Bleeding Disorders

Question 1

Bleeding
Petechiae, purpura, inc BT

Answer 1

Primary plug disorders

Question 2

Bleeding
Ecchymosis, henarthrosis, inc CT

Answer 2

Secondary plug disorders

Question 3

In primary plug dis check plt count if dec check

Answer 3

Immatute plt fraction

Question 4

If immature plt fraction <6% in prim plug dis

Answer 4

Amegakaryocytic thrombocytopenia

Question 5

If immature plt fraction >6% in prim plug dis

Answer 5

Megakaryocytic thrombocytopenia

Question 6

Megakaryocytic thrombocytopenia
Renal failure, diarrhoea

Answer 6

Peripheral smear shows schistocytes
Thrombotic thrombocytopenic purpura

Question 7

TTP tx

Answer 7

Plasmapheresis, steroids, IVIg, splenectomy, ffp, aspirin

Question 8

Megakaryocytic thrombocytopenia
Viral inf

Answer 8

Acute itp
Tx - wait and watch

Question 9

Megakaryocytic thrombocytopenia
Female, autoimmunity

Answer 9

Chronic itp
Tx- steroids, IVIg, splenectomy

Question 10

Megakaryocytic thrombocytopenia
Inc clotting time

Answer 10

DIC

Question 11

Primary plug dis eith plt count normal

Answer 11

Check if its ass with glomerulonephritis, pneumonitis
Yes- small vessel vasculitis
No- plt function dis

Question 12

In primary plug dis with normal plt count
Plt function dis

Answer 12

Do plt aggregation test

Question 13

In primary plug dis with normal plt count
Plt function dis
Plt aggregation test- absent ristocetin aggregation

Answer 13

Vw dx
Bernaud soullier

Question 14

In primary plug dis with normal plt count
Plt function dis
Plt agg test- absent ADP and collagen aggregation

Answer 14

Glanzman thrombasthenia
Aspirin

Question 15

In primary plug dis with normal plt count
Small vessel vasculitis

Answer 15

Age
Child or adult

Question 16

Small vessel vasculitis
Child
Abd cramps, arthritis

Answer 16

Henoch schonlein purpura

Question 17

Small vessel vasculitis adult
ANA+, malar rash

Answer 17

Lupus

Question 18

Small vessel vasculitis adult
P ANCA+

Answer 18

Asthma, eosinophilia, cardiomyopathy- chrugs strauss dx
Ntg from above mentioned- M PAN

Question 19

Small vessel vasculitis adult
Saddle nose, granulomas, C ANCA+

Answer 19

Wegners

Question 20

In secondary plug dis
Only pt elevated, aptt normal

Answer 20

Factor 7 def - vit k def
Tx- inj vit k iv 2mg or ffp

Question 21

In secondary plug dis
Only aptt inc, pt normal

Answer 21

Child- look for sex

Question 22

In secondary plug dis
Only aptt inc, pt normal
Sex- boy

Answer 22

Do mixing studies
1. Hemophilia A -tx recombinant f-8 or cryoprecipitate
2.christmas dx- tx reco f9 or ffp
3. Hemophilia c- ffp

Question 23

In secondary plug dis
Only aptt inc, pt normal
Sex- girl

Answer 23

Vw dx
Hemophilia c

Question 24

In secondary plug dis
Only aptt inc, pt normal
Adult

Answer 24

Symptomatic (bleeding) - do mixing studies- factor inhibitors
No bleeding/ thrombosis-
1. No recurrent abortion h/o- factor 12 def (tx- heparin)
2. H/o recurrent abortion- APLA ( tx-heparin)

Question 25

Confirmatoey test for APLA

Answer 25

Dilute russel viper venom test

Question 26

Secondary plug dis Pt, aptt normal

Answer 26

Factor 13 def Tx- reco f13, cryoprecipitate

Question 27

Secondary plug dis Pt, aptt normal Thrombin time normal

Answer 27

Factor 10 def

Question 28

Secondary plug dx Pt, aptt inc

Answer 28

Thrombin time...

Question 29

Secondary plug dis Pt, aptt normal Thrombin time inc

Answer 29

See plt and d dimers Normal-afibrogenemia (tx- cryo) Low plt, d dimer high- dic (tx- plt 6 units, ffp. No response- add heparin)