18. Haemostasis and Thrombosis

Question 1

What is haemostasis?

Answer 1

Arrest of blood loss from damaged vessels

Question 2

What is thrombosis?

Answer 2

Pathological formation of a haemostatic plug within vasculature in absence of bleeding

Question 3

What are the factors of Virchow?

Answer 3

Factors that predispose to thrombosis

1. Injury to vessel wall
2. Altered blood flow
3. Abnormal coaguability

Question 4

What defects can lead to haemostatic disorders?

Answer 4

Platelets too low or dysfunctional
Coagulation factors
Fibrinolytic system

Question 5

What system is DIC a defect in?

Answer 5

Fibrinolytic

Question 6

Where is it common to have venous thrombi?

Answer 6

Lower limb

Lungs

Question 7

Where are less common sites for venous thrombi?

Answer 7

Upper limb
Mesenteric veins
Hepatic
Cerebral
Portal

Question 8

What are the symptoms of a DVT?

Answer 8

Pain
Erythema
Swelling

Question 9

What are the symptoms of a PE?

Answer 9

SOB
Tachycardia
Tachypnoea
Haemoptysis

Question 10

What is the best choice of imaging to show a PE?

Answer 10

Pulmonary angiogram

Question 11

How is a PE diagnosed?

Answer 11

History and exam
Ultrasound for lower limb, or pulmonary angiogram
Well’s score for PE

Question 12

Why is a left sided DVT more common in pregnancy?

Answer 12

due to uterus position

Question 13

How are DVTs treated in pregnant women?

Answer 13

Low Molecular Weight Heparin

Question 14

When is the highest risk for pregnancy related DVT?

Answer 14

6 weeks post partum

Question 15

Why is cancer high risk for DVT?

Answer 15

Tumour might cause obstruction to veins
Associated surgery
Prothrombotic signals from tumour cells
Central lines and chemotherapy

Question 16

What score is used to assess the risk of DVT in cancer?

Answer 16

Khorana score

Question 17

How is DVT treated in cancer patients?

Answer 17

6 months LMWH or DOACS

Question 18

What are the diagnostic criteria for Antiphospholipid Antibody syndrome?

Answer 18

One of:
Arterial/venous thrombosis
3 consecutive 1st trimester miscarriages
Loss in 2nd or 3rd trimester
AND positive test on 2 occasions 12 weeks apart

Question 19

What are the treatment options for VT?

Answer 19

1. LMWH (5 days) and warfarin

2. DOACs (may need LMWH lead-in)

Question 20

How long does treatment last for provoked venous thrombosis?

Answer 20

3-6 months

Question 21

How long does treatment last for unprovoked VT?

Answer 21

Longterm

Question 22

What does DIC stand for?

Answer 22

Disseminated Intravascular Coagulation

Question 23

What is DIC characterised by?

Answer 23

Presence of both thrombin and plasmin

Question 24

How is DIC treated?

Answer 24

By treating the underlying cause

Question 25

What are the lab results for DIC?

Answer 25

High prothrombin time and activated partial thromboplastin time
Low fibrinogen
high D-dimers
Low platelet count