Subject: PATHOPHYSIOLOGY

Place: Department of General and Experimental Pathology, room 371

Division: FACULTY OF MEDICINE

YEAR: 3

CLASS no: 8

Disorders of hemostasis

Goal: to explain etiology, pathogenesis and consequences of selected disorders of hemostasis

Time: 4 hours

Didactic tools: multimedia presentation

Before the classes students should revise physiology of blood coagulation and fibrinolysis,
as well as laboratory tests of hemostasis (platelet count, BT, aPPT, PT, TT, D-dimers).

Topics:

Mechanisms of hemostasis.
Disorders of hemostasis:

Etiology, pathogenesis, clinical manifestations and consequences of:
- vascular bleeding disorders
- qualitative and quantitative platelet bleeding disorders
- coagulation bleeding disorders
Hemostatic alterations in liver failure.

Etiology, pathogenesis, clinical manifestations and consequences of thrombosis.
Hypercoagulability states: due to increased platelet function, due to increased clotting activity.

Etiology, pathogenesis, clinical manifestations and consequences of disseminated intravascular coagulation (DIC).

References:

Porth's Pathophysiology: Concepts of Altered Health States - Tommie L Norris; Wolters Kluwer; 10^th Edition, International, (November 3, 2018), chapter 22.
Color Atlas of Pathophysiology - Stefan Silbernagl, Florian Lang,  Thieme; 3^rd Edition, 2016.

Diseases
Hereditary hemorrhagic telangiectasia (HHT)
Henoch-Schönlein purpura
Immune/Idiopathic thrombocytopenic purpura (ITP)
Thrombotic Thrombocytopenic Purpura (TTP)
Hemolytic-Uremic Syndrome (HUS)
Heparin Induced Thrombocytopenia (HIT)
Bernard-Soulier Syndrome (BSS)
Glanzmann thrombasthenia
von Willebrand disease
Hemophilia A
Hemophilia B
Disseminated Intravascular Coagulation (DIC)
Thrombocytosis
Factor V Leiden
Protein C deficiency
Dysfibrinogenemia
Antiphospholipid syndrome

Problems

Clinical manifestations of impaired primary hemostasis.

Examples of diseases with impaired primary hemostasis.

Clinical manifestations of impaired secondary hemostasis.

Examples of diseases with impaired secondary hemostasis.

Examples of diseases with impaired primary and secondary hemostasis.

Causes of prolonged bleeding time (BT).

Cause of prolonged activated partial thromboplastin time (APTT).

Cause of prolonged prothrombin time (PT).

Causes of prolonged thrombin time (TT).

Cause of prolonged APTT and PT.

Causes of increased concentration of D-dimers.

Causes of platelet disorders.

Examples of platelet bleeding disorders: inborn, acquired.

Pathomechanisms (mechanisms) of thrombocytopenia.

Pathogenesis of ITP and pathomechanism of thrombocytopenia in its course.

Pathogenesis of HIT-2 and what are the pathomechanisms of thrombocytopenia in its course.

Pathogenesis of TTP and pathomechanism of thrombocytopenia in its course.

Pathogenesis of HUS and pathomechanism of thrombocytopenia in its course.

Pathomechanism of microangiopathic haemolytic anemia in TTP/HUS.

Causes of thrombocytopathy.
Impact of aspirin on platelets’ function.

Impaired platelets’ function in Bernard-Soulier syndrome.

Impaired platelets’ function in Glanzmann’s thrombasthenia.

Causes of inherited and acquired disorders of coagulation (coagulation bleeding disorders)

Pathogenesis of von Willebrand disease and pathomechanisms of bleeding in its course.

Pathogenesis of haemophilia A and pathomechanism of bleeding in its course.

Pathogenesis of haemophilia B and pathomechanism of bleeding in its course?

Causes of vitamin K deficiency.

Virchow’s triad

Pathogenesis of arterial thrombosis.

Pathogenesis of venous thrombosis.

Differences between arterial and venous thrombi.

Thrombocytosis.

Causes of increased platelet function.

Causes of increased clotting activity.

Prothrombotic mechanisms in hypercoagulability states.
Pathogenesis of DIC.
Pathomechanisms of bleeding in DIC.
Patomechanisms of thrombosis in DIC.