2: Inherited and Acquired Thrombophilias Flashcards

(37 cards)

1
Q

What is a thrombophilia

A

Inherited or acquired genetic disorder that leads to recurrent DVTs or PEs

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2
Q

What are 5 inherited thrombophillias

A
  • Factor V Leiden
  • Prothrombin mutation
  • Protein C deficiency
  • Protein S deficiency
  • Antithrombin 3 mutation
  • Hyperhomocystinaemia
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3
Q

What is the most common inherited thrombophilia

A

Factor V Leiden

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4
Q

What is the second most common inherited thrombophilia

A

Prothrombin gene mutation

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5
Q

Name 3 aquired thrombophillias

A

COCP
SLE
HRT

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6
Q

how do thrombophillias usually present

A

Recurrent VTE

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7
Q

what may arterial involvement cause

A
  • Stroke
  • MI
  • Miscarriage
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8
Q

what is the inheritance pattern of all thombophillias, except hyper homocystinaemia

A

Autosomal Dominant

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9
Q

what is the most common inherited thrombophilia

A

Factor V Leiden

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10
Q

explain pathophysiology of factor V Leiden

A

Protein C normally inhibits F5. In F5 Leiden, there is mutation meaning protein C can’t bind and inhibit F5. Therefore F5 stimulates pro-thrombin

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11
Q

what is prothrombin gene mutation

A

Increase prothrombin levels

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12
Q

what factor does Protein C inhibit

A

F5

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13
Q

what factor does protein S inhibit

A

F8

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14
Q

what does protein C and S deficiency cause

A

Increase activation coagulation cascade

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15
Q

what also may occur in protein C and S deficiency

A

Skin necrosis - especially if on warfarin

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16
Q

what will homozygous deficiency for either protein C or S cause

A

Neonatal purpura fulminans

17
Q

what is the role of anti-thrombin

A

Co-factor for heparin

18
Q

if homozygous anti-thrombin deficiency what happens

A

Individual is incompatible with life

19
Q

what is the role of hyperhomocystinaemia

A

increase F5 and F7

20
Q

what does hyperhomocystinaemia lead to

A

increase viscosity of blood

21
Q

what is the inheritance pattern of hyperhomocystinaemia

A

autosomal recessive

22
Q

what does antiphospholipid syndrome increase risk of

A

arterial and venous thrombosis

23
Q

how may antiphospholipid syndrome present

A
  • History recurrent arterial and venous thrombosis
  • Recurrent miscarriages
  • Livedo reticularis
  • Pre-Eclampsia
24
Q

what is key in history with thrombophilia

25
what is a key investigation for thrombophilias
Coagulation studies
26
how will anti-phospholipid syndrome present in coagulation studies
Raised APTT
27
what is APTT
Partial thromboplastin time
28
what does APTT test
Intrinsic pathway
29
what 4 factors comprise the intrinsic pathway
F12 F11 F9 F8
30
how does factor V Leiden present on coagulation studies
Increased PT
31
what is PT
prothrombin time
32
what does PT test
extrinsic pathway
33
what are the factors in the extrinsic pathway
``` F5 F7 F10 Prothrombin Fibrinogen ```
34
who should be tested for thrombophilia
- MI or stroke under 50 years - unprovoked VTE under 40 years - Recurrent VTE - >3 miscarriages
35
how are thrombophilias managed
lifelong warfarin: aiming for INR 2-3
36
what is problem with warfarin in protein C and S deficiency
can promote skin necrosis
37
which thrombophilia has the highest risk of VTE
antithrombin 3 deficiency (10-20)