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Haematology > Thrombotic disorders > Flashcards

Thrombotic disorders Flashcards

1
Q

What are the elements of haemostasis?

A
  • Primary haemostasis (primary plug formation)
  • Blood coagulation
  • Fibrinolysis (after clot has been made)
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2
Q

What is a thrombus?

A
  • Clot arrising in the wrong place
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3
Q

What is a thromboembolism?

A

‘Movement of clot along a vessel’

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4
Q

What are the three elements of virchow’s triad?

A
  • Stasis
  • Hypercoagulability
  • Vessel damage
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5
Q

What factors increase stasis?

A
  • Bed rest
  • Travel
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6
Q

What factors increase coagulability?

A
  • Pregnancy
  • HRT
  • Malignancy
  • Trauma
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7
Q

What factors increase vessel wall damage?

A

Atherosclerosis

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8
Q

Arterial thrombus

Why?

Where?

What?

A
  • ‘White clot’~platelets and fibrin
  • Results in ischaemia and infarction
  • Principally secondary to atherosclerosis
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9
Q

What are some examples of arterial thrombus?

A
  • Coronary thrombosis:
    • MI Unstable angina
  • Cerebrovascular thromboembolism:
    • Stroke
    • Transient ischaemia
  • Peripheral embolism
    • Limb ischaemia
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10
Q

RF for arterial thrombus?

A
  • Age
  • Smoking
  • Sedentary lifestyle
  • Hypertension
  • Diabetes mellitus
  • Obesity
  • Hypercholesterolaemia
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11
Q

Management of arterial thrombus?

A
  • Primary prevention
    • Lifestyle modification
    • Treatment of vascular risk factors
  • Acute presentation
    • Thrombolysis
    • Antiplatelet/anticoagulant drugs
  • Secondary prevention
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12
Q

Venous thrombus

Why?

Results in?

Which part of virchow’s triad?

A
  • ‘Red thrombus’~fibrin and red cells
  • Results in back pressure
  • Principally due to stasis and hypercoagulability
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13
Q

Examples of venous thromboembolism?

A
  • Limb deep vein thrombosis
  • Pulmonary embolism
  • visceral venous thrombosis
  • intracranial venous thrombosis
  • superficial thrombophlebitis
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14
Q

RF for venous thromboembolism?

A
  • Increasing age
  • Pregnancy
  • Obesity
  • HRT
  • Tissue trauma
  • Immobility
  • Surgery: can be within last 3 months, and can include day case patients
  • FH
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15
Q

Which systemic diseases can lead to VTE?

A
  • Cancer
  • Myeloproliferative Neoplasm (MPNs)
  • Autoimmune disease
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16
Q

How can we make a diagnosis of VTE?

A
  • •Pretest probability scoring
    • –Wells score
    • –Geneva score
  • •Laboratory testing if pretest probability low
    • –D-dimer
  • •Imaging
17
Q

What is the gold standard imaging for VTE?

A
  • CT Pulmonary angiogram
18
Q

What other imaging options are available for VTE?

A
  • If have nuclear imaging available use V/Q scan - (need to have a normal CXR)
  • Looking for mismatch between the images
19
Q

What is the aim of management for VTE?

A
  • Prevent clot extension
  • Prevent clot embolisation
  • Prevent clot recurrence in long term treatmenta
20
Q

What drugs are used in the Mx of VTE?

A
  • •Anticoagulants
    • –LMWH
    • –Coumarins (warfarin)
    • –DOACs
  • •Thrombolysis only in selected cases
    • –Massive PE
21
Q

What is heritable thrombophilia?

A

An inherited predisposition to venous thrombosis

22
Q

What are the most common types of heritable thrombophilia?

A
  • Factor V leiden
  • Prothrombin G20210A
23
Q

What factor does V leiden act on?

A

Acts on activated factor 5

[it’s literally in the name]

24
Q

What are the clinical recommendations for people with hereditary thrombophilias?

A
  • Majority are not predictive of recurrent event
  • Screening of asymptomatic family members not recommended
  • Limited thrombophilia screening: restricted to high risk heritable thrombophilia (antithrombin deficiency)
25
Q

Microvascular thrombus

What causes this?

What does it affect?

A
  • Platelets and/or fibrin
  • Results in diffuse ischaemia
  • Principally in Disseminated Intravascular Coagulation [DIC]
26
Q

What is DIC?

When does it occur?

What does it cause?

A

Disseminated Intravascular Coagulation

  • Diffuse systemic coagulation activation
  • Occurs in:
    • Septicaemia
    • Malignancy
    • eclampsia
  • Causes tissue ischaemia
    • Gangrene
    • organ failure
  • Consumption of platelets and clotting factors leading to bleeding

Haematology (16 decks)

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