Veidlapa Nr. M-3 (8)

Study Course Description

Haemorrhagic Conditions and Thromboses

Main Study Course Information

Course Code

RHE_050

Branch of Science

Clinical medicine

ECTS

9.00

Target Audience

Medicine

LQF

Level 8

Study Course Implementer

Course Supervisor

Sandra Lejniece

Residency Speciality

Speciality

Hematologist

Supervisor of Medical Speciality

Sandra Lejniece

Contacts

About Study Course

Objective

To ensure acquisition and improvement of theoretical knowledge and practical skills in haemorrhagic conditions and thromboses in accordance with the requirements of the haematology specialty in order to prepare the doctor for certification in the haematology specialty.

Learning Outcomes

Knowledge

1.- Will know about laboratory methods for the diagnosis of changes in platelets and coagulation and the diagnosis of PARP inhibitors. - Will know about thrombophilia tests. - Will know about classification of haemorrhagic conditions and definition of vasopathies, causes, diagnosis, principles of treatment, prognosis. - Will know about thrombocytopenias, their pathogenesis, causes, clinic, laboratory diagnosis, their classification, diagnostic criteria, differential diagnosis, therapy. - Will know about immune thrombocytopenic purpura (ITP), its pathogenesis, causes, clinic, diagnosis, principles of treatment, indications for splenectomy. - Will know about haemophilia, its causes, pathogenesis, clinic, laboratory diagnosis, principles of therapy. - Will know about inhibitory forms of haemophilia. - Will know about acquired haemophilia. - Will know about Von Willebrand disease, its causes, pathogenesis, clinical picture, laboratory diagnosis, differential diagnosis. - Will know about congenital coagulation disorders. - Will know about acquired coagulation disorders and DIC syndrome. - Will know about arterial and venous thromboses.

Skills

1.- Will be able to diagnose platelet and coagulation changes; - Will be able to analyse thrombophilia tests; - Will be able to diagnose and treat thrombocytopenias, coagulopathies and vasopathies.

Competences

1.Diagnosis and treatment of thrombocytopathies, vasopathies, thrombocytopenias and coagulopathies.

Assessment

Individual work

Title	% from total grade	Grade
1. Individual work	-	-
1. Independently studies the literature related to the course topics; 2. Independently prepares for seminars.

Examination

Title	% from total grade	Grade
1. Examination	-	-
Mandatory attendance of seminars (100%) and performance of practical work (100%) in each study course.

Study Course Theme Plan

FULL-TIME

Part 1

Seminar

Modality	Location
-	-

Topics

Laboratory methods for the diagnosis of changes in platelets and coagulation. Inhibitor diagnosis (e.g. antiphospholipid antibodies). Thrombophilia tests.

Seminar

Modality	Location
-	-

Topics

Classification of haemorrhagic conditions. Vasopathies - definition, causes, diagnosis. Osler’s disease - causes, pathogenesis, clinical picture, diagnostic criteria, complications, principles of treatment, prognosis.

Seminar

Modality	Location
-	-

Topics

Thrombocytopenias - pathogenesis, causes, clinic, laboratory diagnosis, classification, diagnostic criteria, differential diagnosis, therapy. Immune thrombocytopenic purpura (ITP) - pathogenesis, causes, clinic, diagnosis, principles of treatment, indications for splenectomy.

Seminar

Modality	Location
-	-

Topics

Haemophilia - causes, pathogenesis, clinic, laboratory diagnosis, degrees of severity, principles of therapy, complications. Inhibitory forms of haemophilia. Acquired haemophilia. Von Willebrand disease - causes, pathogenesis, clinical picture, laboratory diagnosis, differential diagnosis, types of disease, treatment. Acquired Von Willebrand disease. Rare congenital coagulation disorders.

Seminar

Modality	Location
-	-

Topics

Acquired coagulation disorders. Bleeding in cases of liver and kidney diseases. Disseminated intravascular coagulation. Massive bleeding in childbirth, trauma and surgical operations. Bleeding as a complication of anticoagulant and antithrombotic therapy.

Seminar

Modality	Location
-	-

Topics

Mechanisms and risk factors of arterial and venous thrombosis. Congenital thrombophilia. Acquired thrombotic tendencies. Treatment and prevention of venous thromboembolism during pregnancy.

Total ECTS (Creditpoints):

9.00

Number of Residency Seminars:

Length (weeks):

Final Examination:

Residency exam (Theory and practice)

Bibliography

Required Reading

Middeldorp S. Inherited thrombophilia: a double-edged sword. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):1-9. doi: 10.1182/asheducation-2016.1.1. PMID: 27913455; PMCID: PMC6142488.

Trasca LF, Patrascu N, Bruja R, Munteanu O, Cirstoiu M, Vinereanu D. Therapeutic Implications of Inherited Thrombophilia in Pregnancy. Am J Ther. 2019 May/Jun;26(3):e364-e374. doi: 10.1097/MJT.0000000000000985. PMID: 30985485.

Campello E, Spiezia L, Adamo A, Simioni P. Thrombophilia, risk factors and prevention. Expert Rev Hematol. 2019 Mar;12(3):147-158. doi: 10.1080/17474086.2019.1583555. Epub 2019 Feb 26. PMID: 30773075.

Armstrong EM, Bellone JM, Hornsby LB, Treadway S, Phillippe HM. Acquired Thrombophilia. J Pharm Pract. 2014 Jun;27(3):234-42. doi: 10.1177/0897190014530424. Epub 2014 Apr 17. PMID: 24742931.

Montagnana M, Lippi G, Danese E. An Overview of Thrombophilia and Associated Laboratory Testing. Methods Mol Biol. 2017;1646:113-135. doi: 10.1007/978-1-4939-7196-1_9. PMID: 28804823.

van Vlijmen EF, Wiewel-Verschueren S, Monster TB, Meijer K. Combined oral contraceptives, thrombophilia and the risk of venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost. 2016 Jul;14(7):1393-403. doi: 10.1111/jth.13349. Epub 2016 Jun 16. PMID: 27121914.

Connors JM. Thrombophilia Testing and Venous Thrombosis. N Engl J Med. 2017 Sep 21;377(12):1177-1187. doi: 10.1056/NEJMra1700365. PMID: 28930509.

Nathwani AC. Gene therapy for hemophilia. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):1-8. doi: 10.1182/hematology.2019000007. PMID: 31808868; PMCID: PMC6913446.

Arruda VR, Doshi BS, Samelson-Jones BJ. Novel approaches to hemophilia therapy: successes and challenges. Blood. 2017 Nov 23;130(21):2251-2256. doi: 10.1182/blood-2017-08-742312. Epub 2017 Oct 10. Erratum in: Blood. 2018 Jun 28;131(26):2995. PMID: 29018078; PMCID: PMC5813735.

10.

Makris M, Oldenburg J, Mauser-Bunschoten EP, Peerlinck K, Castaman G, Fijnvandraat K; subcommittee on Factor VIII, Factor IX and Rare Bleeding Disorders. The definition, diagnosis and management of mild hemophilia A: communication from the SSC of the ISTH. J Thromb Haemost. 2018 Dec;16(12):2530-2533. doi: 10.1111/jth.14315. Epub 2018 Nov 15. PMID: 30430726

11.

Peters R, Harris T. Advances and innovations in haemophilia treatment. Nat Rev Drug Discov. 2018 Jul;17(7):493-508. doi: 10.1038/nrd.2018.70. Epub 2018 Jun 8. PMID: 29880919.

12.

Mingot-Castellano ME, Núñez R, Rodríguez-Martorell FJ. Acquired haemophilia: Epidemiology, clinical presentation, diagnosis and treatment. Med Clin (Barc). 2017 Apr 7;148(7):314-322. English, Spanish. doi: 10.1016/j.medcli.2016.11.030. Epub 2017 Jan 22. PMID: 28118963

13.

Calmette L, Clauser S. La maladie de Willebrand [Von Willebrand disease]. Rev Med Interne. 2018 Dec;39(12):918-924. French. doi: 10.1016/j.revmed.2018.08.005. Epub 2018 Sep 29. PMID: 30279008

14.

Sharma R, Flood VH. Advances in the diagnosis and treatment of Von Willebrand disease. Blood. 2017 Nov 30;130(22):2386-2391. doi: 10.1182/blood-2017-05-782029. PMID: 29187375; PMCID: PMC5709787

15.

Ng CJ, Di Paola J. von Willebrand Disease: Diagnostic Strategies and Treatment Options. Pediatr Clin North Am. 2018 Jun;65(3):527-541. doi: 10.1016/j.pcl.2018.02.004. PMID: 29803281

16.

Mondoloni M, Guyon A, Descroix V, Lescaille G. Purpura thrombopénique immunologique [Immune thrombocytopenic purpura]. Rev Prat. 2019 Mar;69(3):290. French. PMID: 30983256

17.

Marini I, Bakchoul T. Pathophysiology of Autoimmune Thrombocytopenia: Current Insight with a Focus on Thrombopoiesis. Hamostaseologie. 2019 Aug;39(3):227-237. doi: 10.1055/s-0039-1678732. Epub 2019 Feb 25. PMID: 30802916

18.

Hrdinová J, D'Angelo S, Graça NAG, Ercig B, Vanhoorelbeke K, Veyradier A, Voorberg J, Coppo P. Dissecting the pathophysiology of immune thrombotic thrombocytopenic purpura: interplay between genes and environmental triggers. Haematologica. 2018 Jul;103(7):1099-1109. doi: 10.3324/haematol.2016.151407. Epub 2018 Apr 19. PMID: 29674502; PMCID: PMC6029525

19.

Johnstone C, Rich SE. Bleeding in cancer patients and its treatment: a review. Ann Palliat Med. 2018 Apr;7(2):265-273. doi: 10.21037/apm.2017.11.01. Epub 2017 Dec 18. PMID: 29307210

20.

Boender J, Kruip MJ, Leebeek FW. A diagnostic approach to mild bleeding disorders. J Thromb Haemost. 2016 Aug;14(8):1507-16. doi: 10.1111/jth.13368. Epub 2016 Jun 27. PMID: 27208505

21.

Hayward CPM. How I investigate for bleeding disorders. Int J Lab Hematol. 2018 May;40 Suppl 1:6-14. doi: 10.1111/ijlh.12822. PMID: 29741250

22.

Franchini M, Marano G, Cruciani M, Mengoli C, Pati I, Masiello F, Veropalumbo E, Pupella S, Vaglio S, Liumbruno GM. Advances in managing rare acquired bleeding disorders. Expert Rev Hematol. 2020 Jun;13(6):599-606. doi: 10.1080/17474086.2020.1756259. Epub 2020 Apr 23. PMID: 32286895

23.

Menegatti M, Biguzzi E, Peyvandi F. Management of rare acquired bleeding disorders. Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):80-87. doi: 10.1182/hematology.2019000066. PMID: 31808848; PMCID: PMC6913473

Additional Reading

Cines DB, Bussel JB, Liebman HA, Luning Prak ET. The ITP syndrome: pathogenic and clinical diversity. Blood. 2009 Jun 25;113(26):6511-21. doi: 10.1182/blood-2009-01-129155. Epub 2009 Apr 24. PMID: 19395674; PMCID: PMC2710913

Mannucci PM, Franchini M. The real value of thrombophilia markers in identifying patients at high risk of venous thromboembolism. Expert Rev Hematol. 2014 Dec;7(6):757-65. doi: 10.1586/17474086.2014.960385. Epub 2014 Sep 18. PMID: 25231393.

Stevens SM, Woller SC, Bauer KA, Kasthuri R, Cushman M, Streiff M, Lim W, Douketis JD. Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis. 2016 Jan;41(1):154-64. doi: 10.1007/s11239-015-1316-1. PMID: 26780744; PMCID: PMC4715840.

Moll S. Thrombophilia: clinical-practical aspects. J Thromb Thrombolysis. 2015 Apr;39(3):367-78. doi: 10.1007/s11239-015-1197-3. PMID: 25724822

Srivastava A, Brewer AK, Mauser-Bunschoten EP, Key NS, Kitchen S, Llinas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A; Treatment Guidelines Working Group on Behalf of The World Federation Of Hemophilia. Guidelines for the management of hemophilia. Haemophilia. 2013 Jan;19(1):e1-47. doi: 10.1111/j.1365-2516.2012.02909.x. Epub 2012 Jul 6. PMID: 22776238.

Klamroth R. A new era of treatment for patients with haemophilia A? Hamostaseologie. 2017 Aug 8;37(3):216-218. doi: 10.5482/HAMO-16-07-0028. Epub 2016 Nov 25. PMID: 27885373