protein C and S

30
Q

What are the 2 types of haemophilia? Which is more common? Which factors are effect in each type?

A

A - VIII (80%)

B - IX

31
Q

What is the inheritance pattern in haemophilia?

A

X linked

32
Q

How does haemophilia present?

A 
Recurrent haemarthrosis
Easy bruising
Haematuria
Haematomas
Prolonged bleeding after minor procedure
33
Q

What is haemarthrosis? Which areas of the body are most effected? What is the pathological response?

A

Bleeding into a joint space
Ankle, elbow, knee
Neovascularisation

34
Q

What is the complication of haemarthrosis in haemophilia?

A

Haemophilic arthropathy

Mx joint replacement

35
Q

What effect does haemophilia have on platelet count, APTT and PT?

A

Normal PLT count
Raised APTT
Normal PT

36
Q

What is the management of haemophilia?

A

IV infusion of factors every 2 days

37
Q

What is DIC?

A

Disseminated intravascular coagulation

Increased and inappropriate haemostasis activation

38
Q

What stages of haemostasis are effected in DIC?

A

Primary + secondary + fibrinolysis

39
Q

What leads to organ failure in DIC?

A

Microvascular thrombus formation

40
Q

What is the aetiology of DIC?

DIC is not a diagnosis

A 
Massive trauma eg RTA
Septic/hypovolaemic shock
ABO incompatible
Obstetric emergency
Cancer
41
Q

What effect does DIC have on D-dimers, PLT count, PT and APTT?

A

Very raised D-dimers
Decreases platelets
Raised PT
Raised APTT

42
Q

What is the management of DIC?

A

Tx cause
Replace fibrinogen
Transfuse PLT + plasma

43
Q

Where are common sites of arterial and venous thrombosis?

A

Arterial: coronary, cerebral, peripheral
Venous: DVT, PE

44
Q

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 ______.

A

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
Q

What are some risk factors for arterial thrombosis?

A 
BP
HTN
Smoke
Atherosclerosis
DM
46
Q

What are the components of Virchow’s triad?

A

Hypercoagulability
Stasis
Valve damage

47
Q

Venous thrombosis activates the _____

A

Coagulation cascade

48
Q

Pulmonary embolisms cause ____ sided heart strain and knife like sharp pain on ____.

A

Right

Inhalation

49
Q

Do DVTs cause pitting or non-pitting edema?

A

Pitting

50
Q

What are some non-modifiable risk factors for VTE?

A

Age
Family history
PMH VTE
Thrombophilia

51
Q

What is the strongest RF for VTE?

A

PMH VTE (damages endothelium)

52
Q

What are some modifiable RF for VTE?

A 
Obesity
Cancer 
Immobility
Puerperium/pregnant
Estrogen eg CHC
Trauma
Infections
53
Q

Multiple risk factors for VTE have _____ effect

A

Synergistic

54
Q

Why is infection a risk factor for VTE?

A

Some clotting factors are acute phase proteins

55
Q

Thrombophilia increases the risk of ____

A

VENOUS thrombosis

56
Q

What is a cause of acquired thrombophilia?

A

APS

57
Q

What are some genetic causes of thrombophilia?

A

Factor V Leiden deficient
Antithrombin deficient
Prothrombin mutation
Protein C/S deficient

58
Q

What is the pathology of factor V Leiden deficiency?

A

Protein C and S less effectively switches off factor V

59
Q

What are some red flags for factor V Leiden deficiency?

A

VTE under 45yr
Recurrent VTE
VTE in unusual place eg arm

60
Q

What drug should be avoided in factor V Leiden deficiency?

A

CHC

61
Q

What is the management of factor V Leiden deficiency in pregnancy?

A

Heparin

62
Q

What is the management of factor V Leiden deficiency ONLY if VTE recurs?

A

PO long-term anticoagulant

63
Q

APS causes ____ and ____ thrombosis

A

Arterial and venous

64
Q

What stages of haemostasis are effected in APS?

A

Primary + secondary

65
Q

What effect does APS have on PLT count, PT, APPT?

A

Mild decreased PLTs
Normal PT
Raised APTT (not deficient but interferes w test)

66
Q

What autoantibodies are found in APS?

A

B2 glycoprotein Ab

Lupus anticoagulant

67
Q

What are the 2 most common complications of APS?

A

Miscarriage

Stroke

68
Q

What is the management of APS?

A

Aspirin, warfarin

Y3 Haematology (15 decks)

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