Bleeding disorders

Question 1

What history should be taken if a bleeding disorder us suspected?

Answer 1

Types of bruising
Severity
Pattern
Congenital vs acquired

Question 2

What types of bleeding may be reported?

Answer 2

Bruising
Epistaxis
Post surgical
Menorrhagia
Post partum haemorrhage
Post trauma

Question 3

What is the pattern of platelet type bleeding?

Answer 3

Mucosal
Epistaxis
Purpura
Menorrhagia
GI

Question 4

What is the pattern gf coagulation factor bleeding?

Answer 4

Articular
Muscle haematoma
CNS

Question 5

What history should be taken to establish congenital vs acquired?

Answer 5

Previous episodes
Age at first event
Previous surgical challenges
Associated history

Question 6

What is the genetic basis of haemophilia?

Answer 6

X linked

Question 7

What is distinctive about severe haemophilia?

Answer 7

Spontaneous bleeding

Question 8

What are the clinical features of haemophilia?

Answer 8

Haemarthrosis- esp in hinge and weight bearing joints
Muscle haematoma
CNS bleeding
Retroperitoneal bleeding
Post surgical bleed

Question 9

How is haemophilia diagnosed?

Answer 9

Clinical
Genetic analysis
Prolonged APTT
Normal prothrombin time
Reduced factor VIII or IX

Question 10

What is the pharm treatment of haemophilia?

Answer 10

Coagulation factor replacement- given as prophylaxis in severe
Demopressin
Tranexemic acid
Analgesia

Question 11

What is the general management of haemophilia?

Answer 11

Splints

Physio

Question 12

What is the surgical management of haemophilia?

Answer 12

Synovectomy

Joint replacement

Question 13

What are the complications of haemophilia?

Answer 13

Synovitis
Chronic haemophilic arthropathy
neuromuscular compression
Other sequelae of bleeding- stroke

Question 14

What are the complications of demopressin?

Answer 14

MI

Hyponatraemia in babies

Question 15

What is common in those recieving factor VIII?

Answer 15

Development of inhibitors

Question 16

What are the types of von Willebrand disease?

Answer 16

Type 1= quantitive deficiency
Type 2= mutation causing poor function
Type 3= complete deficiency

Question 17

What is the genetic basis of von Willebrand disease?

Answer 17

Autosomal

Question 18

What is the treatment of von Willebrand?

Answer 18

vWF concentrate or demopressin
Tranexemic acid
OCP for women- prevent menorrhagia

Question 19

What are the 2 types of causes of thrombocytopenia?

Answer 19

Decreased production

Increased consumption

Question 20

What are the causes of decreased production thrombocytopenia?

Answer 20

Marrow failure
Aplasia
Infiltration

Question 21

What are the causes of increased consumption thrombocytopenia?

Answer 21

Immune ITP
Non immune DIC
Hypersplenism

Question 22

What are the clinical features of thrombocytopenia?

Answer 22

Petechia
Ecchymosis
Mucosal bleeding
Rarely CNS bleeding

Question 23

What is ITP associated with?

Answer 23

Infection
Lymphoma
Collagenosis
Drug induced

Question 24

What is the treatment of ITP?

Answer 24

Steroids
IV IgG
Splenectomy
Thrombopoietin analogues

Question 25

Why does liver failure cause bleeding?

Answer 25

Failure to produce factors I, II, V, VII, VIII, IX, X, XI

Question 26

what are the clinical features of bleeding caused by liver failure?

Answer 26

Bleeding from structural lesions

Question 27

how is bleeding due to liver failure diagnosed?

Answer 27

Prolonged prothrombin time and APTT | Reduced fibrinogen

Question 28

What are the acquired causes of bleeding disorders?

Answer 28

``` Thrombocytopenia Liver failure Renal failure DIC Drugs ```

Question 29

What drugs can cause bleeding disorders?

Answer 29

Warfarin Heparin Aspirin Clopidogrel etc

Question 30

What causes haemorrhage disease of the newborn?

Answer 30

Vit K deficiency