Bleeding Disorders

Question 1

What are the 4 parts of haemostasis?

Answer 1

Vasconstriction
Platelet adhesion
Stabilisation
Self limitation

Question 2

What causes self limitation of clotting?

Answer 2

tPA - plasminogen -> plasmin

Question 3

What are protein C and protein S?

Answer 3

anticoagulants

Question 4

What are the investigations used to assess a Bleeding disorder?

Answer 4

FBC - platelets
Coag screen - INR
APTT

FVII levels, vWF activity

Question 5

What pathways does INR measure?

Answer 5

extrinsic and intrinsic pahways

Question 6

Which pathway does APTT measure?

Answer 6

intrinsic

Question 7

What symptom with patients experience when their platelets drop below 50?

Answer 7

petaecia

Question 8

What are the two reasons for thrombocytopaenia?

Answer 8

decreased production of platelets (leukaemias)

consumption of platelets

Question 9

What is the most common immune mediated thrombocytopaenia

Answer 9

Thrombocytopaenic purpura

Question 10

What is the patogenisis of thrombocytopaenic purpura?

Answer 10

Abs against platelets cause them to be removed by the spleen

Question 11

What are the two syndrome which occur in Thrombocytopaenic purpura?

Answer 11

Acute and chronic

Question 12

What are the features of acute thrombocytopaenic purpura?

Answer 12

Children after an infection will be symptomatic but will not usuallyneed treatment

Question 13

What are the features of chronic thrombocytopaenic purpura?

Answer 13

Happens in middle aged women and requires steroids or splenectomy

Question 14

What drugs can cause immune mediated thrombocytopenia? (3)

Answer 14

penicillin, heparin, blood transfusion

Question 15

Which two conditions should be excluded before the diagnosis of Thrombocytopenic purpura is confirmed?

Answer 15

SLE and HIV

Question 16

What are the inherited coagulopathies?

Answer 16

Haemophilia and vW disease

Question 17

What can cause acquired coagulopathy?

Answer 17

liver disease, Vit K deficiency

Question 18

What are the two most common haemophillias?

Answer 18

Haemopillia A

Haemophillia B

Question 19

Which haemophillia is most common?

Answer 19

Haemophillia A

Question 20

What would coagulation screen look like in haemophillia?

Answer 20

high APTT normal PT as there is no insult on the extrinsic pathway

Question 21

Which factor is depleted in haemophillia A?

Answer 21

Factor VIII

Question 22

How is Von Wilibrand disease inherited?

Answer 22

Autosomal Dominant

Question 23

How will Von Willibrand disease look on coag screen?

Answer 23

may look normal, may have to do a specific test

Question 24

What is the treatment of VonWillibrand disease?

Answer 24

Desmopressin

Question 25

Which clotting factors are affected by Vit. K?

Answer 25

Factors II, VII, IX, X

Question 26

What causes vit K def.?

Answer 26

malnutrition, malabsorbtion and warfarin

Question 27

What causes Disseminated intravascular coagulation?

Answer 27

gram -ve sepsis end stage maligancy mismatched transfusions

Question 28

Name three exogenous causes of thrombopillia

Answer 28

Pregnancy, immobility and OCP, surgery

Question 29

What is the main inherited cause of thrombophillia?

Answer 29

Factor V leiden

Question 30

How quickly does heparin work?

Answer 30

immediate

Question 31

How should unfranctionated heparin be given?

Answer 31

IV

Question 32

How should LMW heparin be given?

Answer 32

subcut

Question 33

What anticoagulant should be used in a pregnant woman?

Answer 33

heparin NOT WARFARIN

Question 34

How is heparin reversed?

Answer 34

Protamine