Flashcards in Lecture 9: Bleeding and Clotting Disorders Deck (21)
When should we be worried about bleeding disorders with epistaxis, cutaneous bruising, or oozing from minor wounds?
E - > 5 per year
C - 5 visible bruises at least 1 cm
M - > 10 min
What is the difference between a Primary Hemostatic Disorder and a Secondary Hemostatic Disorder?
Primary - platelet disorder
Secondary - coagulation factor deficiency/inhibitor
What 3 things can we test for if we suspect Von Willebrand Disease?
test the amount of vWF antigen, the amount of cofactor, and amount of Factor VIII
- will see an increased PTT time
What can we give to a patient that has Von Willebrand Disease that can help treat them?
- helps release vWF from endothelial cells/platelets
What types of Von Willebrand Disease are autosomal dominant?
types 1, 2A, and 2B
- harder to detect in males than females
What is considered "heavy menstrual bleeding"?
- changing pad/tampon every hour
- passing clots that are larger that 1 cm
What factor deficiencies would show elevated PTT and PT times?
PTT - factors VIII, IX, and XI
PT - factor VII
Why is genetic testing important for Hemophilia A? How is Hemophilia A passed on?
- can predict the disease severity
- eliminates other diseases from differential (such as Von Willebrand Disease
- Hemophilia A is X-linked recessive
What is the most standard therapy for Hemophilia A treatment? How should pts manage their condition?
give pt Recombinant Factor VIII
avoid bleeding in acute/chronic situations --> disease can progress to Hemophilic Arthropathy (bleeding in sinovial joint that can cause arthritis overtime)
Acquired Hemophilia A and Mixed Study PTT
- pts. with prolonged PTT (as in a factor deficiency) should fully correct with 50% of normal factor lvls
- failure of PTT to correct with study could indicate ANTIBODIES are present (extra Abs would bind to normal blood)
**if antibodies are suspected, check for family history of autoimmune disease**
What is Acquired Hemophilia A (Factor VIII Inhibitor)?
- often seen in adults (50+) but can occur postpartum or during pregnancy (<50)
- associated with autoimmune diseases (SLE/RA)
- treat mainly by suppressing the inhibitor
**pts with CONGENITAL Hemophilia A can develop Abs to FVIII over the course of their disease**
Where does DVT usually appear at?
typically originates in the calf (painful, cramping sensation)
How do we diagnose a thromboembolism if we suspect a patient may have one?
GENEVA criteria (score for risk factors)
- PT/DVT before?, cancer?, recent medical problem?, hemoptysis?, tachycardia?, >65?
How is a thromboembolism diagnosed?
Labs --> check for D-dimer
Radiography --> Ultrasound (DVT) or CT angio (PE)
Why is D-dimer important for diagnosing a Thromboembolic event?
has HIGH NEGATIVE predictive value
- if D-dimer isn't found (normally a degradation product of cross-linked fibrin) you are NOT dealing with a TEV
How are ultrasounds and CT angiograms helpful in diagnosing DVT and PE?
US - lumen of occluded vein will NOT collapse during compression
CT - show normally white vessels, but if there is an occlusion it will appear dark
How is Ventilation/Perfusion Scanning helpful in PE diagnosis?
breath a radiotracer dye to measure ventilation, then get injected with a radiotracer dye to measure perfusion
- any difference between the two patterns is a mismatch and can indicate PE
What is the difference between a Red and White thrombus?
Red - VENOUS (red cells, stasis, lower extremity)
White - ARTERIAL (platelet, high shear stress, atherosclerosis, coronary/cerebral arteries)
What is a Paradoxial Embolism and what is the most common route of transmission?
- passage of embolus from venous circulation to arterial circulation
- commonly travels through patent foramen ovale
- found in 50-60% of pts <55 who have had stroke
- normally only in 15-20% of the population
For a patient with "provoked" thromboembolism with NO underlying conditions or risk factors, how long should they be on anticoagulants?
- for pts. with life-threatening, unusual, or underlying risk factor --> probably wanna anticoagulate indefinitely