Flashcards in Conditions Deck (19)
Describe Von Willebrand's Disease
- Commonest coagulopathy - autosomal dominant
- Mucocutaneous bleeding
- 15% of women with menorrhagia have it
- Can be difficult to diagnose
What are the types of VW disease?
Type 1 - reduced amount of normal VW protein
Type 2 - abnormal VW protein (IIb overactive)
Type 3 - little or no VW (undetectable levels) and decreased VIII
Describe type 1 VW disease
- Autosomal dominant
- Bruising/mucosal bleeding
- Operations/dental extraction
- Treat with DDAVP (24 hrs half-life)
Describe type 2 VW disease
- Autosomal dominant
- Indistinguishable from type 1 based off symptoms
- Watch for type 2: overactive protein, can result in thrombocytopenia (abnormal level of platelets), avoid DDAVP (releases VWF causing further overactivation), use VWF concentrate
Describe type 3 VW disease
- Autosomal recessive
- Severe illness
- Serious mucosal bleeding
- Operative treatment will cause severe bleeding
What patients need to be considered at risk for a venous thromboembolism?
- Over 18
- Immobile i.e. in bed, after surgery
- Often hypercoagulable - acute phase reactant proteins include fibrinogen, factor VIII + VWF
- Endothelial injury - obvious if leg or pelvic operation or needs post-operative plaster cast but even stasis itself will cause some endothelial damage
Why is surgery a risk for thromboembolism?
- Knee and hip replacement
- Anaesthesia leads to immobility, stasis and reduced blood flow in legs
- Post-operative period with bed rest - increased risk with increased duration
- Acute reactants post surgery
- Open surgery greater risk than laparoscopic
What is a DVT?
Formation of thrombus in deep veins (usually leg). This can travel to heart > RA > RV > pulmonary arteries and cause a PE > cardiac arrest.
How is PE defined?
Massive PE is classified by the presence of arterial hypotension (systolic BP < 100mmHg) or cardiogenic shock/cardiac arrest. This is an emergency and requires urgent thrombolysis.
What are the risk factors for DVT?
- Immobility > 3days (or major surgery within 12 weeks)
- FH DVT
- Age (>60yrs)
- Active cancer (includes treatment within the last 6 months)
- Previous DVT
What is thrombophilia?
A condition that increases the risk of blood clots - usually only treated when a clot develops (DVT or PE). Occurs in 25-55% of surgery patients.
What are differentials of DVT?
- A ruptured baker's cyst
- Muscle haematoma
What is haemarthrosis?
Bleeding in joints
What does haemodynamically unstable mean?
Low BP so organs in the body aren't being sufficiently perfused. Give patients thrombolysis (altaplase) to break down clot.
What are the 3 processes after injury that halt bleeding?
2. Gap-plugging by platelets
What do vascular and platelet disorder cause?
They lead to prolonged bleeding from cuts, bleeding into the skin (e.g. easy bruising, purpura) and bleeding from mucous membranes (e.g. epistaxis, bleeding from gums, menorrhagia).
What do coagulation disorders cause?
Delayed bleeding into joints and muscle - haemophilia, VW disease.
Describe haemophilia A
X-linked recessive pattern in 1:10,000 male births (30% have no FH).