Surgery - Surgical Bleeding Disorders Flashcards Preview

CP3 @ UoN - Medicine & Surgery > Surgery - Surgical Bleeding Disorders > Flashcards

Flashcards in Surgery - Surgical Bleeding Disorders Deck (20):
1

What is Haemophilia A?

Factor VIII deficiency
-X-linked recessive
-high rate of de novo mutations

2

What is Haemophilia B?

Factor IX deficiency
-X-linked recessive

3

What are the clinical features of Haemophilia?

Major bleeds following minor trauma
Recurrent haemarthroses --> crippling arthropathies
Compartment syndrome/nerve palsies

4

What are the appropriate investigations in suspected haemophilia?

Raised APTT
Low factor VIII/IX

5

What are the management options for haemophilia?

Avoid NSAIDs/IM injections
Minor bleeding
-compression & elevation
-desompressin
Major bleeding
-recombinant factor VIII/IX to raise factor levels (50% of normal)
Life threatening
-recombinant factor VIII/IX to raise factor levels (100% of normal)

6

What are the common causes of clotting factor deficiency?

Haemophilia
vWD
Liver disease
DIC
Vit K deficiency
Anticoagulant drugs

7

What is Von Willebrand's Disease?

Absence of vWF OR presence of abnormally functioning vWF

8

What are the sx of vWD?

Epistaxis
Menorrhagia
Haemarthroses rare

9

What is the inheritance of vWD?

Autosomal recessive (20%)
-complete absence of detectable vWF
Autosomal dominant (80%)
-less severe depletion of vWF

10

What are the appropriate investigations in suspected vWD?

APTT (increased)
INR (normal)
Platelets (normal)

11

What are the management options for vWD?

Tranexamic acid (mild bleeds)
Desompressin/recombinant factor VIII (severe bleeds)

12

What questions would identify potential bleeding disorders?

Site of bleed?
Duration of hx/family hx?
Severity?
Surgical hx?
PMH?
Drug hx?

13

What factors about the site of bleed may help identify a bleeding disorder?

Muscle/joint bleeds
-coagulation issue
Purpura/epistaxis/menorrhagia/GI haemorrhage
-platelet/vWD
Recurrent bleeds
-local endothelial abnormality

14

What factors about the surgical hx may help identify a bleeding disorder?

If starts immediately = platelet
If starts after sev hours = coagulation

15

What signs may suggest a bleeding disorder?

Skin (purpura, bruises, telangiectasia)
Joints (haemarthroses)
Abdomen (splenomegaly, hepatic dysfunction)

16

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

17

What are the common causes of DIC?

Infection
Trauma
Malignancy
Obstetric complication (amniotic emboli, pre-eclampsia)
Severe liver failure
Tissue destruction (pancreatitis/burns)
Toxic/immunogenic stimuli

18

What are the clinical features of DIC?

Bruising
Excessive bleeding from any site
Renal failure

19

What are the appropriate investigations in suspected DIC?

Low platelets
Low fibrinogen
Raised PT & APTT
Raised D-dimer
Blood film (shistocytes)

20

What are the management options for DIC?

Treat the cause
Aggressive resus
-replacing platelets
-coag factors
-fibrinogen
Protein C (reduces mortality in multi-organ failure/sepsis)

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