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A Haematology and Immunology > Thrombotic Disorders > Flashcards

Thrombotic Disorders Flashcards

1
Q

What are the elements of haemostasis?

A
  • Primary haemostasis
  • Blood coagulation
  • Fibrinolysis
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2
Q

What is involved in primary haemostasis?

A
  • Vasoconstriction
  • Platelet adhesion
  • Platelet aggregation
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3
Q

What is involved in coagulation?

A
  • Insoluble fibrin formation
  • Fibrin cross-linking
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4
Q

How does fibrinolysis take place?

A
  • Urokinase, tPA (tissue plasminogen activator) and factor XII convert plasminogen to plasmin
  • Plasmin converts fibrin to fibrinogen/fibrin degradation products
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5
Q

What is a thrombus?

A

A clot arising in the wrong place

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6
Q

What is a thromboembolism?

A

Movement of clot along a vessel

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7
Q

What is Virchow’s triad?

A

These factors increase risk of thrombosis:

  • Stasis
  • Hypercoagulability
  • Vessel damage
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8
Q

What contributes to stasis?

A
  • Bed rest
  • Travel
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9
Q

What contributes to vessel damage?

A

Atherosclerosis

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10
Q

What contributes to hypercoagulability?

A
  • Pregnancy
  • Combined pill or HRT
  • Trauma
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11
Q

What are the 3 types of thrombosis?

A
  • Arterial
  • Venous
  • Microvascular
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12
Q

What is an arterial clot formed of?

A

White clot = platelets and fibrin

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13
Q

What do arterial clots result in?

A

Ischaemia and infarction

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14
Q

What are arterial clots usually secondary to?

A

Atherosclerosis

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15
Q

Give examples of arterial thromboembolism.

A
  • Coronary thrombosis
    • MI
    • Unstable angina
  • Cerebrovascular thromboembolism
    • Stroke
    • Transient ischaemia
  • Peripheral embolism
    • Limb ischaemia
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16
Q

What are the risk factors for arterial thrombosis?

A
  • Age
  • Smoking
  • Sedentary lifestyle
  • Hypertension
  • Diabetes mellitus
  • Obesity
  • Hypercholesterolaemia
17
Q

How is arterial thrombosis managed?

A
  • Primary prevention
    • Lifestyle modification
    • Treatment of vascular risk factors
  • Acute presentation
    • Thrombolysis
    • Antiplatelet/anticoagulant drugs
  • Secondary prevention
18
Q

What are venous thrombi formed of?

A

Red thrombus = fibrin and RBC

19
Q

What does venous thrombosis result in?

A

Back pressure in venous system (eg swollen red leg)

20
Q

What is venous thrombosis principally due to?

A

Stasis and hypercoagulability

21
Q

Give examples of venous thromboembolism.

A
  • Limb deep vein thrombosis
  • Pulmonary embolism
  • Visceral venous thrombosis
  • Intracranial venous thrombosis
  • Superficial thrombophlebitis
22
Q

What are the risk factors for venous thrombosis (stasis and hypercoagulability)?

A
  • Increasing age
  • Pregnancy
  • Hormonal therapy (COCT/HRT)
  • Tissue trauma (including surgery)
  • Immobility
  • Obesity
  • Systemic disease
  • Family history
23
Q

What systemic diseases are associated with increased risk of venous thrombosis?

A
  • Cancer
  • Myeloproliferative neoplasm
  • Autoimmune disease
    • Inflammatory bowel disease
    • Connective tissue disease e.g SLE
    • Antiphospholipid syndrome: arterial and venous thrombosis
24
Q

How is venous thrombosis diagnosed?

A
  • Pretest probability scoring
    • Wells score
    • Geneva score
  • Lab test if probability low
    • D-dimer
  • If Thrombosis likely then go straight to Imaging
    • Doppler US
    • V/Q scan (chest X ray done first to exclude other causes of chest symtoms)
    • CT pulmonary angiogram (gold standard when investigating for PE. Gives anatomical information.)
25
Q

What is the aim of management in venous thrombosis?

A
  • Prevent clot extension
  • Prevent clot embolisation
  • Prevent clot recurrence in long term treatment
26
Q

What drugs can be given for venous thrombosis?

A

Anticoagulants (for 3 months or long term)

  • LMWH (can be used in pregnancy and for cancer associated thrombosis) -
  • Coumarins (warfarin)
  • DOACs
  • Thrombolysis only in selected cases
    • Massive PE
27
Q

Heritable thrombophilia

A

An inherited predisposition to venous thrombosis

28
Q

Give examples of common heritable thrombophilia’s.

A
  • Factor V Leiden
  • Prothrombin G20210A
29
Q

Give examples of rare heritable thrombophilias.

A
  • Antithrombin deficiency
  • Protein C deficiency
  • Protein S deficiency
30
Q

What is the clinical utility of screening for heritable 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)
31
Q

What are microvascular clots formed of?

A

Platelets and/or fibrin

32
Q

What does microvascular thrombus result in?

A

Diffuse ischaemia

33
Q

What does microvascular thrombus principally occur in?

A

Disseminated Intravascular Coagulation (DIC)

34
Q

What is DIC?

A

Diffuse systemic coagulation activation

35
Q

What does DIC occur in?

A
  • Septicaemia
  • Malignancy
  • Eclampsia
36
Q

What does DIC cause?

A
  • Gangrene
  • Organ failure
37
Q

What causes bleeding in DIC?

A

Consumption of platelets and clotting factors leads to bleeding

38
Q

Management of DIC

A

Low dose anticoagulant (Most deaths are caused by microvascular thrombosis rather than bleeding)

A Haematology and Immunology (20 decks)

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