Thrombocytopenic Disorders Flashcards
what are risk factors for thrombosis?
- hereditary or acquired thrombophilic defects
- malignancy, inflammation, autoimmunde disorders
- surgery, inactivity, travel,
- hormonal effects
signs and symptoms of DVT/PE?
- Unilateral extremity swelling, pain, redness, warmth
- shortness of breath
- cough
- hemoptysis
- chest pain due to lung infarcts
- may be hypoxic and/or tachycardic
what are tests that can be done for DVT/PE?
- D-dimer: all patients with clinically thrombosis will have D-dimer (very sensitive, but not specific at all)
- CT angiography: used for people you think has PE; diagnotic test of choice for positive D-dmer and appropriate clinical probabilty
- ventilation/perfusion (V/Q) scans: sensitive but not specific (anything that alters profusion would affect)
- venogram is gold standard for DVT but has dye loadn and risk of clot. NOT used in most clinical settings
- Doppler US
what should you use if someone has a high probability of DVT/PE
doppler US
CT angiogram, MR angiogram
what immediate therapy should be considered for a patient with DVT/ PE?
- Consider embolectomy or thrombolytic therapy in unstable patient or cases of RH strain (catheter directed thrombolysis)
- Vena Cava Filter: PE/proximal DVT in someone who has contraindication to anticoagulation
- anticoagulation (UFH, LMWH, Fondaparinux, DOAC) should be started immediately (will not breakdown clot but prevent more)
- DOACS are mainly used
what are examples of provoked DVT? how long would you treat a transient risk factors? persistent risk factors?
Provoked: surgeries, long flights, car rides over 4 hours, cancers, inflammatory dieseases pregnancy
transient risk factor: treatment for 3 months
persistent major risk factor: indefinite
unprovoked DVT/PE treatment
- Unprovoked DVT: single episode: at least 3 months, risk benefit discussion re:indefinite
- Unprovoked PE: indefinite
recommendation for hereditary thrombophilia or APLA with no VTE
No medications- doesn’t change anything
What are considered unusual sites for thrombophilia?
hepatic, or mesenteric veins, saggital sinus
NOT upper extremities or catheters
what conditions are considered Hereditary thrombophilias?
- Factor V leiden
- Protrombin Gene mutation
- Proctein C deficiency
- Proteins S deficiency
- antithrombin III deficiency
protein C&S and antithrombin III deficiency highest risk of clots
- hereditary resistance to activated protein C
- defect in factor which renders it unable to be degrated by protein C
- screen with activated protein C resistance test
- confirm with genetic analysis for factor mutation
- only associated with venous thrombois
Factor V leiden
inhibits clotting factors
* inherited or acquired
* inherited is autosomal dominnat
* deficiency increaes risk of venous thrombosis 30 fold
Antithrombin III
- what is a strong indepedent predictor of recurrence risk, and so is a potential indication for long term anticoagulation?
- the presence of this is not a good predictor of VTE recurrence risk and so chould not generally be used for the basis of proloning therapy?
1.) Idipathic VTE
2. the presence of inherited thromobphilia
- antibodies directed against phospholipid-protein complexes on plasma membranes
- acquired condition
- may be primary or secondary
- associated with: venous thrombosis, stroke, early onset dementia, migraines, fetal loss
antiphospholipid antibody syndrome (APLA)
Treatment of APLA
- immunosupression does not decrease risk of thrombosis
- venous thrombosis: warfarin
- warfarin refractory: LMWH
- pregnancy with hx of thrombosis: LMWH
- Pregnancy w/o thrombosis: prophylactic LMWH +ASA
- throbocytopenia: steroids, IVIG, anti D
