Acquired bleeding disorders

Question 1

Most prevalent between acquired and inherited coagulation disorders

Answer 1

Acquired more common than inherited

Question 2

How many coagulation factors are affected in acquired coagulation disorders

Answer 2

More than 1

Question 3

Classification of acquired coagulation disorders

Answer 3

Deficiency of vitamin k
liver function related
Antibody induced
Drug/transfusion induced
Interference from abnormal proteins
Consumptive coagulopathy

Question 4

Why will a deficiency of vitamin k cause coagulation disorders

Answer 4

This is because some coagulation factors are vitamin k dependant

Question 5

How does poor liver function cause coagulation disorders

Answer 5

This is because a lot of coagulation factors are produced in the liver.

Hepatitis, cirrhosis, hepatocellular ca etc

Question 6

How do antibodies cause coagulation disorders

Answer 6

Antibodies can be produced against certain factors necessary for coagulation

Question 7

Vitamin K is important in the synthesis of these coagulation factors

Answer 7

factor 2, 7,9, 10

which are important factors in all the pathways, hence without it none of the pathways can function

Question 8

Sources of vitamin k

Answer 8

green vegetables, bacterial synthesis in the gut

Question 9

In what circumstances does vitamin k deficiency occur

Answer 9

Newborn
Biliary obstruction
Malabsorption
Inhibition of vitamin k

Question 10

Why does vitamin K deficiency occur in the newborn

Answer 10

Newborn does not eat green vegetables, and their gut is not well developed to synthesize vitamin k

Breast milk contains low amount of vitamin k

Question 11

Causes of malabsorption syndrome

Answer 11

surgery, tropical sprue, gluten sensitive enteropathy

Question 12

warfarin and vitamin k

Answer 12

warfarin is a vitamin k antagonist

Question 13

The abscence of vitamin k leads to the production of

Answer 13

PIVKA. Protein induced in vitamin k absence which in themselves lead to a bleeding tendency

Question 14

Antibodies being produced against certain factors may be

Answer 14

Induced or spontaneous

Question 15

Von willebrands disease is

Answer 15

Autoimmune with antibodies being produced against von willebrands factor

Question 16

How does massive transfusion cause coagulation disorders

Answer 16

They dilute coagulation factors of receiver. Donors blood does not carry all the factors due to duration of preservation etc .

Anticoagulants are present in blood during preservation to keep it from clotting. massive transfusion will cause anticoagulant effect to be pronounced.

Question 17

How does interference from abnormal proteins cause coagulation factor disorder

Answer 17

Abnormal proteins like plasma cell myelomas and paraproteins coat the surface of platelets leading to poor function

They also interfere with fibrin formation

Question 18

Initiators of consumptive coagulopathy

Answer 18

vessel wall damage
tissue factor release
platelet aggregation

Question 19

Initiators of consumptive coagulopathy

Answer 19

infections
malignancies
obstetric complications
Hypersensitivity reaction
widespread tissue damage
vascular abnormalities
hypothermia
heat stroke
acute hypoxia

Question 20

Haemorrhagic disease of the newborn

Answer 20

Acquired bleeding disorder in the newborn

Question 21

What causes HDN

Answer 21

Vitamin k deficiency

Liver cell immaturity

Question 22

Presentation of HDN

Answer 22

Bleeding from second to fourth day of life

Question 23

Diagnosis of HDN

Answer 23

Normal platelet count
Prolonged PT
Prolonged APTT

Question 24

Prophylaxis for HDN

Answer 24

Vitamin K

Question 25

Treatment for HDN

Answer 25

1mg of vitamin K every 6 hours | In case of severe bleeding use prothrombin complex concentrate

Question 26

What causes bleeding in patient with liver dx

Answer 26

Biliary obstruction leads to impaired absorption of vitamin k which is fat dependent Vitamin k dependent factors are affected Dysfibrogenemia Reduction of other coagulation factors DIC Oesophageal varices

Question 27

Diagnosis of liver dx

Answer 27

Underlying dx features Deranged liver enzymes Reduced albumin Raised PT and APTT

Question 28

Prophylaxis for liver dx

Answer 28

5mg/day Vitamin K

Question 29

If person is bleeding in liver dx

Answer 29

10mg iv vitamin k slowly Prothrombin complex Fresh frozen plasma

Question 30

DIC

Answer 30

Coagulation system triggered into overdrive with coagulation factors used up and reduced in number and the formation of microthrombi in the vascular system

Question 31

DIC characterised by

Answer 31

``` End organ damage Bleeding Consumption of platelets Thrombotic syndrome gangrene ```

Question 32

Investigation of DIC

Answer 32

Check for underlying disease Full blood count i.e low platelets, fibrinogen, increased PT,APTT, fibrin degradation products, D-dimers Hemolytic anemia due to microangiopathy

Question 33

Treatment of DIC

Answer 33

``` Treat underlying cause Treat bleeding with ; FFP Platelets Cryoprecipitate Red cells Treat thrombus with heparin ```