thrombotic disorders Flashcards

1
Q

elements of haemostasis

A

primary heamostasis
coagulation cascase
fibrinolysis

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2
Q

primary haemostasis

A

in reponse to damaged vessel

vasoconstriction
platelet adhesion to collagen
platelet aggregation

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3
Q

coagulation cascade

A

to form fibrin –> stable clot

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4
Q

fibrinolysis

A

plasmin when plasminogen is activated (f11 + 12, urokinase, TPA)

breakdown of fibrin network

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5
Q

thrombus

A

clot arising in wrong place

e.g. DVT

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6
Q

thromboembolism

A

clot moving along vessel

e.g. DVT –> PE

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7
Q

virchow’s triad

A

stasis: bed rest, travel
hypercoaguability: pregnancy, trauma
vessel damage: atheroma

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8
Q

arterial thrombosus

A

white clot: mostly platelets and fibrin
most 2ry to atheroma
cause tissue ischaemia and infarction

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9
Q

arterial thrombosis risk factors

A
age 
smoking 
obese
sedentary 
DM 
HTN
high cholesterol 
FHx
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10
Q

arterial thrombosis management

A

1ry prevention: lifestyle, vascular risk factors
acute: thrombolysis, anti-platelets, anti-coags
2ry prevention

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11
Q

venous thrombosis

A

red clot: fibrin and red cells
stasis + hypercoagubility
back pressure

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12
Q

risk factors venous thrombosis

A
age 
pregnant
hormonal Rx e.g. HRT
tissue trauma
surgery 
immobility
obese
systemic disease
FHx
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13
Q

systemic disease + venous thrombosis

A

malignancy
myeloproliferative neoplasms
autoimmune e.g. IBD, SLE

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14
Q

diagnosis venous thrombosis

A
pre-test probability scoring: Wells, Geneva
D-dimer
doppler USS
V/Q scan 
CT pulm anigo
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15
Q

aims of venous thrombosis Rx

A

prevent clot extension
prevent embolisation
prevent recurrence - longterm Rx

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16
Q

factor V leiden mutation

A

actions of protein C inhibiting FV are blocked
resistance to activated protein C
ongoing drive towards thrombin generation and fibrin clot production

17
Q

protein C/S deficiency

A

usually inactivates F5 and F8

drive to thrombin

18
Q

anti-thrombin normally

A

potentiates formation complexes between heparin and serum protease so direct blocking effect on thrombin

19
Q

anti-thrombin deficiency

A

no thrombin blocking and so thrombin generation continues

20
Q

microvascular thrombosis

A

platelets and/or fibrin
results in diffuse ischaemia
principally DIC

21
Q

DIC

A

diffuse systemic coagulation activation

  • microvascular thrombi: vascular obstruction, ischaemia, multi-organ failure
  • depletion of platelets and clotting factors: spontaneous bleeding
22
Q

causes of DIC

A

sepsis
malignancy
eclampsia
placental abruption