Bleeding disorders:

• Inherited:
  • vWF disease
  • Haemophilia A and B
• Acquired:
  • Vitamin K deficiency
  • liver disease - vitK deficiency, reduced synthesis, DIC, thrombocytopenia (hyposplenism), functional abnormalities
  • DIC (usually secondary to sepsis)
  • excessive fibrinolysis - occurs in certain malignancies, surgeries involving tumours of prostate, breast, apncreas, uterus (release of tissue plaminogen activators)
  • massive transfusion - fewer platelets and coagulation factors are found in stored blood
  • Inhibitors of coagulation - Factor VIII autoantibodies (haemophilia but also in SLE, elderly patients, malignancy, sometimes after childbirth)
  • Thrombocytopenia

Thrombotic events

Virchows triad - Endothelial injury, venous stasis, hypercoagulability

Hypercoagulation disorders

Common causes of hypercoagulability: CALM SHAPES

• protein C deficiency - Protein C is an Inhibitor of activated factor V and VIII
• Anti-phospholipid antibody syndrome
• factor V Leidin
• Malignancy - Brain tumours, APL, mucin secreting adenocarcinomas
• protein S deficiency - This is the co-factor with protein C
• Hemocystinemia (elevated in vit B12 and folate deficiency)
• Heparin induced thrombocytopenia (after the use of heparin, antibodies against platelets=platelet count drops)
• Antithrombin deficency
• Prothrombin G20210A (A mutation that increases activity of prothrombin)