Bleeding Disorders

Question 1

Disseminated intravascular coagulation

Answer 1

Excessive and inappropriate activation of the haemostatic system

Question 2

Causes of Disseminated intravascular coagulation (4)

Answer 2

Sepsis, obstetric emergencies, malignancy and Hypovolaemic shock

Question 3

What may be seen on blood film in Disseminated intravascular coagulation

Answer 3

Fragmented RBCs

Question 4

What happens to PT, APTT and TT in Disseminated intravascular coagulation

Answer 4

Very prolonged

Question 5

What happens to fibrinogen levels in Disseminated intravascular coagulation

Answer 5

Reduced

Question 6

Is D dimer positive or negative in Disseminated intravascular coagulation

Answer 6

Positive

Question 7

FBC results in Disseminated intravascular coagulation

Answer 7

Severe thrombocytopenia

Question 8

Clinical sign of Disseminated intravascular coagulation

Answer 8

Bleeding from the mouth, nose and venepuncture sites, easy bruising

Question 9

What is haemophilia

Answer 9

Condition which affects bloods ability to clot causing prolonged bleeding

Question 10

What is the inheritance of haemophilia

Answer 10

X linked recessive

Question 11

What is deficient in haemophilia A

Answer 11

Factor VII

Question 12

What is deficient in haemophilia B

Answer 12

Factor IX

Question 13

What is more common, haemophilia A or B

Answer 13

A

Question 14

What is a consequence of haemophilia

Answer 14

Bleeding into the joints

Question 15

Clinical presentation of mild haemophilia

Answer 15

Bleeding associated with an injury or surgery

Question 16

Clinical features of severe haemophilia (3)

Answer 16

Recurrent haemarthrosis
Recurrent bruising
Prolonged bleeding after procedures

Question 17

Test result indicating haemophilia

Answer 17

Isolated prolonged APTT

Question 18

Management of haemophilia

Answer 18

Replace clotting factors

Question 19

Complication of the treatment of haemophilia

Answer 19

Formation of antibodies against the clotting factor meaning the treatment is ineffective

Question 20

Management of acute episodes of bleeding in haemophilia

Answer 20

Infusion of clotting factor
Desmopressin to stimulate VWF
antifibrinolytics

Question 21

Give an example of an antifibrinolytic

Answer 21

Tranexamic acid

Question 22

Von willebrands disease

Answer 22

A deficiency or abnormality of VWF

Question 23

Where is the VWF gene located

Answer 23

Chromosome 12

Question 24

Consequence of low VWF

Answer 24

Impaired platelet adhesion to the subendothelium

Question 25

Consequence of reduced VWF on other clotting factors

Answer 25

Causes factor VII deficiency as it is not protected from premature degradation

Question 26

Clinical presentations of Von willebrands disease

Answer 26

Nosebleeds , menorrhagia etc.

Question 27

Epistaxis

Answer 27

Nose bleed

Question 28

Menorrhagia

Answer 28

Heavy or prolonged periods

Question 29

Thrombotic thrombocytopenic purpura

Answer 29

Formation of small blood clots throughout the body

Question 30

What causes Thrombotic thrombocytopenic purpura

Answer 30

Deficiency of metalloproteinase ADAMTS13

Question 31

Clinical presentation of Thrombotic thrombocytopenic purpura (5)

Answer 31

Fever Haemolytic anaemia Thrombocytopenia Acute renal failure Neurological symptoms

Question 32

Blood film in Thrombotic thrombocytopenic purpura

Answer 32

Schistocytes and elevated reticulocyte count

Question 33

Urinalysis result in Thrombotic thrombocytopenic purpura

Answer 33

Proteinuria and microscopic haematuria

Question 34

Management of Thrombotic thrombocytopenic purpura

Answer 34

IV plasma exchange

Question 35

Second line management in patients with Thrombotic thrombocytopenic purpura

Answer 35

Splenectomy

Question 36

Massive haemorrhage

Answer 36

Bleeding with signs of shock , already required prompt transfusion

Question 37

What can cause haemorrhage

Answer 37

Traumatic bleeding Infection

Question 38

What can we give to patients to replace fibrinogen

Answer 38

Cryoprecipitate

Question 39

Role of tranexamic acid

Answer 39

Reduces or prevents excessive bleeding by inhibiting the break down of blood clots

Question 40

Causes of secondary ITP

Answer 40

Anti phospholipid antibody syndrome SLE viral infections (cytomegalovirus, varicella-zoster, hepatitis C, HIV) h.pylori infection Meds Lymphoproliferative disorders

Question 41

What causes immune thrombocytopenic purpura

Answer 41

Type 2 hypersensitivity reaction - production of antibodies that target and destroy platelets

Question 42

ITP

Answer 42

Immune thrombocytopenic purpura

Question 43

When does ITP usually present

Answer 43

Children under 10

Question 44

Usual history in ITP

Answer 44

History of recent viral illness

Question 45

Symptoms of ITP

Answer 45

Bleeding, bruising and petechial or purpurin rash

Question 46

Investigation for ITP

Answer 46

Full blood count

Question 47

Positive result that indicates ITP

Answer 47

Isolated thrombocytopenia

Question 48

Usual management of patients with ITP

Answer 48

Monitoring until platelets return to normal

Question 49

Management of severe thrombocytopenia

Answer 49

Prednisolone IV immunoglobulins Blood transfusions if required