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Haematology and Immunology > Thrombotic Disorders > Flashcards

Thrombotic Disorders Flashcards

1
Q

What is a thrombus?

A

Clot arising in the wrong place

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2
Q

What is a thromboembolism?

A

Movement of clot from primary site

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3
Q

What is Virchow’s triad?

A

Vessel wall damage (atherosclerosis, trauma), stasis (bed rest, travel) + hypercoagulability (pregnancy, trauma)

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4
Q

What are the categories of thrombosis?

A

Arterial
Venous
Microvascular

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5
Q

What are arterial thrombus made up of?

A

Platelets (main component) and fibrin

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6
Q

What are the outcomes of arterial thrombosis?

A

Ischaemia and infarction

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7
Q

What is the most common cause of arterial thrombosis?

A

Rupturing atherosclerotic plaques

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8
Q

What are some common examples of arterial thrombosis?

A

MI, stroke, limb ischaemia and unstable angina

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9
Q

What are the risk factors for arterial thrombosis?

A 
Age
Smoking
Sedentary lifestyle
Hypertension
Diabetes mellitus
Obesity
Hypercholesterolaemia
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10
Q

How is arterial thrombosis managed?

A

Primary prevention- lifestyle modification and treatment of vascular risk factors
Acute presentation- thrombolysis and antiplatelet/anticoagulant drugs
Secondary prevention

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11
Q

What are venous thrombus made up of?

A

Fibrin (main component) and red cells

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12
Q

What are the outcomes of venous thrombus?

A

Back pressure which causes valvular insufficiency resulting in post-thrombotic syndrome which can persist for up to two years following the thrombus

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13
Q

What are some examples of venous thromboembolism (VTE)?

A 
DVT 
PE
Visceral venous thrombosis
Intracranial venous thrombosis
Superficial thrombophlebitis
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14
Q

What are the risk factors for VTE?

A

Increasing age
Pregnancy
Hormonal therapy (COCP/HRT)
Tissue trauma
Immobility
Surgery (not just due to immobility, vessel damage in surgery causing release of prothrombotic factors. Outpatient surgery still a risk factor. Risk up to 12 weeks post operatively)
Obesity
Systemic disease (malignancy- especially GI tract and pancreatic cancers, haematological cancer, myeloproliferative neoplasm and autoimmune disease ie IBD, SLE, antiphospholipid syndrome)
Family history (first degree relatives only)
Smoking not shown to increase risk

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15
Q

How is VTE diagnosed?

A

Pretest probability scoring (Wells Score)
Laboratory testing (D-dimer)
Imaging.
There is a specific Wells score for PE.
If probability is high on a Wells score then go straight to imaging.
In low risk individuals a D-dimer can be done and follow up imaging if this is positive.
Imaging is usually a Doppler US
PE investigated with a ventilation/perfusion (V/Q) scan or CTPA. CXR usually done prior to eliminate other causes

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16
Q

What are the aims of management of VTE?

A

Prevent clot extension
Prevent clot embolization
Prevent clot recurrence in long term treatment

17
Q

How long should anticoagulants be given following a VTE?

A

3 months following a VTE. Long term treatment can be given if there are ongoing risk factors that will persist beyond the 3 months

18
Q

What drugs can be used to give anticoagulation following a VTE?

A

LMWH (used in malignancy and pregnancy)
Coumarins (warfarin)
DOACs (contraindicated by metallic heart valve)
Thrombolysis only in selected cases (massive PE)

19
Q

What are the causes of heritable thrombophilia?

A 
Factor V Leiden mutation (most common)
Prothrombin mutation
Antithrombin deficiency (only condition where family testing indicated)
Protein C deficiency
Protein S deficiency
20
Q

What are the characteristics of microvascular thrombi?

A

Made of platelets, fibrin or both
Results in diffuse ischaemia.
Generally limited to severely ill patients in ITU/HDU settings.
Usually caused by disseminated intravascular coagulation (DIC).
There is a drive towards both clot formation and breakdown, but as the clotting factors become exhausted there is a risk towards bleeding.
Digital ischaemia most common presentation

21
Q

What conditions can cause disseminated intravascular coagulation?

A

Septicaemia
Malignancy
Eclampsia

22
Q

What are the possible outcomes of disseminated intravascular coagulation?

A

Tissue ischaemia and can result in gangrene or organ failure

Haematology and Immunology (12 decks)

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