Term
| name some drugs that can induce thrombocytopenia |
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Definition
Heparin
NSAIDs
furosemide
penicillin]rifampicin
anticonvulsants: valproate
quinine
abciximab |
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Term
| congenital causes of thrombocytopenia (platelets <150) |
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Definition
megakaryocytic hypoplasia
thrombocytopenia absence raddi (TAR syndrome)
fanconis anemia |
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Term
| bleeding pattern in thrombocytopenia |
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Definition
epistatis
bleeding gums
spontaneous bruising
bleeding after surgery
bleeding after aspirin
PPH
metromenorrhagia
in later stages: Haemoptysis, haematemesis, haematuria, haematochezia |
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Term
| bleeding pattern in thrombocytopenia |
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Definition
epistatis
bleeding gums
spontaneous bruising
bleeding after surgery
bleeding after aspirin
PPH
metromenorrhagia
in later stages: Haemoptysis, haematemesis, haematuria, haematochezia |
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Term
| what is Wiskott-Aldrich syndrome? |
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Definition
there is B and T cell dysfunction leading to immunodeficiency
X link recessive
mutation in WASP gene
features: low IgM levels, recurrent chest infections, eczema, thrombocytopenia |
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Term
In ITP antibodies are directed against which glycoprotein?
what is evans syndrome? |
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Definition
IIb/IIIa or Ib-V-IX complex
Evan's syndrome: ITP and AIHA |
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Term
| what is formed from the supernant of FFP and is rich in Factor 8 and fibrinogen? |
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Definition
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Term
| when should you consider transfusing platelets? |
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Definition
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Term
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Definition
rx underlying condition first e.g ABx if infection.
if they have prolong PT and aPTT then FFP may be helpful |
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Term
| in cases of DIC where thrombosis predominates what could you use? |
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Definition
| unfractionated heparin due to its short half life. |
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Term
| which is the most common inherited thrombophillia? |
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Definition
Factor V Leiden. this is known as protein C resistance because the mutation in factor V makes it resistant to being broken down by Protein c.
present in 5% population
if heterozygous 5 fold increase risk for DVT/PE
if homozygous risk increase 50 fold.
thormbotic risk increased in pregnancy and those on oestrogen's. |
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Term
| what happens in prothrombin gene mutation? |
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Definition
| there is down regulation of fibrinolysis so there is increased risk of thrombosis |
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Term
| what is the heterozygous and homozygous consequence of being protein C and S deficient? |
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Definition
heterozygous -risk thrombosis
homozygous - neonatal purpura fulminas that is fatal if unrx |
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Term
| antithrombin deficiency characteristics and consequences of being heterozygous and homozygous |
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Definition
antithrombin is a co factor of heparin and inhibits heparin.
if you are heterozygous your risk for thrombosis is greater than if you were deficient in protein C or S
if you are homozygous then it is incompatible with life. |
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Term
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Definition
deficiency in factor VIII
x linked recessive
heamarthroses, hematoma, prolonged bleeding post surgery or trauma
blood tests show prolonged aPTT but PT, TT and bleeding time normal
Up to 10-15% of patients with haemophilia A develop antibodies to factor VIII treatment |
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Term
| x linked condition where the person is deficient in factor IX. what is this disease also known as? |
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Definition
Hemophilia B
Christmas disease
prolonged aPTT
normal bleeding time. thrombin time and PT |
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Term
| in which haemophilia do pts develop antibodies to their treatment? |
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Definition
hemophilia A
antibodies to factor VIII |
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Term
| out of A and B which haemophilia is the least severe? |
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Definition
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Term
what signs do platelet deficiencies cause
what signs would you see in clotting factor deficiencies? |
|
Definition
platelet deficiencies cause petichael haemorrhages and bruising
clotting factor deficiencies cause hematomas and haemarthroses |
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Term
| what injections should you not give to someone with haemophilia? |
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Definition
| IM injections as they can produce a painful haematoma |
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Term
| management of haemophilia B? |
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Definition
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Term
warfarin - which factors does it inhibit?
indications for warfarin and target INR |
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Definition
10, 9, 7 ,2 protein C
AF - 2-3 target 2.5
VTE -2.5 if recurrent 3.5
mechanical heart valves 3.5 |
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Term
| factors that can potentiate warfarin |
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Definition
cranberry juice
p450 inhibitors: amiodarone, ciprofloxacin
NSAIDs |
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|
Term
|
Definition
haemorrhage
teratogenic
skin necrosis
purple toes
INR is PT - extrinsic coagulation pathway |
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Term
| both unfractionated and LMWH activate antithrombin III but then what other factors do these act on? |
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Definition
UFH - factor IXa, Xa, XIa, XIIa
LMWH just Xa |
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|
Term
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Definition
given SC
long duration of action
SE: bleeding, HIT, hyperkalemia, osteoporosis
overdose: protamine sulphate |
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|
Term
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Definition
given IV
short duration of action so good in renal failure
SE: bleeding, HIT, hyperkalemia, osteoporosis
monitoring? aPTT - measures intrinsic pathway |
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Term
| in HIT antibodies are produced against which two things? |
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Definition
Heparin and platelet factor 4.
it does not occur until 5-10 days of treatment. |
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Term
| which NOAC is a direct thrombin inhibitor |
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Definition
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Term
| which NOACs inhibit factor Xa? |
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Definition
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Term
| which medications does aspirin potentiate? |
|
Definition
oral hypoglycemics
warfarin
steroids |
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Term
| in acute haemorrhage and chronic anemia what would you transfer? |
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Definition
rbc
but the decision to give a transfusion should be reached both on the patient's clinical situation and on laboratory findings, not on Hb alone. |
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Term
| transfusion is not considered until Hb is <7. what if the pt had unstable angina or MI? |
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Definition
| consider transfusion when Hb < 10 |
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Term
| a single unit of blood is expected to raise the Hb by how much? |
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Definition
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Term
| a neutropenic pt has neutrophils at < 0.5 what would you consider giving? |
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Definition
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Term
| what would you give if the to had multiple coagulation deficiencies, major trauma, DIC, |
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Definition
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Term
| indications for using FFP |
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Definition
urgent reversal of warfarin
DIC
multiple coagulation factor deficiencies in liver disease
massive transfusion protocol
obstetric emergencies
GI or surgical haemorrhage |
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Term
| what would you give to someone with vWD or hypofibrineamia? |
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Definition
Cryoprecipitate
made from thawing FFP |
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Term
| SE of receiving a plasma transfusion? |
|
Definition
fever
chills
bronchospasm
ARDS |
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Term
| what could you give in immune thrombocytopenia, GBS, and AIHA? |
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Definition
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Term
| acute complications of blood transfusion |
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Definition
infection: HIV, CJD, hepatitis
allergic reaction
haemolytic reaction
anapylactic reaction
transfusion associated circulatory overload
urticarial reaction |
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Term
| late complications of blood transfusion |
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Definition
delayed haemolytic reaction
iron overload
transfusion associated graft versus host disease. |
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Term
| what other medication should you not give with azathiprine. why? |
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Definition
| Allopurinol. it is a xanthine inhibitor and if the 2 are given together it can result in azathioprine toxicity. |
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Term
MOA of ciclosporin
what is is used for?
main SE? |
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Definition
Calcineurin inhibitor
role in reducing organ rejection and marrow transplant
SE: dose related nephrotoxicity. do blood levels
other SE: gum hyperplasia, tremor, increase BP, confusion, lymphoma - avoid sunbathing. |
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Term
| define pyrexia of unknown origin (PUO) |
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Definition
| temp of >38.3 for >3 weeks with no obvious source despite appropriate investigations |
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