Coagulopathies

coagulopathies

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Question 1 of 1

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485217

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Primary homeostasis consists of activation of what?

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Explanation

Adhesion, activation and aggregation of platelets is primary homeostasis for clotting. vWF binds collagen and is regulated by ADAMTS13 Thrombin is regulated by antithrombin and activated Protein C Fibrin is cleaved by plasmin in degradation products - think D Dimer

485222

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Secondary disorders are largely categorised by the following Sx and Sgx

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Explanation

Primary - epistaxis, petechiae, bruising and menorrhagia; plt, vwf and vessel wall defects Secondary - soft tissue bleeds and bleeding into joints; coagulation factors and fibrinogen defects

485224

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What does the PT concern?

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Explanation

PT concerns the extrinsic pathway aPTT concerns the intrinsic pathway. Both concern X, V II (common pathway) Normal PT is 11-14s Normal aPTT is 13-24s

485228

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Haemophilia is classically presented by which symptom?

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Explanation

Haemophilia is PAINFUL bleeding, coagulation pathway disorder, mild provoked bleeding if factor missing is <5%; severe, spontaneous bleeding if <1% Rx is give factor concentrates. Not much else can be done at present

485230

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What is associated with severe vWD?

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Explanation

vWD is commonest genetic disorder. Normally mediates plt adhesion and stabilises FVII. Mild: only one defect. Mild Sx and slightly reduced FVIII but not obvious bleeding Rx Tranxamic acid (anti fibrinolytic), DDAVP/desmopression, vWF/FVII concentrate

485239

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Biliary obstruction can lead to

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Explanation

Synthesis - Liver, vit K (2.7.9.10) and warfarin Function - heparin, DOACs, aspirin, antiplt Dilution - massive transfusion, dilution by fluid, cardiac bypass Consumption - DIC, TTP in sepsis

485242

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A patient has liver disease, with increased PT and aPTT, reduced Plt and fibrinogen. You are called to see them and find them stable. What Mx should you take?

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Explanation

If the Pt is stable, no Rx is needed If Pt is decompensated or BLEEDING, replace EVERYTHING - txa, fibrinogen, vit K, FFP.

485243

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Which of these conditions is associated with ADAMTS13 deficiency due to antibody presence?

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Explanation

DIC has increased APTT and PT and DDIMER. Categorised by massive bleeding and multiorgan failure. Rx is full supportive care, correct the stimulus (e.g sepsis) and aggressively restore homeostasis - give PLT, FFP and fibrinogen conc. TTP has anti-ADAMTS13 antibodies leading to reduced vWF proteolysis leading to increased mw multimers (hyaline bodies). Agglutinate in high shear vessels with mechanical haemolysis. BLEEDING, often neuro sx, jaundice, pallor and fatigue. RED CELL fragments on blood film. PT and aPTT are usually NORMAL. TROPONIN wil be raised.. Rx is EXCHANGE everything via plasma exchange - plasmaphoresis.

485244

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Thassaemias are associated with which type of cell?

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Explanation

Target cells are thalassaemias Reed-sternberg are HL SCFs are SCD

485245

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What is the acute and long term mx of DVT/PE?

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Explanation

Immediate management is NOT thrombolysis (think stroke/STEMI). Anticoag with heparin/clexane/LMWH followed by warfarin/DOAC long term. No role for aspirin.

485246

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Which of these is not a pro-thrombotic marker?

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Explanation

ADAMTS13 deficiency is associated with thrombocytopaenia in TTP FV Leden is caused by reduced activation of FV by Protein C, increased VTE risk by 4x APLS (antiphospholipid syndrome) is caused by antibodies, either anti CL, antiB2G1 or Lupusanticoag (which may also increase aPTT paradoxically); associated with livedo reticularis, pregnancy loss and thrombocytopaenia. Long term anticoagulaion required if thrombotic events recur. Give DMARDs if underlying SLE.

485247

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Which of these is NOT an anti-coagulant?

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Explanation

Anti coagulants should be used for VTE or low pressure vessel thrombosis. Warfarin/DOACs for valvular clots, enoxaparin for prophylaxis Anti-platelets should be used in arterial thrombosis.

485249

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Which of these anti-coagulants has the longest t1/2?

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Explanation

Warfarin has a t1/2 of 36 hours. Reversed by Vitamine K and Factor concentrate if severe bleeding. Stop for 5 days if low risk of VTE prior to surgery, restart one day after. If HIGH risk, need to bridge with LMWH, or UF if very high risk of bleeding. LMWH has t1/2 of 4-6 hours. Stop if bleeding and give protamine IV. Close INR control of 1.5-2.0 wanted (PT) Last dose for bridging 24 hours before surgery UF can be given 2-4 hours before surgery as a last dose in high risk patients, as t1/2 is only 1-2 hours. Rivaroxaban is a Xa inhibitor affecting the extrinsic pathway. Stop 24 hours if normal risk, 48-72 hours before if high risk of bleeding, restart either 6-12 hours after or 48hrs after depending on risk of bleeding. No monitoring routinely, may increase PT/aPTT. Caution in renal impairment. STOP if bleeding and consider specialist products.

Coagulopathies

Question 1 of 1

Time Left

Primary homeostasis consists of activation of what?

Select the correct answer(s).

(0/0)

Explanation

Secondary disorders are largely categorised by the following Sx and Sgx

Select the correct answer(s).

(0/0)

Explanation

What does the PT concern?

Select the correct answer(s).

(0/0)

Explanation

Haemophilia is classically presented by which symptom?

Select the correct answer(s).

(0/0)

Explanation

What is associated with severe vWD?

Select the correct answer(s).

(0/0)

Explanation

Biliary obstruction can lead to

Select the correct answer(s).

(0/0)

Explanation

A patient has liver disease, with increased PT and aPTT, reduced Plt and fibrinogen. You are called to see them and find them stable. What Mx should you take?

Select the correct answer(s).

(0/0)

Explanation

Which of these conditions is associated with ADAMTS13 deficiency due to antibody presence?

Select the correct answer(s).

(0/0)

Explanation

Thassaemias are associated with which type of cell?

Select the correct answer(s).

(0/0)

Explanation

What is the acute and long term mx of DVT/PE?

Select the correct answer(s).

(0/0)

Explanation

Which of these is not a pro-thrombotic marker?

Select the correct answer(s).

(0/0)

Explanation

Which of these is NOT an anti-coagulant?

Select the correct answer(s).

(0/0)

Explanation

Which of these anti-coagulants has the longest t1/2?

Select the correct answer(s).

(0/0)

Explanation

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