Acquired Blood dys

Question 1

what 3 things are required for clotting

Answer 1

platelets, vessel wall, clotting factors

Question 2

what happens to clotting in massive blood loss

Answer 2

RBC’s can’t push platelets to vessel wall so they can’t adhere

Question 3

describe what PT measures in clotting

Answer 3

prothrombin time - measures factors 2, 5, 7, 10 and fibrinogen which is the extrinsic pathway
time in seconds from exposure to clot formation

Question 4

what is the only test that measures factor VII

Answer 4

prothrombin time

Question 5

what are causes of prolonged PT test

Answer 5

deficiency in 2, 5, 7, 10 or fibrinogen (vit K deficiency) - they are on warfarin or have liver disease

Question 6

what clotting tests give evidence of early liver disease

Answer 6

isolated prolonged PT but normal APTT

Question 7

which clotting factor has the shortest half life

Answer 7

VII

Question 8

what is an APTT and what does is measure

Answer 8

activated partial thromboplastin time

measure 2, 5, 8, 9, 10, 12, kallikrein, HMWK and fibrinogen

Question 9

what can make a APTT test be abnormal without having bleeding problems

Answer 9

deficiencies in kallikrein, HMWK and factor 12

Question 10

what can cause isolated APTT

Answer 10

UFH, lupus anticoagulant, haemophilia or deficiencies sin APTT clotting factors

Question 11

what are common things that cause prolonged PT and APTT

Answer 11

deficiency in 2, 5, 10 or fibrinogen, DIC, HMWK, kallikrein deficiency

Question 12

what does the thrombin time TT measure

Answer 12

function and amount of function of fibrinogen

Question 13

what causes prolonged TT

Answer 13

dysfibrinogenaemia - none
low fibrinogen
heparin
DIC

Question 14

what is LAC in coagulation

Answer 14

lupus anticoagulant - IgG/M autoantibody which prolongs the APTT

Question 15

what type of drug is heparin

Answer 15

anticoagulant

Question 16

what is the mode of action of heparin and its subtypes

Answer 16

wraps around antithrombin - inhibits factor X
LMWH - inhibits factor Xa
UFH - inhibits Xa and thrombin to switch of coagulation cascade

Question 17

what is the efficacy ratio of LMWH

Answer 17

higher ratio of anti Xa compared to anti LLa (thrombin)

Question 18

what are the two benefits of using LMWH

Answer 18

better bioavailability and longer half life

Question 19

why do you want to avoid using UFH and what is it monitored using

Answer 19

badly monitored but with APTT

can be hard to anticoagulate in infants

Question 20

what are some complications of heparin treatment

Answer 20

HIT - heparin induced thrombocytopenia

skin / allergic reactions and bleeding

Question 21

what is given for patients with too much UFH from bleeding

Answer 21

protamine sulphate - derived from fish sperm - may have allergies

Question 22

what is the mechanism of action of warfarin

Answer 22

inhibits vit K epoxide reducatase - prevents activation of vit K factors 2, 7, 9, 10 and protein C/S

another anticoagulant

Question 23

what do you monitor treatment of warfarin

Answer 23

INR

Question 24

how do you treat excessive bleeding on warfarin

Answer 24

stop warfarin
give prothrombin complex conc
vit K

Question 25

what are DOAC's used for and give examples

Answer 25

inhibitors of factor Xa (drugs that end in xaban) | drugs that inhibit thrombin IIa - dabigatran

Question 26

what is fondaparinux

Answer 26

similar to heparin | anti-Xa

Question 27

give examples of two types of anti-platelet agents

Answer 27

aspirin - inactivates platelet cyclooxyrgenase | P2Y12 antagonists - clopidogrel

Question 28

what factors are inactive in VIT k deficiency and what is the treatment / cause

Answer 28

``` def in factor 2, 7, 9, 10 causes - obstructive jaundice, neonates treat with oral vit K ```

Question 29

what is another name for bleeding in the liver

Answer 29

cirrhotic coagulopathy

Question 30

in cirrhotic coagulopathy which factor is not deficient

Answer 30

VIII

Question 31

what are the clinical features of cirrhotic caoguloppathy

Answer 31

impaired homeostasis platelet dysfunction excessive plasmin activity

Question 32

what is the treatment for bleeding in the liver ie cirrhotic coagulopathy

Answer 32

platelet transfusion | prothrombin complex concentrate

Question 33

what are the clinical features of bleeding with renal disease and what is the risk with hypertension

Answer 33

bruising, gum bleeding, nose bleeds | risk of intracerebral haemorrhage

Question 34

what are the causes and features of bleeding with renal disease

Answer 34

anaemia - decreased platelet interaction with lining penecillin blocking platelets uraemia - disrupts platelet interactions and impaired binding

Question 35

how to you prevent bleeding in renal disease

Answer 35

EPO and transfusion | desmopressin (stimulates vWF release)

Question 36

in a major haemorrhage how much blood is needed for transfusion

Answer 36

equal to patients total blood volume in less than 24 hours | with HR greater than 110 and BP less than 90

Question 37

what can massive haemorrhages lead to with clotting factors

Answer 37

DIC - become over active

Question 38

what is DIC in bleeding

Answer 38

disseminated intravascular coagulation - overactive clotting leading to fibrin clots = organ failure

Question 39

what is the pathogenesis and causes of DIC

Answer 39

excess thrombin generation - reduced natural anticoagulant activity and decreased fibrinolysis acute cause - sepsis, trauma, acute liver haemolysis, live disease chronic cause - malignancy

Question 40

what test results signify DIC

Answer 40

low platelet, elevated d dimer, prolonged PT low fibrinogen

Question 41

what is the management of `DIC

Answer 41

treatunderlying cause ie chemo, antibiotics | folic acid and VK supplementation