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Haematology > Venous Thrombosis > Flashcards

Venous Thrombosis Flashcards

1
Q

Venous thrombosis types (2)

A

DVT,

PE

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2
Q

Arterial thrombosis types

A

coronary,
cerebral,
peripheral

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3
Q

Arterial thrombosis formation and clot type

A

piece of arthersclerosis breaks off, collagen exposed and then platelet rich thrombus comes and occludes vessel

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4
Q

Treatment for arterial thrombosis

A

aspirin and other anti-platelets drugs

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5
Q

Arterial high pressure/low pressure venous high/low pressure

A

venous low

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6
Q

Venous thrombosis formation and clot type

A

valves deteriorate meaning blood stasis which activates coagulation cascade so platelets not activated but clot is rich in fibrin

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7
Q

Virchows triad and venous thrombosis

A

stasis,
vessel wall (degenerating valves e.g. old age, previous DVT)
hypercoagulability (higher levels of acute phase proteins e.g. CRP, VIII, TF, vWF due to inflammation etc )

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8
Q

Treatment for venous thrombosis

A

heparin,
warfarin,
new oral anticoagulants

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9
Q

Highest risk factor for DVT?

A

history of previous DVT

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10
Q

DVT presentation

A

hot, swollen, tender limb,

pitting oedema

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11
Q

PE pattern of events including heart

A 
pulmonary infarction, 
pleuritic chest pain, 
Cardiovascular collapse/death, 
hypoxia, 
right heart strain
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12
Q

Risk of VTE

A

1/1000 per year

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13
Q

lifetime risk of VTE

A

2.5%

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14
Q

Risk factors for Venous thromboembolism (11)

A 
age, 
obesity, 
pregnancy, 
puerperium, 
oestrogen therapy, 
previous DVT/PE, 
trauma/surgery, 
malignancy, 
paralysis, 
infection, 
thrombophilia
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15
Q

Clotting factors rise/fall in pregnancy to reduce bleeding?

A

rise

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16
Q

Which components of normal haemostatic system is most commonly dysfunctional in thrombophilia?

A

anticoagulant defences abnormal

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17
Q

Which 7 risk factors for VT are under stasis

A 
age, 
obesity, 
pregnancy, 
trauma/surgery, 
malignancy, 
paralysis, 
previous DVT/PE
18
Q

Which 2 particular risk factors fall under vessel wall damage?

A

age,

previous DVT/PE

19
Q

Which 8 risk factors fall under hypercoagulability?

A 
age, 
pregnancy, 
puerperium, 
oestrogen therapy, 
trauma/surgery, 
malignancy, 
infection, 
thrombophilia
20
Q

Hypercoagulability are associate with release of what and raised what? (3)

A

release of tissue factor,

raised vWF and factor VIII

21
Q

Thrombophilia definition?

A

familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis

22
Q

What is the most common mechanism of thrombphilia?

A

Decreased anticoagulant activity

23
Q

What type of naturally occurring anticoagulant is anti-thrombin?

A

Serine protease inhibitor

24
Q

What does anti-thrombin switch off?

A 
thrombin, 
TF/VII,
V/X. 
VII,
IX
25
Q

Which is main protein and which is cofactor - protein c and protein s?

A

Protein C is main one and protein s is cofactor

26
Q

How do protein c and protein s switch of clotting pathway?

A

When haemostasis achieved thrombin binds to thrombomodulin which changes function from being protein involved in forming fibrin to switch on protein c and s. these inhibit factor V and factor VIII

27
Q

Commonest inherited blood clotting disorder? How does it cause VT?

A

Factor V Leiden - factor V slightly mutated, works normally but isn’t switched off as efficiently by protein c/s and so have x5 increased risk of VT

28
Q

List the 5 hereditary thrombophilias?

A 
factor V leiden, 
prothrombin 20210 mutation, 
antithrombin deficiency, 
Protein C deficiency, 
protein S deficiency
29
Q

In what cases would you consider hereditary thrombophilia screening? (5)

A 
venous thrombosis <45 years, 
recurrent venous thrombosis,
unusual venous thrombosis, 
FH of venous thrombosis, 
FH of thrombophilia
30
Q

Management of hereditary thrombophilia? (4)

A

advice on avoiding risk,
short term prophylaxis for periods of risk,
short term anticoagulation to treat thrombotic events,
long term Anticoagulation if recurrent thrombotic events

31
Q

When do you give long term anticoagulation to those with hereditary thrombophilia? What are you trying to balance?

A

if RECURRENT thrombotic events,

risk of recurrent thrombosis vs risk of serious haemorrhage

32
Q

Clinical history is less important than the results if thrombophilia screening are positive. T/F?

A

False! Clinical history much more important

33
Q

List factors from clinical history that indicate higher risk of recurrent thrombosis starting at highest risk (4)

A

history of previous thrombosis,
spontaneous thrombosis rather than acquired transient risk factor,
FH,
thrombophilia screen results

34
Q

Give an example of an acquired thrombophilia?

A

antiphospholipid antibody syndrome

35
Q

APS is a stronger risk factor for thrombosis than the hereditary thrombophilias. T/F?

A

True

36
Q

List 3 main features of APS

A

recurrent thromboses (arterial and venous),
recurrent fetal loss,
mild thrombocytopenia

37
Q

Pathogenesis of APS

A

Antibodies lead to a conformational change in β2 glycoprotein 1 (a protein with unknown function in health) which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities.

38
Q

antiphospholipid antibodies

A

listen to let

39
Q

screening tests for APS

A

listen to lec

40
Q

investigations for aps (3)

A

Levels of aCL, anti-beta2 GPI or lupus anticoagulant (LA) on two occasions at least 12 weeks apart,
FBC: thrombocytopenia, haemolytic anaemia,
Clotting screen

41
Q

List 5 conditions associated with antiphospholipid antibodies

A 
autoimmune disorders, 
lymphoproliferative disorders, 
viral infections, 
drugs, 
primary  (listen to lector's)
42
Q

Treatment of APS

A

aspirin warfarin (listen to lector’s)

Haematology (25 decks)

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