thrombotic disorders

Question 1

what is a thrombus

Answer 1

a clot that arises ‘in the wrong place’

Question 2

what is a thromboembolism

Answer 2

then the thrombus moves along the vessel

Question 3

what is virchows triad

Answer 3

stasis
vessel damage
hypercoagubility

Question 4

what is an arterial thrombosis made up of

Answer 4

platelet and fibrin clot

Question 5

risk factors for arterial thrombosis

Answer 5

age
smoking 
diabetes 
sedentary lifestyle 
hypertension 
obesity

Question 6

what can an arterial thrombosis cause

Answer 6

ischaemia and infarction

symptoms depend on site (stroke, MI, acute limb ischaemia etc)

Question 7

what is a venous thrombus made of

Answer 7

fibrin and RBCs

Question 8

why do venous clots form

Answer 8

usually because of stasis and hypercoagulability

Question 9

what can venous thrombi cause

Answer 9

DVT
PE
thrombophlebitis

Question 10

risk factors for venous clots

Answer 10

age
pregnancy 
hormone therapy 
trauma 
immobility 
surgery 
obesity 
FH
systemic disease

Question 11

what systemic diseases can increase risk of VTE

Answer 11

cancer
IBD
connective tissue diseases

Question 12

what could you use for probability testing in VTE

Answer 12

wells

geneva score

Question 13

investigations for thromboembolisms

Answer 13

d-dimer
doppler
V/Q scan
angiogram

Question 14

what is factor V leiden

Answer 14

hereditable disease
mutation of factor V
means protein C can’t bind to it

Question 15

what is the result of factor V leiden

Answer 15

excess clotting in veins

Question 16

when chould you suspect factor V leiden

Answer 16

young (<45) Caucasian patient with a clot

Question 17

what is microvascular thrombus

Answer 17

platelets/fibrin in small vessels

Question 18

what does microvascular thrombus cause

Answer 18

diffuse ischaemia

Question 19

when is microvascular thrombosis seen

Answer 19

disseminated intravascular coagulopathy

Question 20

what is disseminated intravascular coagulopathy

Answer 20

serious condition where blood clots form in blood vessels all over the body

Question 21

what are some examples of precipitating factors that can cause DIC

Answer 21

shock 
sepsis 
major trauma/burns 
malignancies 
obstetric emergencies 
severe immune related conditions 
severe organ dysfunction

Question 22

what is the pathology of DIC

Answer 22

systemic inflammatory response to the trigger
upregulation of TF and other pro-coagulants
activation of clotting cascade

Question 23

what happens to circulating clotting factor concentration in DIC

Answer 23

decreases because all the clotting factors are being used up

Question 24

do you get thrombocytopenia in DIC

Answer 24

yes

platelets are being used up

Question 25

presentation of DIC

Answer 25

bleeding from unusual sites like nose, GI tract, ears 
widespread easy bruising 
confusion/disorientation 
petechia or purpura 
widespread skin necrosis 
oliguria 
hypotension

Question 26

investigations for DIC

Answer 26

FBC - thrombocytopenia
coagulation screen
D-dimer - elevated

Question 27

management of DIC

Answer 27

treat underlying cause
platelet transfusions for bleeding
concentrated solutions of clotting factors
heparin if there is lots of thrombosis
lower dose oral heparin if patient is non-bleeding

Question 28

complications of DIC

Answer 28

organ failure 
haemorrhage 
cardiac tamponade 
haemothorax 
gangrene 
intracranial haemorrhage