bleeding disorders Flashcards
history of bleeding
bruising epistaxis menorrhagia PPH post trauma post surgery: dental surgery, tonsillectomy, appendectomy
platelet pattern of bleeding
mucosal epistaxis purpura GI menorrhagia
coagulation factor pattern of bleeding
muscle haematoma
articular esp hinge joints
CNS
haemophilia
x-linked recessive disorder
A: factor 8 deficiency
B: factor 9 deficiency
haemophiia severity
<1% severe: spontaneous unprovoked bleeding
1-5% moderate: bleed extensively after surgery/trauma
5-30% mild: bleed after surgery/biopsy if no approp Rx
haemophilia features
haemarthrosis muscle haematoma CNS bleeding retroperitoneal bleeding post surgical bleed
haemophilia investigations
prolonged activated partial thromboplastin time
plasma FVIII + IX assay
genetic analysis
haemophilia Rx
coagulation factor replacement (no almost all recombinant products)
desmopressin (DDAVP)
tranexamic acid
gene therapy
haemophilia Rx for haemarthropathy and muscle haematoma
physio analgesia splint synovectomy joint replacement
haemophilia Rx complications
inhibitors: F8 antibodies
transfusion transmitted infection: HIV/HBV/HCV
vonwillebrand disease types
T1: quantitative deficiency, normal VWF but not enough
T2: qualitative, site mutation determines functional issue
T3: severe, complete deficiency
vonwillebrand disease features
platelet bleeding pattern
- epistaxis
- GI bleed
- bleed from minor wounds
- bleed post op
- easy, excessive bruising
- menorrhagia
vonwillebrand disease Rx
VWF concentrate
desmopressin (DDAVP)
transexamic acid
OCP for menorrhagia
acquired bleeding disorders
thrombocytopenia liver failure renal failure DIC drugs: heparin, warfarin, aspirin, clopidogrel
clinical features of acquired bleeding disorders
petechiae
bruising
mucosal bleeding e.g. blood blisters
CNS bleeding
