Bleeding Disorders Revision PDF

Bleeding disorders Classification of bleeding disorders Haemostasis = Disorders of blood vessels Normal physiological Very rare (unlikely to see in patients...

Bleeding disorders Classification of bleeding disorders Haemostasis = Disorders of blood vessels Normal physiological Very rare (unlikely to see in patients) response that prevents o Inherited; significant blood loss after Connective tissue disorders vascular injury. Hereditary haemorrhagic telangiectasia (HHT) (Vasoconstriction, platelet o Acquired; plug formation, coagulation) Severe infections: Meningococcal, typhoid Drugs: Sulphonamides, diuretics Other: Vit C deficiency, senile purpura Disorders of platelets Important for primary haemostasis. o Inherited; Connective tissue disorders Idiopathic Thrombocytopenia Purpura (ITP) o Acquired; Acquired Chemotherapy Rare autoimmune blood disorder. Radiotherapy Immune system attacks body’s own platelets. Other notes… o Acute; Post-virally (chickenpox) Thrombocytopenia More common. Acquired o Chronic; Reduced platelet count. Any age. Decreased/failure of platelet production. Symptoms can last 6months-lifetime. Destruction of circulation platelets. Disorders of platelet function. Renal disease Acquired Liver disease Impaired platelet production and adhesion. Aquired Decrease in platelet factor III (coagulation cascade). Key groups of patient to be aware of Vasodilation. Increased bleeding risk (liver plays key Haemodialysis patients taking heparin (chronic renal role in haemostasis) failure) Reduced platelet numbers. Need to be aware of signs and symptoms, especially Reduced coagulation factors. along with poorly controlled diabetes or hypertension. Alcohol can prolong bleeding time produced by aspirin and NSAIDs. Disorders of coagulation Von Willebrand disease (vWF) Important for secondary haemostasis. More common than haemophilia. o Acquired; 1% of population affected. Liver disease - reduced production of coagulation Males and females. factors. Deficiency/dysfunction of von Willebrand factor. Haematological malignancy (blood cancer) - vWF carrier for factor VIII (8), controls platelets impaired coagulation. adhesion and aggregation. o Inherited; Mild, moderate and severe. Other notes… Nosebleeds, bruising. Haemophilia A Haemophilia B Inherited Inherited Most common. Less common. Deficiency in clotting factor VIII (8) Christmas disease Males affects. Deficiency in clotting factory IX (9) Females are carriers. Males affects. Mild, moderate or severe (depending on how Females are carries. much factor VIII is missing). Bleeding that does not stop. Bleeding that does not stop. Skin bruises easily Skin bruises easily Bleeding gums Bleeding gums Nosebleeds Nosebleeds Pain and stiffness around joints. Pain and stiffness around joints. Antiplatelet drugs Interfere with platelet aggregation by inhibiting steps of platelets activation required for primary haemostasis. Increased risk of bleeding. Examples; Indications; Aspirin. Heart disease Clopidogrel Myocardial infarction Dipyridamole Atrial fibrilation Ticagrelor Coronary stent placement Prasugrel. Renal transplant Anticoagulant drugs Inhibit production or activity of factors required of coagulation cascade, impair secondary haemostasis. Increased risk of bleeding. Examples; Indications; Warfarin. Stroke DOACs - Rivaroxaban, Apixaban, Edoxaban. Deep vein thrombosis Injectable - Dalteparin, Enoxaparin, Tinzaparin. Pulmonary embolism Heparin. Atrial fibrillation/heart valve surgery. Warfarin Requires frequent monitoring. Blood test that measures how long it takes your blood to form a clot. INR - International Normalised Ratio. Target INR can range from 2.5-3.5 Slowly absorbed - affect begins 8-12hours, persists for 72hours. Sensitivity to drug interactions (antibiotics, antifungal, NSAIDs) Sensitivity to diet (green leafy vegetables, pomegranate juice, alcohol) Drugs and diet can either increase risk of bleeding or clotting. Direct oral anticoagulant drugs (DOACs) Less limitations than warfarin. Management is easier, more effective and safer. Rapid onset 1-4hours No need for routine monitoring. Fewer diet and drug interactions. Rivaroxaban, Apixaban, Edoxaban — inhibit factor Xa (10a) coagulation cascade. Dabigatran — direct inhibitor of coagulation factor thrombin. Heparin Mainly used IV in hospitals or subcutaneous injection. Less commonly used. High increased bleeding risk. Short half life 1-2hours. Used in IV dialysis to prevent thrombosis in pump (kidney disease/failure) Prevent thrombosis after myocardial infarct. Minihep reduced deep vein thrombosis in pregnant women or post surgery.