Secondary Haemostasis Issues

Question 1

What is DIC?

Answer 1

Excessive/inappropriate activation of the haemostatic system

Question 2

Give examples of when DIC occurs

Answer 2

Major trauma
ABO incompatibility reactions
Cancers
Septic shock
Ischaemia

Question 3

Describe the pathogenesis of DIC

Answer 3

TF released from damaged tissue
Activates coag cascade
Multiple thrombus formation
Causes ischaemia
More TF release
cycle continues

Question 4

How does DIC present?

Answer 4

Shock
Bleeding from mouth, nose and venopuncture sites
Ecchymoses
Evidence on thrombosis

Question 5

What does coag screen show in DIC?

Answer 5

PT, APTT, TT all prolonged

Question 6

What does FBC show in DIC?

Answer 6

Thrombocytopenia

Question 7

d-Dimer is high in DIC

true/false

Answer 7

True

Question 8

How is DIC treated?

Answer 8

Replace what is lost: Platelets or FFP and fibrinogen

Consider heparin if critically ill and not bleeding

Question 9

What is vitamin K needed for?

Answer 9

Gamma-carboxylation of glutamic acid residues on factors II, VII, IX, X on proteins C and S

Question 10

Why do caog factors need carboxylated to work?

Answer 10

Adds negative COOH group so that positive Ca2+ sticks to the coag factor
Platelets stick to this

Question 11

What is vitamin K?

Answer 11

Fat soluble vitamin

Question 12

What does vitamin K need to be absorbed?

Answer 12

Bile salts

Question 13

How does vitamin K def present?

Answer 13

GI bleed
Cerebral bleed
Bruising
Haematuria

Question 14

What may lead to inadequate stores of vit K?

Answer 14

Abx 
Bleeding disorders (haemorrhagic disease of the newborn)

Question 15

What may leads to malabsorption of vit K?

Answer 15

Obstructive jaundice

Crohns

Question 16

Which drugs may cause def of Vit K?

Answer 16

Abx

OAC

Question 17

What does coag screen show in vit K def?

Answer 17

PT and APTT prolongation

Question 18

What is the management of vit K?

Answer 18

IV vit K1

phytomenadione

Question 19

How may cholestasis lead to vit K def?

Answer 19

Lack of bile salts causing malabsorption of vit K

Question 20

How is haemophilia inherited?

Answer 20

X linked

Question 21

Which factor is defective in haemophilia A?

Answer 21

VIII

Question 22

Which factor is affected in haemophilia B?

Answer 22

IX

Question 23

What are “target joints”?

Answer 23

Mostly ankle or knee
Movement leads to bleed 
Fibrin cant be made to stop bleed
Iron causes joint irritation
Neovascularisation occurs - but these are fragile and break
Cycle continues

Question 24

<1 IU/dL of factor VIII indicates…

Answer 24

Severe haemophilia

Question 25

1-5 IU/dL of factor VIII indicates…

Answer 25

Moderate haemophilia

Question 26

> 5 IU/dL of factor VIII indicates…

Answer 26

Mild haemophilia

Question 27

Describe bleeding in moderate haemophilia

Answer 27

Prolonged bleed following injury

Question 28

Describe bleeding severe haemophilia

Answer 28

Target joints

Bleed spontaneously

Question 29

Describe bleeding mild haemophilia

Answer 29

Prolonged bleeding after surgery

Question 30

Describe coag screen in haemophilia A

Answer 30

Normal PT

Prolonged APTT

Question 31

How is mild haemophilia A treated?

Answer 31

Vasopressin IV/subcut

Or factor VIII IV every 2 days

Question 32

How is haemophilia B treated?

Answer 32

Factor IX given every 2 weeks

Question 33

What is the goal of drug therapy in haemophilia?

Answer 33

To keep factor levels above 2%