Coagulation disorders

Question 1

Warfarin Major bleed T

Answer 1

Stop W
Cit K IV 5mg (phytomenodione K1)
Prothrombin Complex Bereplex 50u/kg

(cant: FFP)

Question 2

Warfarin Minor bleed T

Answer 2

Stop W
Vit K IV 1-3mg (phytomenodion K1)
Repeat in 24hr if INR still high
Restart warfarin INR

Question 3

INR 5-8 (no bleed)

Answer 3

Omit 1-2 doses

Adjust after

Question 4

INR 8+ (no bleed)

Answer 4

Stop W
Vit K oral 1-5mg (swallow IV prep phytomenodione K1)
Repeat in 24hr if INR still high

Question 5

Warfarin mechanism

Answer 5

Vit K dependent factors
2,7,9,10
Protein C + S

Question 6

Warfarin half life

Answer 6

> 40hr

Question 7

INR aim post 1st VTE

Answer 7

provoked: 2-3 for 3m
unprovoked: 2-3 for 6m

Question 8

INR aim post recurrent VTEs no treatment

Answer 8

2-3 for life

Question 9

INR aim recurrent VTEs ON treatment

Answer 9

3-4 for life

Question 10

INR aim on HEART VALVES

Answer 10

Mechanical Aortic 2-3

Mechanical mitral 2.5-3.5

Question 11

Describe Intrinsic pathway

Answer 11

Eposed collagen
12a hageman
11a
9a + 8a
10a + 5a
2a thrombin
1a + 13a
fibrin clot

Question 12

Describe extrinsic pathway

Answer 12

tissue damage
7a + tissue factor thromboplastin 3
10a + 5a
2a thombin
1a + 13a
Fibrin clot

Question 13

Vit K factors

Answer 13

7, 9, 10, 2

protein C + S

Question 14

Thrombomodulin

Answer 14

+ 2a thrombin + Protein S
causes Protein C -> Active protein C
INHIBITs 5a + 8a

Question 15

Antithrombin 3

Answer 15

Binds heparin
HMWH/ unfractionated: 2,9,10,11,12 (IV)
LMWH: 10a only (SC)

Question 16

Tissue Factor Pathway inhibitor

Answer 16

Inhibts 7aTF

Question 17

Fibrinolysis (tPa)

Answer 17

tPa
Plaminogen to Plasmin
Fibrin to Fibrinogen

Question 18

Measuring intrinsic

Answer 18

aPPT

Question 19

Measuring extrinsic

Answer 19

PT

Question 20

Thrombin functions

Answer 20

Activates 11, 8, 5 and 13

+thrombomodulin & protein S -> activate Protein C

Question 21

Haemophilia A

Answer 21

Low Factor 8

A8

Question 22

Haemophilia B

Answer 22

Low Factor 9

B9

Question 23

Haemophilia inheritence

Answer 23

X linked (male only)
female carry

Question 24

Haemarthrosis

Answer 24

haemophilia

Question 25

Christmas disease

Answer 25

Haemophilia B9

Question 26

Haemophilia bloods

Answer 26

``` High APPT (intrinsic) normal PT (extrinsic) normal vWF Low 8 (A) or 9(B) ```

Question 27

haemophilia A T

Answer 27

Replace A8 | Demopression increases 8

Question 28

haemophilia B T

Answer 28

Replace B9

Question 29

Variant CJD risk

Answer 29

Haemophilia

Question 30

Chronic arthropathies

Answer 30

Haemophilia

Question 31

``` High APPT (intrinsic) normal PT (extrinsic) normal vWF Low 8 (A) or 9(B) ```

Answer 31

Haemophilia

Question 32

High APPT, normal PT low vWF Low 8

Answer 32

vW disease

Question 33

No 1 bleeding disorder

Answer 33

vW disease

Question 34

vW disease types

Answer 34

1-partial drop in vWF 2-abnormal vWF 3-NovWF

Question 35

vW disease inheritence

Answer 35

``` Autosomal dominant (type 3-no vWF is AR) ```

Question 36

vW disease T

Answer 36

Desmopression inreases vWF + 8 vW rich factor 8/ vWF concentrate TRANEXAMIC ACID

Question 37

Thrombophilia primary causes

Answer 37

``` LOW Protein C Protein S Antithrombin 3 Factor 5 Leiden (active protein C cant break 5a down) ```

Question 38

commonest heritable thrombophilia

Answer 38

Factor 5 Leiden (active protein C cant break 5a down)

Question 39

Virchows triad

Answer 39

Venous stasis Hypercoagulation Vascular injury

Question 40

Homan's sign

Answer 40

Pain dorsiflexion in calf DVT | risk of dislodgeing

Question 41

VTE treatment

Answer 41

1. LMWH/ Fondaparinux for 5d+ AND INR >2.0 for 24hr 2, within 24hr start WARFARIN -Provoked 3month -Unprovoked 6months CANCER - LMWH 6months + compression stocking 2yrs Unprovoked = screen for cancer -exam, CXR, FBC, Ca2+, LFTs, urinalysis +/- >40yr CTCAP/ mammography Unprovoked = screen for thrombophilia + antiphospholipid if their on gna be on lifelong warfarin USS review in 1 week

Question 42

Thrombophilia secondary cuases

Answer 42

Immobility, surgery, malignany, smoking, pregnancy ANTI-PHOSPHOLIPID SYNDROME Oestrogens (COCP)

Question 43

Prophylaxis on flights

Answer 43

Aisle seat Ankle exercises Stockings

Question 44

VTE investigations

Answer 44

Two level Wells score | 2+ = USS