Other Disorders

Liver Disease


Obstructive disease

- decreased absorption Vitamin K as it is fat soluble

- Vit K dependent factors affected

- II, VII, IX & X 

- raised INR


Hepatocellular Disease

- impairs synthesis of all coagulation proteins

- bleeding episodes treated with FFP or Cryoprecipitate


Vit K Deficiency


Occurs with impaired intake or malabsorption

- Inflammatory Bowel Disease

- blood contains no functional forms of II, VII, IX & X

- reversed in 1/7 of Vit K administration


Antiphospholipid Syndrome


Phospholipid antibodies

- Broad family of autoantibodies that target phospholipids

- can be either procoagulant or anticoagulant


Lupus anticoagulant antibodies 

- procoagulant

- associated with thromboembolic events rather than clinical bleeding


Antiphospholipid syndrome


Need 1 clinical and 1 laboratory for diagnosis



- Vascular thrombosis

- Catastrophic antiphospholipid syndrome

- Complications of pregnancy (spontaneous abortions / premature intra-uterine deaths)



- detected on 2 tests 6 weeks apart

- anticardiolipin antibodies

- lupus anticoagulant antibodies




Antiphospholipid antibodies is 1-5% in young adults

SLE : anticardiolipin & lupus anticoagulant – 15-30%




All patients with a first thrombotic episode should be screened for anticardiolipin & lupus anticoagulant antibodies




Antiphospholipid antibodies

- no thrombosis

- modify 2° risk factors if have antibodies

- aspirin is not protective against thrombosis


Antiphospholipid syndrome

- warfarin 2-2.9 decreases thrombosis rate






Platelet count < 50,000 x 10.6/L




1.  Defective production

- disturbane of bone marrow

- i.e. secondary to medication


2. Excessive destruction


Drug-Induced Thrombocytopaenia

- Quinine, Sulphonamides, Digoxin, Morphine & H2 antagonists

- drug binds to platelets & acts as Hapten

- form antigenic substances

- complement activation and Platelets lysis



- 2° AB- heparin-platelet complexes formed & cause platelet aggregation

- thrombocytopaenia from thrombosis

- rapidly reversed once heparin ceased

- should monitor platelet count in patients on heparin


Idiopathic Thrombocytopenic Purpura

- relatively common disorder


3. Excessive splenic pooling


4. Massive transfusion




Spontaneous bleeding if < 20,000

Post-traumatic bleed increased if < 100,000