19 Approach to a Bleeding Patient Flashcards

1
Q

Bleeding is prevented through the process of ____

A

Hemostasis

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2
Q

Vessel wall

Platelets

A

Primary hemostasis

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3
Q

Plasma proteins e.g. clotting and fibrinolytic factors

A

Secondary hemostasis

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4
Q

Follows a cell-based model of hemostasis

A

Secondary hemostasis

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5
Q

Secondary hemostasis begins with the release of ____ and ____ during the initiation phase

A

Tissue factor

FVII

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6
Q

The most important aspect of initiation is the production of a _____

A

Thrombin burst

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7
Q

Coagulation tries to perpetuate itself, multiplying its effects
FIX along with FVIIIa as the intrinsic tenase compex will activate FX

A

Propagation phase

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8
Q

FXa and FVa complex produced during the propagation phase will activate FII

A

Clot formation

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9
Q

Responsible for the conversion of fibrinogen to fibrin

A

FIIa

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10
Q

Important question to ask in the history of a bleeding patient

A

Spontaneous bleeding or trauma induced?

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11
Q

Systemic diseases associated with bleeding disorder

A

Liver disease

Renal disease

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12
Q

Tells us the adequacy of anti-coagulation factors with vitamin K antagonists

A

International normalized ratio

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13
Q

Measured after the addition of tissue factor, phospholipid and calcium

A

Prothrombin time

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14
Q

If PT is prolonged, there is likely an issue with _____

A

Vitamin K dependent factors

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15
Q

Measured after the addition of negatively charged particles

A

Partial thromboplastin time

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16
Q

To differentiate between factor deficiency or factor inhibition

A

Mixing test

17
Q

If mixing test corrects the prolonged PTT then suspect for ___

A

Factor deficient

18
Q

If PTT is still prolonged after a mixing test then suspect for ____

A

Anticoagulation or inhibitors

19
Q

Thromobocytopenia can result from 3 mechanisms

A

Decreased production
Increased sequestration
Increased destruction

20
Q

Immune mediated destruction of platelets

Possibly immune-mediated inhibition of platelet release from megakaryocyte

A

Immune thrombocytopenia

21
Q

Acute and self-limiting ITP

Usually presents after a viral infection

A

Childhood ITP

22
Q

ITP is treated if bleeding occurs, usually if the platelet count is ____

A

<30 (but bleeding occurs at <20)

23
Q

If the patient has to undergo a surgery, transfuse a blood until platelet count reaches ___

A

100 (50 for other procedures)

24
Q

To suppress immune responses for treating patients ITP

A

Prednisone
Steroids
IV immunoglobulin

25
Monoclonal antibody that acts against protein CD20 found on the surface of B cells
Rituximab
26
Due to mutations in genes encoding FVIII or FVIX, which are found on chromosome ______
Hemophilia | 10
27
Causes for hemophilia among women
Turner syndrome Lyonization Mutation Inhibitors
28
Christmas disease
Hemophilia B
29
Bleeding in the joints
Hemarthrosis
30
Joint which is affected in hemophilia
Target joint
31
Treatment modalities for hemophilia
Desmopressin Transfusion Gene therapy
32
Used as a spray | Stimulates release of FVIII from storage site
Desmopressin
33
Side effect of using desmopressin
Tachyphylaxis
34
Exposure of circulation to pathologic levels of tissue factor leading to organ failure
Disseminated intravascular coagulation
35
Important causes of DIC
Bacterial sepsis Obstetric complications Acute promyelocytic leukemia
36
Signs of microangiopathy
Schistocytes and cell fragments under the microscope
37
Treatment for DIC
Heparin Resolve underlying cause Platelets