(MHD) Clin. Eval of Bleeding Patient Flashcards
(24 cards)
Bleeding into mucosal tissues is associated with what type of bleeding? (immediate or delayed?)
What does it indicate?
Immediate bleeding. It indicates an issues with formation of the initial clot
Bleeding into deep tissue is associated with what type of bleeding? (immediate or delayed?)
What does it indicate?
Delayed
It is associated with the formation of an initial clot, but missing the factors needed to solidify and reinforce the clot.
Menorrhagia
Period in which more than 80ml of blood is loss/cycle
What can we learn/questions can we answer from the CBC? (4)
- Platelet quantity
- Is there involvement of the other cell lines?
- What do the platelets look like?
- Is there evidence of a systemic disorder?
What can we learn/questions can we answer from the PT/aPTT?
- Qualitative and quantitative defects in platelets (but won’t differentiate)
- Sometimes differentiates the clotting factor which is the culprit
- Are there abnormalities in the coagulation system?
What are the differential diagnoses associated with thrombocytopenia? (9)
- Idiopathic Thrombocytopenic Purpura (ITP)
- Gestastional thrombocytopenia
- Drug-induced thrombocytopenia
- Viral infections (HIV, Rubella, EBV)
- Hypersplenism
- Narrow infiltration by neoplasia; CLL
- Microangiopathic Thrombocytopenia (i.e. HUS-TTP)
- DIC
- Lupus
Name the inherited platelet dysfunction diseases (2)
- Glanzmann Thrombasthenia
- Bernard-Soulier Syndrome
Name the disorder of platelet activation?
vWD
List the acquired causes of abnormalities in clotting factors (5)
- Vitamin K def
- Acquired Inhibitors of clotting factors
- Failure of synthetic function of the liver
- Drugs-induced
- DIC
List the inherited abnormalities in clotting factors (4)
- Deficiency of factor VIII (Hem A)
- Deficiency of IX (Hem. B)
- Mutations leading to missense/early stop/ failure to bind
- Secondary deficiency of VII
Relationship between circulating vWF and Factor VIII. What issues can come as a result?
Circulating vWF carries factor VIII, so if you have low levels of vWF, you will also see low levels of factor VIII, leading to potential issues with the coagulation cascade.
What test tells us if the patient has any vWF?
Von Willebrand factor antigen (aka Factor 8 antigen)
What test tells us the vWF that we have works?
Vin Willebrand factor Ristocetin cofactor activity test
What test tells us if factor VIII has been affected in a vWF issue?
Factor VIII clotting activity test
What test tells us the structure of the vWF?
Von Willebrand Multimers (this is a follow up test and not used for initial diagnosis)
Key testing differences between Hem A and vWD
Ristocetin activity: Hem A: NL/ vWD: LOW
vWF:Ag: Hem A: NL/ vWD: LOW/NL
Function of DDAVP
Treatment for vWF deficiency
Therapy which takes storage vWF and moves it to endothelial surface, allowing clots to be produced.
Prolonged PT points to what diseases/issues?
- Liver Disease
- DIC (Early Stage)
- Warfarin
- Factor VII deficiency
Prolonged PTT points to what diseases/issues?
- Heparin
- Factors VIII, Ix, XI and XII
- Lupus Anticoagulant
Prolonged PT and PTT point you towards what diseases/issues?
- Heparin/Warfarin High-dose
- Dilution
- Vit K Deficiency
- Liver Disease
- Paraproteins
What are the (2) umbrella reasons for elevated PT or PTT? What test helps us differentiate between the 2?
- Deficiency of clotting factor
- Inhibitor of clotting factor function
Mixing study is used to differentiate between the 2
Describe a Mixing Study
Used to determine whether there is a deficiency of clotting factors or an inhibitor.
You mix normal plasma with your patient’s plasma. If the problem is deficiency, mixing with normal plasma will lead to clot formation.
What is one of the most common inhibitors of coagulative factors
Lupus anticoagulant
FFP
Fresh Frozen Plasma
Given as treatment to low coagulation factors
