Thrombotic disorders

Questions and Answers

What is the first step in the process of normal haemostasis following injury to a blood vessel?

Coagulation

Platelet activation

Platelet aggregation

Collagen exposed (correct)

Which physiological process follows collagen exposure during normal haemostasis?

Platelet activation (correct)

Coagulation

Platelet secretion

Platelet aggregation

What primarily causes arterial thrombosis?

Venous stasis

Inappropriate activation of platelets (correct)

Clotting factor deficiency

Reduced blood flow

What occurs during the coagulation process related to thrombus formation?

Fibrin strands trap cells Signup and view all the answers

Which condition is a consequence of venous thrombosis?

Deep Vein Thrombosis Signup and view all the answers

What symptom is commonly associated with peripheral arterial disease (PAD)?

Pain during physical activity Signup and view all the answers

What is a recognized sign of ischaemic stroke resulting from arterial thrombosis?

Sudden confusion Signup and view all the answers

Which of the following is NOT a step in normal haemostasis?

Arterial dilation Signup and view all the answers

What is one common diagnostic method used to confirm deep vein thrombosis (DVT)?

Venogram Signup and view all the answers

What is a common prevention measure for deep vein thrombosis (DVT)?

Wearing support stockings Signup and view all the answers

Which condition is commonly associated with an increased risk of developing thrombophilia?

Obesity Signup and view all the answers

What is the risk of fatal pulmonary embolism (PE) associated with deep vein thrombosis (DVT)?

3% Signup and view all the answers

What is the inheritance pattern for Anti-thrombin III Deficiency?

Autosomal dominant Signup and view all the answers

What symptom is commonly associated with arterial thrombosis in the case of a myocardial infarction (MI)?

Chest pain radiating to the back Signup and view all the answers

What is the increased risk of venous thrombosis (VT) for individuals with Protein C Deficiency?

Which diagnostic method is NOT typically used to confirm arterial thrombosis in myocardial infarction (MI)?

Blood glucose testing Signup and view all the answers

In which condition is the level of Protein S known to drop?

Pregnancy Signup and view all the answers

What treatment option is least appropriate for myocardial infarction related to arterial thrombosis?

Lifestyle modification Signup and view all the answers

What percentage of individuals with Anti-thrombin III Deficiency are likely to develop a clot in their lifetime?

50% Signup and view all the answers

What is the prevalence of Protein S Deficiency in the population?

1:3500 Signup and view all the answers

Which sign is NOT indicative of an ischemic stroke?

Fever Signup and view all the answers

What is a common prognosis related to an ischemic stroke?

Permanent deficits after 12 months Signup and view all the answers

What major complication occurs in 40% of cases associated with venous thrombosis?

Post-thrombotic syndrome Signup and view all the answers

Which component is NOT part of Virchow's Triad contributing to venous thrombosis?

Dehydration Signup and view all the answers

Which symptom is specific to deep vein thrombosis (DVT)?

Pain in the leg Signup and view all the answers

Emboli from venous thrombi typically travel to which location?

The lungs Signup and view all the answers

What is a major risk factor for the development of deep vein thrombosis (DVT)?

Prolonged immobility Signup and view all the answers

What percentage of individuals die before reaching a hospital after a first myocardial infarction (MI)?

23% Signup and view all the answers

What conditions are associated with decreased levels of Protein S?

Pregnancy, contraceptive pill use, and hormone replacement therapy Signup and view all the answers

What is the consequence of estrogen therapy on tissue plasminogen activator (tPA) levels?

It decreases tPA levels. Signup and view all the answers

What caution should be observed before initiating estrogen therapy?

Screen for other thrombophilic risk factors. Signup and view all the answers

Which of the following is not a name used for Antiphospholipid Antibody Syndrome?

Vascular thrombosis syndrome Signup and view all the answers

What percentage of healthy individuals are known to have antiphospholipid antibodies?

5% Signup and view all the answers

Which complication is associated with Antiphospholipid Antibody Syndrome in vivo?

Increased arterial and venous thrombosis Signup and view all the answers

What condition is characterized by a raised platelet count above 150-400 x 10^9/L?

Essential Thrombocytosis Signup and view all the answers

What is the primary defect in Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Defect in GPI-anchor formation Signup and view all the answers

Which of the following is not classified as a myeloproliferative neoplasm?

Lupus anticoagulant syndrome Signup and view all the answers

What effect does Paroxysmal Nocturnal Hemoglobinuria have on urine color in the morning?

Urine appears darker due to concentration. Signup and view all the answers

What is the increased risk of venous thrombosis (VT) for heterozygotes of Factor V Leiden?

In which circumstance is activated protein C resistance (APCR) less likely to occur?

Use of anticoagulants Signup and view all the answers

How does the Prothrombin G20210A allele affect prothrombin levels?

Leads to elevated prothrombin levels Signup and view all the answers

What is the inheritance pattern of Dysfibrinogenemia?

Autosomal dominant Signup and view all the answers

Which acquired risk factor increases the risk of thrombosis due to age-related changes?

Reduced activity levels leading to stasis Signup and view all the answers

What is the strongest risk factor for acquired thrombophilia?

Previous thrombosis Signup and view all the answers

How does estrogen therapy specifically affect levels of protein S?

Decreases protein S levels Signup and view all the answers

Which demographic groups are most prone to acquired thrombophilia?

Elderly and obese individuals Signup and view all the answers

Which of the following conditions is associated with compression of the left common iliac vein?

Compression syndrome Signup and view all the answers

How does malignancy contribute to the risk of acquired thrombophilia?

Expresses tissue factor (TF) Signup and view all the answers

Study Notes

Normal Haemostasis Stages

Injury to blood vessel exposes collagen, initiating haemostasis.
Platelet adhesion occurs as platelets bind to exposed collagen.
Platelet activation follows, triggering a cascade of responses.
Activated platelets secrete substances to recruit more platelets.
Platelet aggregation leads to the formation of a platelet plug.
Fibrin strands form to trap cells, creating a stable clot or thrombus.
Coagulation occurs, solidifying the clot structure.

Arterial Thrombosis

Major causes include inappropriate platelet activation due to:
- Atherosclerosis and plaque rupture exposing thrombogenic lipids.
Often results in conditions such as:
- Myocardial Infarction (MI)
- Ischaemic Stroke
- Peripheral Arterial Disease (PAD)
Symptoms for each include:
- Ischaemic Stroke: Sudden weakness, numbness, trouble speaking, and confusion.
- PAD: Leg pain or cramping during activity, sores that don't heal.
- MI: Chest pain radiating to arms/neck, shortness of breath, nausea, and sweating.

Diagnosis and Prognosis of MI

Diagnosed with ECG, elevated troponin, and creatine kinase levels.
Prognosis shows high mortality rates:
- 23% die before reaching the hospital,
- 13% during hospital admission,
- 10% within the first year after discharge.

Venous Thrombosis

Common causes include:
- Immobility (e.g., bed rest, long flights)
- Prolonged postoperative recovery
Symptoms include leg pain, swelling, redness, and heat.
Embolisms typically travel to lungs causing pulmonary embolism (PE).

Diagnosis and Treatment of DVT

Diagnosis via ultrasound, venogram, and elevated D-dimers.
Treatment involves anticoagulation and thrombolytic therapy.
Prevention methods include physical activity and support stockings.

Thrombophilia Overview

Increased long-term risk of venous thromboembolism (VTE).
Can be inherited (e.g., Antithrombin deficiency) or acquired (e.g., immobilization).
Virchow's Triad components: Stasis, Endothelial damage, Hypercoagulability.

Inherited Disorders in Thrombophilia

Antithrombin III Deficiency: Autosomal dominant, high clot risk (50% lifetime).
Protein C Deficiency: Autosomal variation, 10-15 times increased risk of VT.
Protein S Deficiency: Variability in function, 10 times increased risk of VT.

Risk Factors and Conditions

Factor V Leiden: Increased risk for homozygotes (80 times).
Prothrombin G20210A allele: Elevated prothrombin levels, 2-3 times increased risk.
Essential Thrombocytosis: Elevated platelet counts leading to bleeding or thrombosis.

Acquired Thrombophilia Drivers

Previous thrombosis increases risk by 5 times; older adults and obese individuals are more affected.
Major surgeries elevate risk due to stasis and activity reduction.
Hormonal factors (e.g., oral contraceptives) increase clotting factor levels and risk.

Specific Conditions

Antiphospholipid Antibody Syndrome: Linked to increased arterial and venous thrombosis.
Paroxysmal Nocturnal Hemoglobinuria: Lysis of RBCs with lifelong risk of thrombotic events.
Myeloproliferative Neoplasms: Includes Polycythemia Vera with increased RBC production.

Summary on Thrombophilia

Inherited Factors: Antithrombin, Protein C, Protein S deficiencies, Factor V Leiden, and more.
Acquired Factors: Age, immobilization, surgery, malignancy, and hormonal therapies continue to increase VTE risk.

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Description

Explore the intricate steps of normal haemostasis following blood vessel injury. This quiz covers the sequence from collagen exposure to the formation of a stable clot, highlighting the roles of platelets and coagulation in the process.