Bleeding Disorders

Question 1

How do disorders of primary haemostasis formation typically present?

Answer 1

Easy/spontaneous bruising and purpura

Question 2

Disorders of primary haemostasis will show what on fundoscopy?

Answer 2

Retinal haemorrhages

Question 3

Use of what medication may cause failure of primary haemostasis as a result of vascular damage?

Answer 3

Steroids

Question 4

Deficiency of which vitamin may cause failure of primary haemostasis as a result of vascular damage?

Answer 4

Vitamin C

Question 5

The acute form of immune thrombocytopenia (ITP) is most likely to occur in who, and when?

Answer 5

In children, following an infection or vaccination

Question 6

How is the acute form of immune thrombocytopenia treated?

Answer 6

Usually self-limiting over 1-2 weeks

Question 7

The chronic form of immune thrombocytopenia is most likely to occur in who?

Answer 7

Young and middle aged females

Question 8

How is the chronic form of immune thrombocytopenia treated?

Answer 8

Prednisolone

Question 9

Abnormally large and sticky multimers of Von Willebrand’s factor cause platelets to clump within vessels describes the pathophysiology behind what condition?

Answer 9

Thrombotic thrombocytopenic purpura (TTP)

Question 10

Thrombotic thrombocytopenic purpura is rare, but is generally seen in who?

Answer 10

Adult females

Question 11

What is Evan’s syndrome?

Answer 11

ITP with autoimmune haemolytic anaemia

Question 12

What is the most common inherited bleeding disorder?

Answer 12

Von Willebrand’s disease

Question 13

How is Von Willebrand’s disease usually inherited?

Answer 13

Autosomal dominant

Question 14

What are the two most common presentations of Von Willebrand’s disease?

Answer 14

Menorrhagia and epistaxis

Question 15

What happens to the bleeding time in individuals with Von Willebrand’s disease?

Answer 15

Increased

Question 16

Does Von Willebrand’s disease cause a prolonged PT, APTT, both or neither?

Answer 16

APTT

Question 17

Levels of which clotting factor maybe moderately reduced in those with Von Willebrand’s disease?

Answer 17

Factor VIII

Question 18

What is used as a treatment for mild bleeding caused by Von Willebrand’s disease?

Answer 18

Tranexamic acid

Question 19

What medication can be used to raise the levels of Von Willebrand’s factor in those with Von Willebrand’s disease?

Answer 19

Desmopressin

Question 20

Which clotting factors are vitamin K dependent?

Answer 20

II, VII, IX and X

Question 21

What are the three main examples of multiple clotting factor deficiencies?

Answer 21

Liver disease, vitamin K deficiency and DIC

Question 22

What are some potential causes of DIC?

Answer 22

Sepsis, trauma, malignancies and obstetric complications

Question 23

What is the cause of end organ failure in DIC?

Answer 23

Microvascular thrombus formation (from excess clotting)

Question 24

Which end organs are most likely to be damaged as a result of DIC?

Answer 24

Kidneys, liver, lungs, brain

Question 25

How are haemophilias inherited?

Answer 25

X linked recessive

Question 26

Which type of haemophilia is more common?

Answer 26

Haemophilia A

Question 27

In haemophilia A, there is a deficiency of which clotting factor?

Answer 27

Factor VIII

Question 28

In haemophilia B, there is a deficiency of which clotting factor?

Answer 28

Factor IX

Question 29

Which type of haemophilia can also be known as Christmas disease?

Answer 29

Haemophilia B

Question 30

What are the two most common presentations of haemophilia?

Answer 30

Haemarthrosis/haematomas or prolonged bleeding after surgery or trauma

Question 31

How are haemophilias treated?

Answer 31

Injections of factor concentrate every 2-3 days

Question 32

What happens to the platelet count in DIC?

Answer 32

Low

Question 33

Does DIC cause a prolonged PT, APTT, both or neither?

Answer 33

Both

Question 34

What happens to the D-dimer count in DIC?

Answer 34

Increased

Question 35

What may be seen on a blood film of someone with DIC due to microangiopathic haemolytic anaemia?

Answer 35

Schistocytes

Question 36

What happens to the fibrinogen level in DIC?

Answer 36

Low

Question 37

Does haemophilia cause a prolonged PT, APTT, both or neither?

Answer 37

APTT

Question 38

In which bleeding conditions will the bleeding time be increased?

Answer 38

Von Willebrand's disease and DIC

Question 39

Does a deficiency of vitamin K cause a prolonged PT, APTT, both or neither?

Answer 39

Both

Question 40

What are some potential treatments for mild bleeding in haemophilia?

Answer 40

Desmopressin and tranexamic acid

Question 41

Desmopressin should only be used as a treatment for which type of haemophilia?

Answer 41

Haemophilia A

Question 42

Tranexamic acid is not a useful treatment for what type of bleeding in patients with haemophilia?

Answer 42

Haemarthroses or haematomas

Question 43

What is the treatment for severe bleeding in haemophilia?

Answer 43

Factor VIII/IX factor concentrate IV infusion