Bleeding and Thrombocytopenia Exercise Flashcards Preview

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Flashcards in Bleeding and Thrombocytopenia Exercise Deck (13)
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1
Q

List the clincial characteristics for primary (platelet) bleeding

  • Site
  • Bleeding after minor cuts?
  • Petechiae
  • Ecchymoses
  • Hemarthroses, muscle hematomas
  • Bleeding after surgery
A

PRIMARY

  • Site: Skin, mucous membranes (gingivae, nares, GI, GU tract)
  • Bleeding after minor cuts? **yes ***sorry this was wrong before*
  • Petechiae: present
  • Ecchymoses: small, superficial
  • Hemarthroses, muscle hematomas: rare
  • Bleeding after surgery: intermediate, mild
2
Q

List the clincial characteristics for secondary (clotting factor) bleeding

  • Site
  • Bleeding after minor cuts?
  • Petechiae
  • Ecchymoses
  • Hemarthroses, muscle hematomas
  • Bleeding after surgery
A
  • Site: deep in soft tissues (joints, muscles)
  • Bleeding after minor cuts? Not usually
  • Petechiae: Absent
  • Ecchymoses: large, palpable
  • Hemarthroses, muscle hematomas: common
  • Bleeding after surgery: delayed, severe
3
Q

What is the key characteristic of a blood smear in a patient with ITP?

A

Large platelets–almost the size of RBCs. Indicates immature platelets and high cell turnover.

4
Q

How do you treat an adult with ITP?

How do you treat a child with ITP?

A

Adults: IVIG. IVIG is thought to overwhelm macrophages so they destroy fewer platelets coated with auto-abs. Treat with steroids after to decrease auto-ab production.

Children: do not need treatment as most cases resolve sponatenously. Peak incidence is early childhood (1-6yo). More likely to be due to virus. Only 25% of cases result in chronic disease.

5
Q

Describe the following for DIC:

  • Pathology:
  • Lab findings:
  • Associations:
  • Treatment:
A
  • DIC is an acquired syndrome, characterized by systemic intravascular coagulation. *Coagulation always comes first, then followed by bleeding. Always caused by something else.
  • Lab: elevated PT, PTT, thrombin time, dereased factor activities, elevated D-dimer, somtimes thrombocytopenia and hemolytic anemia.
  • Associations: microvascular infarction and hemorrahge. Bleeding complications are common. Other organs affected include liver, kidneys and CNS.
  • Tx: Correct underlying disorder (IE ceftriaxone for meningitis) and supprotive therapy (factor replacement).
6
Q

What are the most important tests for DIC?

A

D-Dimer is the best test for DIC (although non-specific). D-dimer is incative of clot formation that has been broken down. Always + for DIC, but also elevated in cancer, surgery, pregnancy, etc.

Fibrinogen is another important test (expect low leves).

7
Q

Hemophilia

  • Primary disorder for Hemophilia A, B, and C (C not tested)?
  • Inheritance pattern and severity among family?
  • Incidence?
  • Treatment?
A

Hemophilia

  • A: deficiency in factor VIII, B: deficiency in factor IX, C: deficiency in factor XI.
  • Inheritance: A and B are x-linked recessive. Severity level is consistent amont family members. 30% of hemophilia are new mutations. Hemophilia C is autosomal and affects M and F equally.
  • Incidence: A—20/100k males, B—5/100k males. About half of all cases are severe.
  • Treatment: Replace what’s missing. Recombinant factor IX or VIII.
8
Q

Child with PMH of multiple sprained ankles and easy bruising. What kind of bleeding is this?

A

Kids with hemophilia have bleeding into joints. Kids running around with swollen ankle probably has hemorrhage in the ankle!

9
Q

If PT or PTT is elevated, what’s the next step?

A

1:1 mixing study!

If mixing study corrects the time, then you have a factor deficiency.

If not, there is an inhibitor in the blood that is preventing the clotting.

10
Q

VWF

  • Synthesis:
  • Storage:
  • Functions:
  • Levels with age, race, and blood group:
  • Increased by?
  • Decreased by?
A

VWF

  • Synthesis:endothelial cells, megakaryocytes
  • Storage: endothelial cells, alpha granules in platelets
  • Functions: adhesion of platelets to sites of injury, binds and protects factor VIII in circulation
  • Levels with aging (increases), race (15% higher in blacks), and blood group (30% lower in type O):
  • Increased by? Sympathetic stimulation, surgery, trauma, exercise, and pregnancy.
  • Decreased by? hypothyroidism
11
Q

VWF disease (VWD)

  • Incidence:
  • Pathology
  • Clinical characteristics:
  • Treatment:
  • Additional stuff:
A

VWF disease (VWD)

  • Incidence: 0.1-1%, most common inherited bleeding disorder!
  • Pathology: impaired primary hemostasis (mucocutaneous).
  • Clinical characteristics: Mucosal bleeding (epistaxis and menorrhagia), postoperative bleeding, bleeding from oral cavity, GI bleeding.
  • Treatment:
    • DDAVP (desmopressin acetate): synthetic analogue of vasopressing, releases VWF from endothelial storage.
    • Transfusion therapy: viral-inactivated VWF-FVIII concentrate. Cryopreipitate (fibrinogen, VIII, VWF, XIII)–in emergency cases when nothing else is available.
  • Additional stuff: Bleeding disorders are common contributors of iron-deficiency anemia in menstruating females.
12
Q

Woman with heavy periods, nosebleeds during childhood, and easy bruising, often associated with lumps.

  • Disorder:
  • Characterize the bleeding:
  • Blood smear:
  • Other findings:
  • Tx:
A
  • Disorder: VWD
  • Characterize the bleeding: Mucocutaenous and deep (nosebleeds, menorrhagia, muscle hematoma–lumps).
  • Blood smear: microcytic, hypochromic, anisopoikilocytosis (increased RDW)
  • Other findings: low F VIII, because VWF is needed to prolong its activity in circulation.
  • Tx: desmopressin–released VWF from endothelial cells.
13
Q
A