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Bleeding_Disorders_and_Thromboembolic_Phenomena_Expanded_Lecture.pptx
- 1. Bleeding Disorders and ThromboembolicPhenomena Expanded lecture presentation
- 2. Lecture Objectives • Reviewnormal hemostasis • Understand bleeding disorders: classification and mechanisms • Discuss thromboembolic phenomena and pathophysiology • Outline diagnostic approaches • Review evidence-based management principles
- 3. Normal Hemostasis • Physiologicalprocess to prevent blood loss after vascular injury • Occurs in a tightly regulated sequence • Maintains blood fluidity while preventing hemorrhage
- 4. Phases of Hemostasis •Primary hemostasis • Secondary hemostasis • Clot stabilization and fibrinolysis
- 5. Primary Hemostasis • Vasoconstrictionat site of injury • Platelet adhesion via von Willebrand factor • Platelet activation and aggregation • Formation of platelet plug
- 6. Secondary Hemostasis • Activationof coagulation cascade • Intrinsic and extrinsic pathways • Common pathway leads to fibrin formation • Stabilization of platelet plug
- 7. Physiological Anticoagulant Systems • AntithrombinIII • Protein C and Protein S • Tissue factor pathway inhibitor (TFPI)
- 8. Bleeding Disorders –Definition • Conditions characterized by abnormal or excessive bleeding • May be inherited or acquired • Reflect defects in platelets, coagulation factors, or vessels
- 9. Classification of BleedingDisorders • Platelet disorders • Coagulation factor deficiencies • Vascular disorders • Consumptive coagulopathies
- 10. Platelet Disorders • Quantitativeplatelet disorders • Qualitative platelet disorders • Inherited or acquired causes
- 11. Quantitative Platelet Disorders •Thrombocytopenia • Bone marrow failure • Increased peripheral destruction • Splenic sequestration
- 12. Qualitative Platelet Disorders •Inherited platelet function disorders • Drug-induced dysfunction (e.g., aspirin, NSAIDs) • Uremia-related platelet dysfunction
- 13. Coagulation Factor Disorders •Inherited factor deficiencies • Acquired factor deficiencies • Autoantibodies against clotting factors
- 14. Hemophilia A andB • X-linked recessive disorders • Hemophilia A: Factor VIII deficiency • Hemophilia B: Factor IX deficiency • Characterized by deep tissue and joint bleeding
- 15. Von Willebrand Disease •Most common inherited bleeding disorder • Defect in platelet adhesion and factor VIII stability • Usually presents with mucocutaneous bleeding
- 16. Disseminated Intravascular Coagulation (DIC) •Systemic activation of coagulation • Consumption of platelets and clotting factors • Leads to bleeding and thrombosis simultaneously
- 17. Clinical Features ofBleeding Disorders • Mucocutaneous bleeding suggests platelet disorders • Deep tissue bleeding suggests factor deficiency • Hemarthrosis common in hemophilia • Prolonged post-surgical bleeding
- 18. Laboratory Evaluation –Bleeding • Full blood count and platelet count • Prothrombin time (PT) • Activated partial thromboplastin time (aPTT) • Specific factor assays
- 19. Management Principles –Bleeding Disorders • Treat underlying cause • Replace deficient factors • Platelet transfusion if indicated • Avoid drugs that worsen bleeding
- 20. Thromboembolic Phenomena – Definition •Pathological formation of intravascular clots • May obstruct blood flow locally or embolize • Major cause of morbidity and mortality
- 21. Types of Thrombosis •Venous thrombosis • Arterial thrombosis • Microvascular thrombosis
- 22. Virchow’s Triad • Endothelialinjury • Abnormal blood flow (stasis or turbulence) • Hypercoagulability
- 23. Venous Thromboembolism (VTE) •Deep vein thrombosis (DVT) • Pulmonary embolism (PE) • Often related to stasis and hypercoagulability
- 24. Arterial Thrombosis • Occursin high-flow systems • Associated with endothelial injury • Commonly causes stroke and myocardial infarction
- 25. Risk Factors forThromboembolism • Prolonged immobilization • Surgery and trauma • Malignancy • Pregnancy and estrogen therapy • Inherited thrombophilias
- 26. Inherited Thrombophilias • FactorV Leiden mutation • Prothrombin gene mutation • Protein C deficiency • Protein S deficiency • Antithrombin deficiency
- 27. Clinical Features – Thromboembolism •Limb swelling and pain (DVT) • Sudden dyspnea and chest pain (PE) • Neurological deficits (stroke) • Acute limb ischemia
- 28. Diagnostic Approach –Thrombosis • Clinical probability assessment • D-dimer testing • Compression ultrasonography • CT pulmonary angiography
- 29. Management – Thromboembolic Disorders •Anticoagulation therapy • Thrombolysis in selected cases • Mechanical thrombectomy or filters • Treatment of underlying risk factors
- 30. Anticoagulant Drugs • Unfractionatedheparin • Low molecular weight heparin • Warfarin • Direct oral anticoagulants (DOACs)
- 31. Prevention of Thromboembolism •Early mobilization • Mechanical prophylaxis • Pharmacological prophylaxis • Risk stratification in surgical patients
- 32. Summary and KeyTakeaways • Hemostasis requires a balance between bleeding and clotting • Bleeding disorders and thrombosis represent opposite ends of imbalance • Early diagnosis and targeted therapy improve outcomes • Prevention is critical in high-risk patients