Flashcards in Surgery - Surgical Bleeding Disorders Deck (20):
What is Haemophilia A?
Factor VIII deficiency
-high rate of de novo mutations
What is Haemophilia B?
Factor IX deficiency
What are the clinical features of Haemophilia?
Major bleeds following minor trauma
Recurrent haemarthroses --> crippling arthropathies
Compartment syndrome/nerve palsies
What are the appropriate investigations in suspected haemophilia?
Low factor VIII/IX
What are the management options for haemophilia?
Avoid NSAIDs/IM injections
-compression & elevation
-recombinant factor VIII/IX to raise factor levels (50% of normal)
-recombinant factor VIII/IX to raise factor levels (100% of normal)
What are the common causes of clotting factor deficiency?
Vit K deficiency
What is Von Willebrand's Disease?
Absence of vWF OR presence of abnormally functioning vWF
What are the sx of vWD?
What is the inheritance of vWD?
Autosomal recessive (20%)
-complete absence of detectable vWF
Autosomal dominant (80%)
-less severe depletion of vWF
What are the appropriate investigations in suspected vWD?
What are the management options for vWD?
Tranexamic acid (mild bleeds)
Desompressin/recombinant factor VIII (severe bleeds)
What questions would identify potential bleeding disorders?
Site of bleed?
Duration of hx/family hx?
What factors about the site of bleed may help identify a bleeding disorder?
-local endothelial abnormality
What factors about the surgical hx may help identify a bleeding disorder?
If starts immediately = platelet
If starts after sev hours = coagulation
What signs may suggest a bleeding disorder?
Skin (purpura, bruises, telangiectasia)
Abdomen (splenomegaly, hepatic dysfunction)
What is DIC?
Systemic activation of coagulation pathway
-extensive intravascular coagulation
-fibrin clot development
-thrombotic occlusion of arterial microvasculature
-depletion of clotting factors/platelet consumption
What are the common causes of DIC?
Obstetric complication (amniotic emboli, pre-eclampsia)
Severe liver failure
Tissue destruction (pancreatitis/burns)
What are the clinical features of DIC?
Excessive bleeding from any site
What are the appropriate investigations in suspected DIC?
Raised PT & APTT
Blood film (shistocytes)