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Haematology > Thrombotic Disorders > Flashcards

Thrombotic Disorders Flashcards

1
Q

What is involved in primary haemostasis?

A

Vasoconstriction, platelet adhesion (following collagen exposure to damaged vessel wall), activation and aggregation

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2
Q

What does blood coagulation lead to?

A

Formation of a fibrin clot after the clotting cascade

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3
Q

What occurs in fibrinolysis?

A

tPA breaks down plasminogen into plasmin

Plasmin breaks down fibrin into fibrin degradation products (one of which is D-dimer)

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4
Q

Define thrombus

A

Clot arising in the wrong place

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5
Q

Define thromboembolism

A

Clot moving along a vessel

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6
Q

What is Virchow’s triad?

A

Factors increasing risk of thrombus formation

Stasis e.g. travelling, in hospital
Hypercoagulability, e.g. pregnancy, trauma
Vessel wall damage, e.g. atherosclerosis

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7
Q

What are arterial thrombi composed of?

A

Platelets and fibrin

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8
Q

What do arterial clots result in?

A

Ischaemia and infarction

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9
Q

What are most arterial clots due to?

A

Atherosclerosis

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10
Q

Give examples of arterial clots

A

Coronary thrombosis –> MI and angina
Cerebrovascular thromboembolism –> stroke/TIA
Peripheral embolism –> limb ischaemia

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11
Q

What are the risk factors for arterial thrombosis?

A

Smoking, sedentary lifestyle, HTN, DM, obesity, hypercholesterolaemia

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12
Q

How do you manage arterial clots?

A

Prevention via modification of lifestyle/risk factors
Acute Rx: thrombolysis and anticoagulation/antiplatelets
Secondary prevention: anticoagulants/antiplatelets

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13
Q

What are most venous thrombi composed of?

A

Fibrin and red cells

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14
Q

What do venous thrombi result in?

A

Back pressure

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15
Q

What are most venous thrombi due to?

A

Hypercoagulability and stasis

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16
Q

Give examples of venous thrombi

A

DVT, PE
Visceral venous thrombosis
Intracranial venous thrombosis
Superficial thrombophlebitis

17
Q

What are risk factors for venous thrombi?

A

Anything increasing hypercoaguability and stasis:

Age, pregnancy, COCP, HRT, tissue damage, immobility, surgery, obesity, systemic disease, FH

18
Q

What systemic diseases may lead to hypercoagulable state that leads to an increased risk of venous thrombi?

A

Cancer
Myeloproliferative neoplasms
Autoimmune disease (IBD, connective tissue dx (SLE), antiphospholipid syndrome

19
Q

How can you assess the probability of venous thrombus?

A

Geneva/well’s score

20
Q

What test can you do to test for venous thrombus likelihood?

A

D-dimer

High levels –> recent intravascular coagulation/fibrinolysis (e.g. from DVT etc.)

21
Q

What imaging can you use if you suspect a venous thrombi?

A

Doppler US
VQ scan
CT pulmonary angiogram

22
Q

How do you treat a massive PE?

A

Thrombolysis

23
Q

How do you treat venous thrombi?

A

Anticoagulants e.g. LMWH, warfarin, DOACs

24
Q

What does LMWH act on?

A

10a/thrombin

25
Q

How does warfarin work?

A

Decreases numbers of vitamin K dependent factors (2, 7, 9, 10)

26
Q

What do DOACs act on?

A

10a

27
Q

What is heritable thrombophilia?

A

Inherited predisposition to venous thrombosis (hypercoagulable state)

28
Q

Give examples of heritable thrombophilias

A

Factor V leiden
Prothrombin
Antithrombin deficiency
Protein C/S deficiency

29
Q

Do we screen for heritable thrombophilias?

A

Only high risk ones e.g. antithrombin deficiency

30
Q

What are microvascular thrombi composed of?

A

Platelets +/- fibrin

31
Q

What do microvascular thrombi result in?

A

Diffuse ischaemia

32
Q

When do you tend to get microvascular thrombi?

A

in DIC - disseminated intravascular coagulation

33
Q

What is DIC?

A

Diffuse systemic coagulation activation

34
Q

When does DIC occur?

A

Septicaemia, malignancy, eclampsia

35
Q

What does DIC result in?

A 
Tissue ischaemia (gangrene, organ failure)
Consumption of platelets and coagulation factors --> bleeding

Haematology (14 decks)

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