19 Approach to a Bleeding Patient Flashcards
Bleeding is prevented through the process of ____
Hemostasis
Vessel wall
Platelets
Primary hemostasis
Plasma proteins e.g. clotting and fibrinolytic factors
Secondary hemostasis
Follows a cell-based model of hemostasis
Secondary hemostasis
Secondary hemostasis begins with the release of ____ and ____ during the initiation phase
Tissue factor
FVII
The most important aspect of initiation is the production of a _____
Thrombin burst
Coagulation tries to perpetuate itself, multiplying its effects
FIX along with FVIIIa as the intrinsic tenase compex will activate FX
Propagation phase
FXa and FVa complex produced during the propagation phase will activate FII
Clot formation
Responsible for the conversion of fibrinogen to fibrin
FIIa
Important question to ask in the history of a bleeding patient
Spontaneous bleeding or trauma induced?
Systemic diseases associated with bleeding disorder
Liver disease
Renal disease
Tells us the adequacy of anti-coagulation factors with vitamin K antagonists
International normalized ratio
Measured after the addition of tissue factor, phospholipid and calcium
Prothrombin time
If PT is prolonged, there is likely an issue with _____
Vitamin K dependent factors
Measured after the addition of negatively charged particles
Partial thromboplastin time
To differentiate between factor deficiency or factor inhibition
Mixing test
If mixing test corrects the prolonged PTT then suspect for ___
Factor deficient
If PTT is still prolonged after a mixing test then suspect for ____
Anticoagulation or inhibitors
Thromobocytopenia can result from 3 mechanisms
Decreased production
Increased sequestration
Increased destruction
Immune mediated destruction of platelets
Possibly immune-mediated inhibition of platelet release from megakaryocyte
Immune thrombocytopenia
Acute and self-limiting ITP
Usually presents after a viral infection
Childhood ITP
ITP is treated if bleeding occurs, usually if the platelet count is ____
<30 (but bleeding occurs at <20)
If the patient has to undergo a surgery, transfuse a blood until platelet count reaches ___
100 (50 for other procedures)
To suppress immune responses for treating patients ITP
Prednisone
Steroids
IV immunoglobulin
Monoclonal antibody that acts against protein CD20 found on the surface of B cells
Rituximab
Due to mutations in genes encoding FVIII or FVIX, which are found on chromosome ______
Hemophilia
10
Causes for hemophilia among women
Turner syndrome
Lyonization
Mutation
Inhibitors
Christmas disease
Hemophilia B
Bleeding in the joints
Hemarthrosis
Joint which is affected in hemophilia
Target joint
Treatment modalities for hemophilia
Desmopressin
Transfusion
Gene therapy
Used as a spray
Stimulates release of FVIII from storage site
Desmopressin
Side effect of using desmopressin
Tachyphylaxis
Exposure of circulation to pathologic levels of tissue factor leading to organ failure
Disseminated intravascular coagulation
Important causes of DIC
Bacterial sepsis
Obstetric complications
Acute promyelocytic leukemia
Signs of microangiopathy
Schistocytes and cell fragments under the microscope
Treatment for DIC
Heparin
Resolve underlying cause
Platelets
