Bleeding Flashcards
(37 cards)
what are important Hx questions to assess Epistaxis
ER visits
ENT seen
Greater than 5 min
Frequency
Menorrhagia definition
Greater than 5 pads
Change every hour
Greater than 7 days
Congenital Platelet disorders
Alport syndrome
Hermansky-pudlack - albinism
Chediak- Higashi syndrome
Wiskott-Aldrich syndrome - eczema and neutropenia, thrombocytopenia, immune deficiency
what is the genetics of Von Willebrand disease
Autosomal dominant
Can be quantitative defect (type1 and 3) or qualitative (type 2)
Type 1 mC
Repeat testing often required- easily varies eg mentruation, illness
Idiopathic thrombocytopenia
Ab mediated and plt are just bystanders
Chicken pox MC
1/1000 will have intracranial bleeds - traumatic or spontaneous
Plt will increase in 2-3 weeks on its own
1 in 5 will develop chronic ITP - after 12 month
Watch and wait if not bleeding - no Advil!!!!
Treat if bleeding - IV ig or steroid or anti D.
Chronic mgnt- Rituximab/ splenectomy
Severe Hemophilia management
On weekly prophylaxis Keep weight off Apply ice Infuse factor Tranexamic acid for mucous bleeds
how do you treat vWillebrand?
Treatment is desmopressin
Blood product for severe - humate P or Wilate
No issue making antibodies if receive Wilate
what does vWillebrand factor do?
when injured tissu, it attaches plts to the exposed subendothelium
what does thrombin do
it activates more plts when needed
converts fibrinogen to fibrin
when you have a fibrin clot, what will start to break it down?
plasmin
releases D-dimers
what are common congenital hypercoagulable disorders
- Factor V Leiden
- Protein C or S def
- Antithrombin III def
- homocysteinuria
What are acquired hyper coagulable disorders
- Catheters
- nephrotic syndrome
- Malignancy
- OCP
- Pregnancy
- Immobilization
- Trauma
- infection,
- IBD
- lupus anticoagulant/antiphospholipid syndrome
how does amegakaryocytic thrombocytopenia present?
soon after birth
severe thrombocytopenia
NO megakaryocyte in BM
progress to aplasia of all cell lines
what are fetal low PLT causes
neonatal alloimmune thrombocytopenic purpura Maternal ITP Congenital infection - CMV, rubella Trisomy severe Rh hemolytic disease WAS
baby has eczema, low plt and recurrent infections. What is the Dx
Wiskott-Aldrich syndome X linked defect in protein found in plt and T lymphocytes (hypogammaglobinemia) Rx with splenectomy and HSCT (5% develop LYMPHOMA)
what are neonatal causes of low PLT ? (early)
asphyxia sepsis immune mediated TORCH congenital
what are neonatal causes of low PLT ? (>3 d)
NEC TORCH metabolic = MMA, proprionic congenital - TAR, CAMT autoimmune
what is neonatal alloimmune thrombocytopenic purpura
mom maxes Abx to fetal plts that they share with dad
worsens with every preganncy
30% risk of ICH
How do you manage neonatal alloimmune thrombocytopenic purpura
- plan CS
- mom gets IV iG starting 2nd trimester
- monitor fetal plts
- Baby gets steroid or IV IG or washed mat plats
- Resolves by 2-4 months
How can maternal ITP affect baby?
can lead to LOW plt less severe than NATP mom gets IV IG and steroid Baby might get same after birth resolves by 2-4 months
what causes ITP
occurs 1-4 weeks post viral ( EBV… HIV)
can also be 1st presentation of AI - SLE
Ab againts plt and spleen destroys
otherwise should have nothing else!
indication for BM in ITP
if any other line is affected
if physical exam makes you consider other Dx - LN, HSM…
If chronic ITP
what are 3 treatment options for ITP
- IV Ig for 2 days
- Prednisone for 2 weeks
- IV anti-D for Rh + patients
only decrease rate of clearance
what can you do in severe bleeding during ITP
- Plt transfusion
2. Splenectomy
