Haemostasis Disorders - Essay Example

 Haemostasis Disorders – Case Study 1 1. The testing was done because the patient showed symptoms, medical history, and family history of a genetic blood disorder, specifically one related to clotting. The patient reports extensive bruising, unusual nosebleeds, and a family history of similar symptoms. Testing Factor VIII-related antigens and Factor VIIIc is therefore indicated because of their connection to blood clotting disorders, especially haemophilia. Similarly, bleeding time, prothombin time, and APTT are used as indicators of the clotting tendency of the blood of the patient and can be used to detect any abnormalities. Since platelets are the cause of blood clotting, it also makes sense that platelet function would be tested and a platelet count taken. Testing for vWF is indicated since the patient is showing signs and symptoms of von Willebrand disease. 2. The patient's test results continue to support a diagnosis of a clotting disorder. The prolonged bleeding time is indicative of a platelet function disorder, not a coagulation disorder such as hemophilia. Prothombin time is within the normal range, also indicating normal coagulation. This is also borne out by the presence of normal levels of Factor VIIIc and Factor VIII-related antigens, which rules out haemophilia completely. The patient has a normal platelet count but a reduced platelet function, indicating a platelet adhesion or aggregation disorder. Finally, the low levels of von Willebrand factor in the patient's blood confirm a diagnosis of von Willebrand disease, a hereditary condition which is indicated by the patient's personal medical history, her family history, and her blood tests. 3. As shown in the above question, the patient in this case study is suffering from von Willebrand disease, a disorder that affects platelet adhesion. Given the mild nature of the patient's symptoms and a reduced but not absent level of wWF, it is likely she has Type 1 vWD. Type 1 vWD requires very little in the way of regular treatment. The patient's heavy menstrual periods can be treated using a contraceptive pill or injection, which can reduce the frequency or duration of menstruation. If she requires surgery, a prophylactic treatment may be indicated to help with bleeding during and after the surgery. Case Study 2 The patient in this case study shows reduced levels of antithrombin III, meaning that he will have increased susceptibility to pulmonary embolism and deep vein thrombosis. Continued monitoring of this patient requires watching of antithrombin levels to ensure the warfarin treatment is successful. However, the patient also needs to be monitored for potential adverse effects from the warfarin. Regular checks of the patients INR are necessary to avoid haemorrhage and adjust dosage as indicated. Vitamin K intake levels should be carefully monitored to prevent interactions and also to monitor the patient's risk of osteoporosis-related fractures. Protein C levels should be monitored as well, in case of warfarin necrosis, unless the patient is also given heparin as a preventative. Case Study 3 1. The disease process in this patient has continued since the patient was young. Initial symptoms appeared in the childhood years, became acute, but then resolved. The patient likely developed a chronic form of the disease, where the symptoms disappeared for some years and then the patient relapsed. 2. The patient in this case study is showing lower than normal values for haemoglobin, haematocrit, MCV, serum sodium, serum potassium, and serum carotenoids, but prolonged prothombin time and APTT. The likely cause of the abnormal clotting results is a chronic anaemia, while the excessive faecal production is the likely cause of the slightly low potassium and sodium levels. 3. The patient is likely suffering from chronic pancreatitis. This can be diagnosed through the high faecal fat levels seen in the patient, the patient's stool description, and the abdominal swelling seen in the patient. The anaemia is the likely result of bleeding in and around the pancreas. The inflammation that is the primarily result of the pancreatitis leads to bleeding, which then results in anaemia. 4. Confirming a diagnosis of pancreatitis can be done with a blood test for the pancreatic enzymes amylase and lipase, however the blood tests are not always conclusive. An x-ray, CT scan, or ultrasound of the abdominal cavity may be necessary to visualize the swelling and calcification of the pancreas and any complications involving the gallbladder, liver, or connecting ducts. Case Study 4 There are many foods and beverages that can interfere with warfarin. Excessive alcohol use is one, but alcohol primarily elevates INR, rather than decreasing it. Foods that could decrease his INR would include those that are high in Vitamin K. Patients with a diet high in Vitamin K have been shown to need a higher dose of warfarin, because it prevents the warfarin from working properly. Case Study 5 1. The patient's prolonged prothombin time, low RBC, and low haemoglobin levels are all consistent with a diagnosis of disseminated intravascular coagulation. However, the patient's high platelet count, low APTT, high WBC, and high fibrinogen levels are all inconsistent with this diagnosis. 2. The patient is showing a prolonged prothombin time, a slightly low APTT, and a slightly elevated platelet count. She is also showing normal Factor V and Factor IX levels, low Factor VII and Factor X levels, and high Factor VIII levels. The reduced levels of Factor VII could result in abnormal clotting, as could the low levels of Factor X. The low levels of Factor X can probably be explained by the absorption of the factor by the fibroids. Her increased levels of Factor VIII, however, increase her chances of clotting and could result in the formation of a DVT or PE. These mixed factor results help to explain why the patient had mixed clotting results in regards to prothombin time versus APTT. 3. The increased fibrinolysis in the patient is likely due to the physical trauma of the failed pregnancy, which led to bleeding and anemia. The patient should be treated with antifibrinolytics in order to inhibit the process and avoid excess bleeding. The patient may also require blood transfusion in order to bring her RBC and blood pressure levels back to normal, depending on the severity of the bleeding. Case Study 6 1. The second set of tests was done because the patient was showing signs of anemia and a clotting disorder. Continuing to bleed from his incision sites and IV puncture sites could indicate a clotting abnormality, while the hypotension indicates internal bleeding, also likely related to a clotting disorder. Prudent medical treatment demands further testing in this case, especially since his test results were normal except for evidence of blood loss immediately following his injury. 2. The presence of E. coli in the patient's blood cultures, as well as the patients extremely low platelet count and fibrinogen levels, indicate that he is suffering from sepsis. His prolonged prothombin time and APTT also uphold this diagnosis. 3. The patient will need to be treated with appropriate antimicrobial therapy. For an E. coli infection likely contracted from the patient's bowel trauma, the proper course of treatment would be cephalosporin, metronidazole, carbapenem, moxiloxacin, or a beta-lactam inhibitor. The patient may also require surgery to clean out the abdominal cavity and prevent re-infection. Blood transfusion may be necessary depending on the severity of the hypotension and the amount of oxygen in the patient's bloodstream; however, transfusion is only necessary to maintain hemoglobin levels above 7 mg/dL. Read More