Bleeding And Thrombotic Disorders

Question 1

What is disseminated intravascular coagulation (DIC) and what would you see on blood film?

Answer 1

• activation of the coagulation cascade resulting in the deposition of microthrombi due to intravascular deposition of fibrin
• exhaustion of cascade resulting in bleeding due to depletion of platelets
• blood film shows red cell fragments

Question 2

What are the possible causes of DIC?

Answer 2

• sepsis
• malignancy
• severe haemorrhage
• severe trauma
• pregnancy complications

Question 3

What is the treatment of DIC?

Answer 3

• treat underlying cause
• if risk of bleeding give FFP, cryoprecipitate and a platelet transfusion

Question 4

What would you do for a patient suffering from warfarin complications?

Answer 4

• stop warfarin or reduce the dose
• give vitamin K (oral/IV)
• give coagulation factors (II, VII, IX, X)

Question 5

What are the consequences for coagulation in liver disease?

Answer 5

• poor coagulation factor synthesis in the liver
• vitamin K deficient (poor diet, obstructive component from jaundice)
• hypersplenism
• reduced thrombophlebitis synthesis

Question 6

How would you treat coagulation factor deficiency?

Answer 6

• education
• desmopressin
• replacement therapy
• gene therapy

Question 7

Describe features of Von Willebrand disease

Answer 7

• AD inheritance
• variable penetrance
• musical bleeding pattern (frequent node bleeds, menstrual etc.)
• type 1: quantitative deficiency of VWF
• type 2: qualitative deficiency of VWF
• type 3: complete deficiency of VWF

Question 8

How would you treat a bleed caused by Von Willebrand disease?

Answer 8

• pressure
• tranexamic acid/desmopressin
• platelet transfusion
• replacement factor VII