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Clinical Relevance of Hemostasis. David Lillicrap Dept Pathology & Molecular Medicine. The Hemostatic Balance. Bleeding. Clotting. Arterial Thrombosis. EASY BRUISING. How easy? Where are the bruises? How many bruises? How large are the bruises? How frequent?.

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clinical relevance of hemostasis

Clinical Relevance of Hemostasis

David Lillicrap

Dept Pathology & Molecular Medicine

slide2

The Hemostatic Balance

Bleeding

Clotting

easy bruising
EASY BRUISING

How easy?

Where are the bruises?

How many bruises?

How large are the bruises?

How frequent?

other mucocutaneous bleeding
OTHER MUCOCUTANEOUS BLEEDING

Epistaxis

How Frequent?

Duration of bleeding?

Both nostrils?

Gum Bleeding

other mucocutaneous bleeding7
Other Mucocutaneous Bleeding

Menorrhagia

Duration

Amount of bleeding

Pads/ Tampons

“Flooding”

Clots

Anemia/ Iron replacement

musculoskeletal bleeding
MUSCULOSKELETAL BLEEDING

Joint bleeds (hemarthroses)

Soft Tissue/Muscle Bleeds

slide9
GASTROINTESTINAL BLEEDING

GENITOURINARY BLEEDING

Beware intrinsic lesions

previous challenges to the hemostatic system
PREVIOUS CHALLENGES TO THE HEMOSTATIC SYSTEM

Surgery

Tonsillectomy

Wisdom teeth extraction

In contrast - minor abdominal surgery may be uneventful

family history
FAMILY HISTORY

X-Linked recessive: Hemophilias

Autosomal dominant: VWD

Autosomal recessive: Others

medication history
MEDICATION HISTORY

Anticoagulants

Coumadin

Heparin

Platelet Antagonists

medication history13
MEDICATION HISTORY

Platelet Antagonists

Aspirin

NSAIDS

Alcohol

Antihistamines

Beta blockers

Nitrates

Calcium blockers

acquired disorders of coagulation
ACQUIRED DISORDERS OF COAGULATION

Does the patient have symptoms or signs of liver disease?

Is there a reason why the patient should be vitamin K deficient?

Malnutrition

Biliary obstruction

Broad Spectrum antibiotics

acquired disorders of coagulation15
ACQUIRED DISORDERS OF COAGULATION

Does the patient have a co-existent

systemic disease?

Sepsis

Disseminated malignancy

Obstetric problems

Burns

Snake Bite

which one of the following proteins is not involved in platelet plug formation
Which one of the following proteins is NOT involved in platelet plug formation?
  • Von Willebrand Factor.
  • Collagen
  • Glycoprotein Ib
  • Prothrombin
which one of the following functions is not performed by von willebrand factor
Which one of the following functions is NOT performed by von Willebrand Factor?
  • Stabilization of FVIII in plasma.
  • Attachment of platelets to the subendothelium.
  • Promotion of platelet-platelet interaction.
  • Activation of Factor X.
slide20

FVIII - VWF

Stabilizing complex

in plasma

physiological protein based hemostasis is initiated by which one of the following phenomena
Physiological protein-based hemostasis is initiated by which one of the following phenomena?
  • Thrombin generation.
  • Fibrinogen binding to platelets.
  • Activation of FXI
  • Exposure of tissue factor to FVIIa
slide24

+ve

feedback

the prothrombin time pt coagulation test evaluates which one of the following hemostatic pathways
The prothrombin time (PT) coagulation test evaluates which one of the following hemostatic pathways?
  • The intrinsic pathway.
  • Conversion of fibrinogen to fibrin.
  • The extrinsic pathway.
  • Factor X activation.
slide26

Extrinsic Pathway

(prothrombin time - PT)

slide27
Which one of the following coagulation proteins is NOT evaluated by the Activated Partial Thromboplastin time (aPTT)?
  • Factor VII.
  • Factor VIII.
  • Factor XI.
  • Factor IX.
the thrombin clotting time measures which one of the following coagulation reactions
The thrombin clotting time measures which one of the following coagulation reactions?
  • Activation of Factor X.
  • Conversion of Prothrombin to thrombin.
  • Factor IX activation.
  • Conversion of fibrinogen to fibrin.
which one of the following coagulation proteins is not a serine protease enzyme
Which one of the following coagulation proteins is not a serine protease enzyme?
  • Factor X
  • Factor IX
  • Factor VIII
  • Factor XI
which one of the following proteins is not a natural anticoagulant
Which one of the following proteins is NOT a natural anticoagulant?
  • Protein C.
  • Protein S
  • Factor XII.
  • Antithrombin.