Lecture 9: Bleeding and Clotting Disorders Flashcards Preview

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Flashcards in Lecture 9: Bleeding and Clotting Disorders Deck (21)
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1

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

2

What is the difference between a Primary Hemostatic Disorder and a Secondary Hemostatic Disorder?

Primary - platelet disorder

Secondary - coagulation factor deficiency/inhibitor

3

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

4

What can we give to a patient that has Von Willebrand Disease that can help treat them?

DESMOPRESSION

- helps release vWF from endothelial cells/platelets

5

What types of Von Willebrand Disease are autosomal dominant?

types 1, 2A, and 2B

- harder to detect in males than females

6

What is considered "heavy menstrual bleeding"?

- changing pad/tampon every hour

- passing clots that are larger that 1 cm

7

What factor deficiencies would show elevated PTT and PT times?

PTT - factors VIII, IX, and XI

PT - factor VII

8

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

9

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)

10

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**

11

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**

12

Where does DVT usually appear at?

typically originates in the calf (painful, cramping sensation)

13

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?

14

How is a thromboembolism diagnosed?

Labs --> check for D-dimer

Radiography --> Ultrasound (DVT) or CT angio (PE)

15

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

16

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

17

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

18

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)

19

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

20

For a patient with "provoked" thromboembolism with NO underlying conditions or risk factors, how long should they be on anticoagulants?

3-6 months

- for pts. with life-threatening, unusual, or underlying risk factor --> probably wanna anticoagulate indefinitely

21

What is a non-pharmacological option for coagulation problems?

Inferior Vena Cava Filters