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Im+Haem yien > Thrombotic Disorders > Flashcards

Thrombotic Disorders Flashcards

1
Q

What are the 3 components of haemostasis?

A
  1. Primary haemostasis
  2. Blood coagulation
  3. Fibrinolysis
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2
Q

What is primary haemostasis triggered by?

A

Triggered by tissue damage causing:

  • Vasoconstriction
  • Platelet adhesion
  • Platelet aggregation
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3
Q

In primary haemostasis, what does tissue damage cause?

A
  • Vasoconstriction
  • Platelet adhesion
  • Platelet aggregation
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4
Q

What does the coagulation cascade result in?

A
  • Insoluble fibrin formation
  • Fibrin cross-linking
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5
Q

What is fibrinolysis?

A

Plasminogen is converted into plasmin:

  • Converted by activation factors XI and XII
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6
Q

What activation factors are required to convert plasminogen into plasmin?

A
  • Converted by activation factors XI and XII
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7
Q

What is plasmin?

A

This is an enzyme that then converts fibrin into fibrinogen/fibrin degradation products

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8
Q

What is a thrombus?

A
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9
Q

What is thromboembolism?

A

Thromboembolism = “movement of clot along a vessel”

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10
Q

Describe the aetiology of thrombosus?

A
  • Virchow’s triad components
    • Stasis
      • Bed rest
      • Travel
    • Vessel damage
      • Atherosclerosis
    • Hypercoagulability
      • Pregnancy
      • Trauma
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11
Q

What are the 3 components of Virchow’s triad?

A

Stasis

Vessel damage

Hypercoagulability

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12
Q

What does an arterial thrombus consist of?

A
  • Platelets and fibrin
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13
Q

What are the 3 different kinds of thrombosis?

A
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14
Q

Describe the aetiology of arterial thrombosis?

A
  • Principally secondary to atherosclerosis
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15
Q

Describe the risk factors for arterial thrombosis?

A
  • Age
  • Smoking
  • Sedentary lifestyle
  • Hypertension
  • Diabetes
  • Obesity
  • Hypercholesterolaemia
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16
Q

What are possible complications of arterial thrombosis?

A
  • Ischaemia and infarction
17
Q

What are some examples of arterial thrombus disease?

A
  • Coronary thrombosis
    • Myocardial infarction
    • Unstable angina
  • Cerebrovascular thromboembolism
    • Stroke
    • TIA
  • Peripheral embolism
    • Acute limb ischamia
18
Q

Describe the management of arterial thrombosis?

A
  • Primary prevention
    • Lifestyle modifications
    • Treatment of vascular risk factors
  • Acute presentation
    • Thrombolysis
    • Antiplatelet/anticoagulant drugs
  • Secondary prevention
19
Q

What is a venous thrombus composed of?

A
  • Fibrin and red cells
20
Q

Describe the aetiology of venous thrombosis?

A
  • Principally due to stasis and hypercoagulability
21
Q

What are the risk factors for venous thrombosis?

A
  • Increasing age
  • Pregnancy
  • Hormonal therapy
    • COCP/HRT
  • Tissue trauma
  • Immobility
  • Surgery
  • Obesity
  • Systemic disease
    • Cancer
    • Myeloproliferative neoplasm (MPNs)
    • Autoimmune disease
      • Inflammatory bowel disease
      • Connective tissue disease such as SLE
      • Antiphospholipid syndrome
  • Family history
    • Heritable thrombophilia
22
Q

What are examples of heritable thrombophilia?

A
23
Q

Describe the pathophysiology of factor V Leiden?

A
  • Normally
    • Protein C activated in presence of thrombin
    • With protein S, protein C inhibits activated factor VIII and V
  • But with factor V mutation
    • Action of protein C inhibiting factor V is blocked
    • Ongoing drive towards thrombin and clot formation
24
Q

Describe the pathophysiology of protein C or S deficiency?

A
  • Factors Va and VIIIa not inhibited
25
Q

Describe the pathophysiology of antithrombin deficiency?

A
  • Thrombin generation continues and fibrin clot formation
26
Q

Describe complications of venous thrombosus?

A
  • Back pressure
27
Q

What are some examples of venous thromboembolic disease?

A
  • Limp deep vein thrombosis
  • Pulmonary embolism
  • Visceral venous thrombosis
  • Intracranial venous thrombosis
  • Superficial thrombophlebitis
28
Q

Describe the diagnosis of venous thrombosis?

A
  • Pretest probability scoring
    • Wells score
    • Geneva score
  • Lab tests if pretest probability low
    • D-dimer
  • Imaging
    • Doppler US – for upper and lower limbs
    • Ventilation/perfusion scan – for lungs
    • CT pulmonary angiogram – for heart and lungs
29
Q

What probability scoring is used in venous thrombosis?

A
  • Wells score
  • Geneva score
30
Q

What lab investigation can be done for thrombosis?

A

D-dimer

31
Q

What imaging is useful for venous thrombosis?

A
  • Doppler US – for upper and lower limbs
  • Ventilation/perfusion scan – for lungs
  • CT pulmonary angiogram – for heart and lungs
32
Q

Describe the management of venous thrombosis?

A
  • Aims
    • Preventions of clot extension
    • Prevent clot embolism
    • Prevent clot recurrence in long term treatment
  • Drugs
    • Anticoagulants – do not break down clot but prevent from extending (workings in clotting cascade)
      • LMWH
      • Coumarins (warfarin)
      • DOACs
    • Thrombolysis – breaks down clot
33
Q

What is a microvascular thrombus composed of?

A
  • Platelets and/or fibrin
34
Q

Describe the aetiology of microvascular thrombosis?

A
  • Principally in Disseminated intravascular coagulation (DIC)
    • Is diffuse systemic coagulation activation
    • Occurs in
      • Septicaemia
      • Malignancy
      • Eclampsia
    • Causes tissue ischaemia
      • Gangrene
      • Organ failure
    • Pathophysiology
      • Whilst forming clots, consumption of platelets and clotting factors leading to bleeding
      • Activation of coagulation leading to microvascular thrombosis deposition
35
Q

What is a complication of microvascular thrombosis?

A

Diffuse ischaemia

36
Q

What does DIC stand for?

A

Disseminated intravascular coagulation

37
Q

What conditions does DIC occur in?

A
  • Septicaemia
  • Malignancy
  • Eclampsia
38
Q

Describe the pathophysiology of DIC?

A
  • Causes tissue ischaemia
    • Gangrene
    • Organ failure
  • Pathophysiology
    • Whilst forming clots, consumption of platelets and clotting factors leading to bleeding
    • Activation of coagulation leading to microvascular thrombosis deposition

Im+Haem yien (23 decks)

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