Thrombotic Disorders Flashcards
What is Disseminated Intravascular Coagulation (DIC)?
Pathological activation of coagulation, resulting in bleeding and widespread microvascular thrombosis
What is the criteria for DIC?
Presence of an underlying condition that can cause DIC plus one of the following
Increased prothrombin time, Suggests tendency to bleed
Decreased platelet count
Decreased fibrinogen, used up for clot formation
Increased D-dimer, patient’s body is working hard to disperse clots
What are the causes of DIC?
Infection/Septicaemia
Malignancy
Obstetric
- HELLP syndrome/eclampsia
- Placental abruption
- Retained placenta
- Amniotic fluid embolus
Anaphylaxis
Acute liver disease and cirrhosis
What investigations are used in DIC diagnosis?
Increased PT
Increased APTT
Increased D dimer
Increased fibrin degradation products
Decreased fibrinogen
Decreased platelets
How is DIC managed?
Treat underlying cause
Platelets
Cryoprecipitate
Fresh frozen plasma
What is thrombophilia?
Group of conditions which induce a pro-coagulant state, resulting in thrombosis
What are the primary causes of thrombophilia?
Protein C deficiency
Protein S deficiency
Antithrombin III deficiency
Factor V Leiden
Prothrombin gene mutation
Homocystinuria
What is the most common cause of inherited thrombophilia?
Factor V Leiden
What are the secondary causes of thrombophilia?
Malignancy
Immobility
Major surgery, especially orthopaedic
COCP
Smoking
Pregnancy
Antiphospholipid syndrome
What 3 factors suggests a patient should be investigated for thrombophilia?
Thromboembolism <45 years, or FH
Recurrent thromboembolism/miscarriage
Thrombosis at an unusual site
What investigations are used in thrombophilia diagnosis?
FBC: Exclude polycythaemia
APTT
PT
Fibrinogen
Blood film
How is thrombophilia managed?
Anticoagulation
Avoid precipitants: OCP
What is antiphospholipid syndrome?
Acquired disorder characterised by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia
It may occur as a primary disorder or secondary to other conditions, most commonly systemic lupus erythematosus (SLE)
What complications can occur due to antiphospholipid syndrome in pregnancy?
Recurrent miscarriage
IUGR
Pre-eclampsia
Placental abruption
Pre-term delivery
Venous thromboembolism
How is antiphospholipid syndrome managed?
Low-dose aspirin should be commenced once the pregnancy is confirmed on urine testing
Low molecular weight heparin once a fetal heart is seen on ultrasound, usually discontinued at 34 weeks gestation
