Bleeding and coagulation disorder

Question 1

Hemostatic Disorders
-Classified into two main categories:
1.
2.

Answer 1

I. Bleeding Diseases.
II. Intravascular Thrombosis.

Question 2

illustrate the def & causes of Bleeding Diseases

Answer 2

• def :
  These are a group of diseases
  chc. by an in tendency to bleeding spontaneously or after trauma.

-causes: due to
1. Vessel wall defects.
2. Platelet disorders (Count or Function).
lead to superficial bleeding
3. Blood clotting disorders
lead to deep bleeding

Question 3

illustrate the def & causes of Bleeding due to defect in the blood vessel (Purpura)

Answer 3

• def :It is a bleeding tendency due to weak fragile vessel wall causing poor constriction of the injured vessel
• causes :
  1. Hereditary.
  2. Acquired:
• nutrient deficiency as Scurvy (Vitamin C deficiency).
• Drugs (e.g. steroid).
• Aging (senile purpura).
• Infections (streptococcal).
• Malignancies.

Question 4

illustrate the causes of Bleeding due to platelet disorder (Purpura)

Answer 4

1. Decreased platelet count (Thrombocytopenia)
   (Thrombocytopenic Purpura)
2. Weak platelet function (Thrombasthenia orThrombocytopathia) (Thrombocytopathic purpura)

Question 5

def of Bleeding due to platelet disorder caused by Decreased platelet count

Answer 5

It is a bleeding tendency due to deficient in platelet plug formation, clot retraction and poor constriction of injured vessel

Question 6

-the normal platelet count range is ……
- Bleeding occurs when platelets count………….
-Internal bleeding occurs when platelets count………….
- Lethal (Fatal) platelets count…………..

Answer 6

150,000-410,000/mm3
< 50,000/µL.
< 20,000/ µl
< 10,000/ µl

Question 7

• People with thrombocytopenia have a tendency to bleed from………….
• The skin of such people displays many small and purplish blotches called……., large………or larger…………
• Bleeding time is …………. with……… clotting time

Answer 7

• small blood vessel
  (venules and capillaries).
• petechiae /ecchymosis/ecchymotic patches
• prolonged / normal

Question 8

illustrate Causes of Decreased platelet count

Answer 8

1.Primary:
Autoimmune disease (Idiopathic thrombocytopenic purpura) (ITP)
2.Secondary:
-Hypersplenism.
-Sever destruction of bone marrow.

Question 9

………..It gives the same clinical picture as thrombocytopenia.

Answer 9

Weak platelet function

Question 10

list Causes of Weak platelet function

Answer 10

1.Prolonged use of aspirin (inhibit platelet aggregation).
2. Renal failure (Toxins or dialysis machine).
3. Deficiency of Von Willebrand factor (inhibit platelet adhesion)

Question 11

what’s the Treatment of bleeding disorders due to vessel wall or
platelet defects?

Answer 11

1. Vitamin C administration.
2. Platelet transfusions.
3. Fresh whole blood transfusion that contain large number of platelets.

Question 12

-In Bleeding due to abnormal coagulation, bleeding tendency due to…
-It is result from………..
-These people usually have a tendency to bleed from ……………..
-……………… is prolonged, while bleeding time is…………

Answer 12

• deficient in clot formation
• lack of any of the clotting factors
• large blood vessel.
• Clotting time / normal

Question 13

list causes of Bleeding due to abnormal
coagulation

Answer 13

1. Acquired:
   Liver diseases
   Vitamin K deficiency
2. Congenital:
3. Due to deficiency of one of the clotting factors

Question 14

why the liver disease cause bleeding ?

Answer 14

because almost all clotting factors are formed by the liver.

Question 15

• in liver disease both PT & aPTT are ……………..
• in early liver disease ……is prolonged & …….. is normal.

Answer 15

• prolonged
• PT / aPTT

Question 16

Vitamin K deficiency lead to insufficiency of the clotting factors …………….

Answer 16

II, VII, IX and X

Question 17

illustrate causes of vitamin K deficiency.

Answer 17

1. Liver disease:
   failure of liver to secrete bile.
2. Failure of absorption:
   - bile duct obstruction
   - chronic diarrhea
   - gastrointestinal disease
3. Deficient intestinal bacteria:
   - prolonged use of antibiotic
   - newly borne infant
4. Anticoagulant drugs :(coumarin) prevent utilization of vit K by liver.

Question 18

def of Hemophilia

Answer 18

• congenital deficiency of factor VIII or IX or XI
• It is an inherited sex-linked anomaly, transmitted by females, who are carriers (show no symptoms), to males who manifest signs of the disease

Question 19

def of Parahemophilia

Answer 19

congenital deficiency of factor V

Question 20

def of Afibrinogenemia

Answer 20

deficiency of fibrinogen

Question 21

def of Hypoprothrombinemia

Answer 21

decreased prothrombin synthesis
by the liver, usually in vitamin K deficiency.

Question 22

illustrate the symptoms and pathological findings in hemophilia

Answer 22

*Symptoms (begin early in life):
- Bleeding either from natural orifices (spontaneously) or after injury or incisions.
- Recurrent hemarthrosis i.e., bleeding in joints, following minor trauma leading to crippling deformity due to fibrous
adhesions.
- Marked increase in clotting time

Question 23

in hemophilia :
- prolonged ……….
- normal …….

Answer 23

• aPTT
• PT

Question 24

illustrate Treatment of hemophilia

Answer 24

Supplying the patient with the deficient clotting factor (Cryoprecipitate)

Question 25

list types of hemophilia

Answer 25

1.Hemophilia A (Classical hemophilia): - due to deficiency of factor VIII. - Represents 85% of hemophilic patients 2.Hemophilia B: - factor IX deficiency (Christmas disease). 3.Hemophilia C: - factor XI deficiency 4.Parahemophilia: factor V deficiency

Question 26

Compare between Hemophilia and Purpura: from -Hereditary -Sex -Causes - Clotting Time (aPTT) -Bleeding Time

Answer 26

1. Hemophilia -Hereditary: Congenital -Sex: Males -Causes Lack of clotting factors - Clotting Time (aPTT): Prolonged -Bleeding Time: Normal 2. Purpura -Hereditary: Not congenital -Sex: Males & Females -Causes: Platelet defect (count & function) - Clotting Time (aPTT): Normal -Bleeding Time: Prolonged ** NOTE : PT is normal in both ** PT evaluate extrinsic pathway **aPTT evaluate intrinsic pathway

Question 27

def Intravascular Thrombosis

Answer 27

Abnormal formation of clot inside the blood vessel (thrombus)

Question 28

illustrate the causes of Intravascular Thrombosis

Answer 28

1.Sluggish blood flow: activation of clotting factors & enhance platelet aggregation. 2.Damaged or roughened endothelial surface of blood vessel as in atherosclerosis. 3. As a complication of septicemia (septic shock) or extensive tissue damage (crush injury). 4.Imbalance between clotting-anticlotting systems 5. Factor V Leiden

Question 29

what's Factor V Leiden?

Answer 29

1- An inherited disorder with abnormal form of factor V. 2- Caused by mutation in the gene coding for clotting factor V. 3- Factor V Leiden is resistant to the action of activated protein C. 4- It leads to increased risk of developing blood clots in legs (DVT) or lungs (PE). 5-It is a life-threatening condition

Question 30

illustrate Effects (Complications) of intravascular thrombosis

Answer 30

1. A thrombus may enlarge → complete occlusion of the blood vessel → prevent blood flow and oxygen from getting to tissues and organs leading to organ failure. e.g. DVT 2. A thrombus may detach or break loose → forming an embolus → stuck in a narrower blood vessel in distant sites (Thromboembolism). e.g., pulmonary embolism: obstruction of the pulmonary artery or its branches by thrombi from the leg veins.

Question 31

Treatment of intravascular thrombosis or abnormal increase in blood coagulation is ..............

Answer 31

Administration of anticoagulant drugs either oral or parenteral.