Week 9 - Bleeding Disorders

Question 1

What is a bleeding disorder?

Answer 1

A condition where haemostasis fails, leading to abnormal bleeding due to platelet defects, coagulation factor deficiencies, or vessel wall abnormalities.

Question 2

List the 3 major mechanisms of bleeding disorders with examples.

Answer 2

Platelet abnormalities — e.g. thrombocytopenia

Coagulation factor deficiencies — e.g. VWD, haemophilia

Vessel wall defects — e.g. Ehlers-Danlos, scurvy

Question 3

Define thrombocytopenia (numeric definition).

Answer 3

Platelet count <150,000/μL.

Question 4

List 3 causes of decreased platelet production.

Answer 4

Leukaemia, chemotherapy/radiotherapy, aplastic anaemia.

Question 5

List 2 causes of increased platelet destruction/sequestration.

Answer 5

Drug-induced immune destruction (quinine/heparin), splenic sequestration.

Question 6

Most characteristic bleeding pattern in platelet disorders?

Answer 6

Mucocutaneous bleeding (petechiae, purpura, gum/nose bleeds).

Question 7

What is Von Willebrand Disease (VWD)?

Answer 7

The most common hereditary bleeding disorder due to reduced or dysfunctional vWF.

Question 8

What role does vWF play in haemostasis?

Answer 8

Anchors platelets to exposed collagen & carries Factor VIII in blood.

Question 9

Describe Type 1 VWD.

Answer 9

Partial quantitative deficiency of vWF; often autosomal dominant; mild.

Question 10

Describe Type 2 VWD.

Answer 10

Qualitative defect — vWF present but dysfunctional.

Question 11

Describe Type 3 VWD.

Answer 11

Near-absent vWF, very low FVIII; severe haemophilia-like bleeding.

Question 12

Clinical features of VWD.

Answer 12

Easy bruising, heavy menses, epistaxis, oral bleeding, prolonged bleeding after trauma.

Question 13

Treatment options for VWD.

Answer 13

Desmopressin (↑vWF release), vWF/FVIII concentrates, antifibrinolytics; avoid aspirin.

Question 14

What is haemophilia and what are the two types?

Answer 14

X-linked recessive clotting factor deficiency disorders:
Haemophilia A = FVIII deficiency
Haemophilia B = FIX deficiency

Question 15

Why does haemophilia affect males more than females?

Answer 15

X-linked recessive — males have only one X chromosome.

Question 16

What is the typical bleeding pattern of haemophilia.

Answer 16

Deep tissue and joint bleeding (haemarthrosis), GI bleeds, spontaneous bleeds after minor trauma.

Question 17

What is the long-term joint complication of haemophilia.

Answer 17

Chronic synovial inflammation → fibrosis and contractures.

Question 18

What is some treatment of haemophilia?

Answer 18

Avoid trauma/aspirin; replace missing factor VIII or IX; desmopressin for mild type A; antifibrinolytics.

Question 19

Is Disseminated Intravascular Coagulation (DIC) a primary disease?

Answer 19

No — it is an acquired coagulopathy secondary to other conditions.

Question 20

List 3 conditions associated with DIC.

Answer 20

Obstetric complications, cancers/leukaemia, sepsis, trauma, shock, transfusion reactions.

Question 21

Briefly describe the pathophysiology of DIC.

Answer 21

Widespread coagulation → microthrombi form → platelets & clotting factors consumed → secondary bleeding + organ dysfunction.

Question 22

Difference between acute and chronic DIC.

Answer 22

Acute DIC — bleeding dominant (e.g. obstetric, trauma)
Chronic DIC — thrombosis dominant (e.g. cancer)

Question 23

Clinical features of DIC.

Answer 23

Bleeding from ≥3 sites (GI/GU, mucosa, brain, wounds/IV sites), petechiae, or thrombotic events depending on phase.

Question 24

Primary strategy in managing DIC.

Answer 24

Treat underlying cause, replace clotting components, prevent further activation of coagulation.