Bleeding Disorders

Question 1

3 Types of Bleeding disorders

Answer 1

Vascular defects (easy bruising)
Platelet disorders (low or abnormal function)
Coagulation disorders (Factor deficiency)
Mixed (DIC)

Question 2

Cause of superficial bleeding?

Answer 2

Vascular defects (easy bruising)
Platelet disorders (low or abnormal function)

Question 3

Cause of Bleeding immediately after injury

Answer 3

Vascular defects (easy bruising)
Platelet disorders (low or abnormal function)

Question 4

Cause of bleeding into deep tissues?

Answer 4

Coagulation disorders (Factor deficiency)

Question 5

Cause of delayed but severe bleeding after injury

Answer 5

Coagulation disorders (Factor deficiency)

Question 6

Cause of prolonged bleeding?

Answer 6

Coagulation disorders (Factor deficiency)

Question 7

Congenital vascular defects?

Answer 7

Osler-Weber-Rendu sydrome

Ehlers-Danlos sydrome (Connective tissue disorders)

Question 8

Acquired vascular defects?

Answer 8

Senile purpura
Infection (meningococcal, measles, dengue)
Steroids
Scurvy (Perifollicular haemorrhages)

Question 9

4 underlying mechanisms of platelet disorders?

Answer 9

Acquired abnormal platelet function
Congenital abnormal platelet function
Reduced production of platelets
Increased destruction of platelets

Question 10

Normal platelet count?

Answer 10

150-400x10^9 g/L

Question 11

Acquired abnormal platelet function conditions?

Answer 11

Aspirin
Cardiopulmonary bypass
Uraemia

Question 12

Congenital abnormal platelet function conditions?

Answer 12

Platelet storage pool disease

Thrombasthenia (Glycoprotein deficiency)

Question 13

Thrombocytopenic conditions

Answer 13

Bone marrow failure
Auto-immune Thrombocytopenic Purpura
Drugs eg. heparin, DIC, HUS, TTP

Question 14

Age of onset of acute and chronic ITP

Answer 14

Acute - 2-6 yrs

Chronic - Adults

Question 15

Treatment of chronic ITP

Answer 15

IV Ig, Steroids, Splenectomy

Question 16

Factor VIII Deficiency

Answer 16

Haemophilia A

Question 17

Inheritance pattern of Haemophilia A

Answer 17

X-linked recessive

1/10000 males

Question 18

Diagnosis of Haemophilia A

Answer 18

Increased APTT
Normal PT
Reduced Factor VIII assay

Question 19

Management of Haemophilia A

Answer 19

Avoid NSAIDs and IM injections
Desmopressin - increases vWF release (factor VIII carrier)
Factor VIII concentrates for life

Question 20

Factor IX Deficiency

Answer 20

Haemophilia B

Question 21

Inheritance pattern of Haemophilia B

Answer 21

X-linked recessive

1/50,000 males

Question 22

Management of Haemophilia B

Answer 22

Factor IX concentrates

Question 23

Reduced platelet function and factor VIII

Answer 23

Von Willebrand’s disease

Question 24

Inheritance pattern of vW DIsease

Answer 24

Autosomal dominant

1/10,000 males

Question 25

Diagnosis of vW Disease

Answer 25

``` Increased APTT Increased Bleeding time Decreased Factor VIII Decreased vWF Ag. Normal INR Normal Platelets ```

Question 26

Management of vW Disease

Answer 26

Desmopressin vWF Factor VIII Concentrates

Question 27

Widespread activation of coagulation

Answer 27

DIC | Clotting factors and platelets are consumed

Question 28

Cuases of DIC

Answer 28

``` Malignancy Trauma Sepsis Obstetric complications Toxins ```

Question 29

Diagnosis of DIC

Answer 29

``` Low plts Low Fibrinogen High FDP/D Dimer Long PT Long INR ```

Question 30

Management of DIC

Answer 30

``` Treat the cause Tranfusions FFP Platelets Cryo ```

Question 31

Liver Disease

Answer 31

Reduced synthesis of factor II, V, VII, IX, X, XI and fibrinogen Reduced Vit K absorption Abnormalities of platelet function

Question 32

Factors reduced in Vit K deficiency

Answer 32

II, VII, IX, X | Protein C, S

Question 33

Cause of Vit K Deficiency

Answer 33

Warfarin Vit K malabsorption/malnutrition Abx Therapy Biliary Obstruction

Question 34

Treatment of Vit K Deficiency

Answer 34

IV Vitamin K | Fresh frozen plasma for acute haemorrhage