Cases for Haemostasis and thrombosis Flashcards
A 20 month old boy attends accident and emergency with his father
The child has refused to walk for the past 2 days having been walking unsupported for 4 months
The right knee is slightly swollen and feels warm to touch
Blood is aspirated from the knee
Whats the most likely diagnosis?
Haemophilia A
How do you differentiate between haemophilia A and B?
Measure Factor VIII and IX levels.
How is haemophilia A inherited?
X-linked.
Effective males and carrier females.
The mother tells you that her father also has haemophilia A and wants to know the chances of haemophilia in any further children born to her
What is the chance of any further child having haemophilia A
1 in 4 chance as mother is an obligate carrier of haemophilia.
Having established the diagnosis of severe haemophilia A with a joint bleed, what optimal treatment should you give
Recombinant factor VIII
The father is concerned about the boy receiving factor VIII because of infections in his father –in-law related to factor VIII treatment
Which of these is not a complication of plasma derived factor VIII treatment.
Hepatitis A - it is not transmitted by concentrate.
What is the other main complication of treatment of severe haemophilia A with factor VIII concentrates?
Biggest complication is development of inhibitory antibodies (about 20%).
What is the best treatment regimen for patients that need recombinant VIII?
Give factor VIII at least 3 times weekly.
A 24 year old female student presents with a 4 day history of easy bruising and small red spots on her ankles.
No previous history of abnormal bleeding.
Previous tonsillectomy with no bleeding.
Recently been off colour with flu like symptoms.
Only medication is COCP.
What symptoms is she unlikely to have?
Swollen, hot painful leg.
She has petechiae, menorrhagia, epistaxis, easy bruising, blood blisters in her mouth.
*Surgical challenge with no bleeding = aquired.
What could be causing this young girls symptoms?
Thrombocytopenia.
What can be some of the possible causes of Thrombocytopenia?
Acute myeloid leukaemia
Aplastic anaemia
ITP
What is this young girls platelet count most likely to be?
10 - mucousal haemorrhage - irrespective of cause if it goes as low as 10.
What underlying illness is associated with ITP?
Glandular fever more often than not.
A 70 year old man has excessive bleeding after a colectomy for cancer
He has bleeding from his abdominal wound but not from his drain or his indwelling line
He has had surgery in the past but had no abnormal bleeding
Which is the most likely cause of this?
Poor surgical technique - single site does not suggest coagulopathic bleeding.
What are risk factors of peri-op VTE?
Surgery
Old age
Active Cancer
