Bleeding History and Tests ☺️

Question 1

Who?

Answer 1

Sex, age, race, FHx

Question 2

When?

Answer 2

Hx of tranfusions, blood components

PMHx, Surgical Hx for abnormal bleeding events

• tooth extractions
• post surgery poor wound healing
• frequent nosebleeds

DHx

Duration of these problems

Question 3

Where?

Answer 3

Skin, mucous membranes => platelet/vascular problem?

• purpura, bruises
• heavy periods, hematuria

Deep tissues (joints, muscles )=> coagulation factor issue?

Question 4

What?

Answer 4

Spontaneous or after trauma

-easy/excess bleeds after injury => inherited bleeding problem?

Question 5

Tests of primary hemostasis

-assessing platelets

Answer 5

Bleeding time - assess platelet count and function
-2-8min :)
Platelet function - assess in aggregometer
Platelet count - 150-400 :)
Blood smear - morphological assessment
-fewer granules, increased size

Question 6

Tests of secondary hemostasis

• PT
• aPTT
• TT
• DD
• INR

Answer 6

PT - extrinsic + common
aPTT - intrinsic + common
TT - assess clot formation in excess thrombin
DD - assess fibrin breakdown products
INR - standardisation of PT, PTT result

Question 7

PT

• what does it assess
• normal result
• high result reasons

INR targets

• normal
• warfarin users
• increased AC needed

Answer 7

Extrinsic - 7, 10, 5, 2, 1
11-15s :)

High

• VitK/FVII low
• Too much active warfarin/FXinh

INR targets

• 0.8-1.2 :)
• 2-3 :) for warfarin
• 3-5 if more intense AC needed

Question 8

aPTT

• what does it assess
• normal result
• high reasons

Answer 8

Intrinsic - 12, 11, 9, 8, 5, 10, 2, 1
35s :)

High

• heparin too high - affects 9, 10, 11, 12
• liver disease - all factors low except 8
• haemophilia A (8), B (9)

Question 9

TT

• what does it assess
• normal result
• too high reasons

Answer 9

Fibrin pathway

12-14s :)

High

• amount/functional fibrinogen low?
• heparin too high?
• D thrombin inh too high?

Question 10

DD

-what does it assess

Answer 10

Fibrin degradation products
Detect thrombotic disorders
Diagnosis of DIC in sepsis and exclude thromboembolic disease

Question 11

Interpretation of

-normal PT/normal aPTT

Answer 11

Platelet issues

• Immune thrombocytopenic purpura
• vWF deficiency

Normal clotting :)

Question 12

Interpretation of

-high PT/high aPTT

Answer 12

Factor V Leiden - APC not broken down

Antithrombin III deficiency - cannot inhibit 2, 9, 10

Question 13

Disseminated intravascular coagulation

• pathophysiology
• causes

Answer 13

Formation of thrombi consume F5, 8, platelets => increased bleeding

• high PT, aPTT, DD
• low fibrinogen, platelets

SUPPORTIVE TREATMENT
TREAT UNDERLYING CAUSE