Thrombotic disorders

Question 1

what are the 3 elements of haemostasis?

Answer 1

primary haemostasis. Blood coag, fibrinolysis.

Question 2

what are the 3 components of primary haemostasis?

Answer 2

vasoconstriction, platelet adhesis, platelet aggregation.

Question 3

what convert plasminogen to plasmin? (FIBRINOLYSIS)

Answer 3

urokinase, tissue plasminogen activator (tPA), Factor 7. (this allows plasmin to cleave fibrin into fibrinogen and fibrin degredation products.

Question 4

define thrombus

Answer 4

clot arising in the wrong place

Question 5

define thromboembolism

Answer 5

movement of clot along a vessel

Question 6

what makes up virchows triad

Answer 6

stasis (bedrest, travel), hypercoagulability (pregnancy, trauma), vessel damage (artherosclerosis)

Question 7

what are the effects of arterial thrombus?

Answer 7

white clot of platlets and fibrin, resulting in ischaemia, principally secondary to artherosclerosis

Question 8

give examples of arterial thromboembolisms.

Answer 8

coronary (mi, unstable angina), cerebrovascular (stroke, TIA), peripheral emobolism (limb ischaemia)

Question 9

RF’s of Arterial thrombus

Answer 9

age, smoking, sedentary lifestyle, hypertension, dm, obesity, hypercholestrolaemia, af.

Question 10

Mx

Answer 10

lifestyle mods, tx of rf’s, thrombolysis - antiplatelets and anticoags

Question 11

what are the effects of venoous thrombus?

Answer 11

Red thrombus of fibrin and red cells, results in back pressure, due to stasis and hypercoagulability.

Question 12

examples of venous thromboembolism

Answer 12

limb deep vin thrombosis, pulmonary emboilsm.

Question 13

DVT (STASIS/ HYPERCOAGULABILITY) RF’s…

Answer 13

age, pregnancy, trauma, HRT, COCP, immobility, surgery, obesuty, systemic disease, fhx, cancer.

Question 14

what systemic diseases may cause VT?

Answer 14

cancer, myeloproliferative neoplasm, ibd, sle, antiphospholipid syndrome.

Question 15

how is thrombus diagnosed?

Answer 15

WELLS SCORE, GENEVA SCORE, lab testing (D-DIMER), imaging. DOPPLER US (compressible or non-compressible). Vqscan, ctpa,

Question 16

tx

Answer 16

Anticoagulants - LMWH, Coumarins (warfarin), DOACs

Thrombolysis only in selected cases - Massive PE

Question 17

give anexample of an inheriteb predisposition to VT

Answer 17

heritable thrombophilia

Question 18

what is a commmon cause of hereitable thrombophilia (heritable causes of VT)

Answer 18

factor 5 leiden, prothrombin, g20210A, (rarer: protein c defiicency, protein s deficiency, antithrombin deficiency)

Question 19

what does factor 5 leiden effect?

Answer 19

prothrombin being turned into thrombin

Question 20

how is protein c produced?

Answer 20

by action of thrombomodulin upon thrombin

Question 21

when is microvascular thrombus commonly seen?

Answer 21

DIC (disseminated intravascular coagulation)

Question 22

where do you commonly see DIC?

Answer 22

cancer, burns and septic shock and eclampsia.

Question 23

what is DIC? What is the pathalogical basis for the condition?

Answer 23

A diffuse systemic coagulation activation - injury triggers the clotting cascade causing systemic microvascular thrombosis. The high consumption of coagulation factors may lead to bleeding but it is usually the end organ damage which leads to high mortality rate.

Question 24

what causes tissue ischamia?

Answer 24

gangrene and organ failure.