Acquired Coagulopathies Flashcards
Commonly associated with bleeding are liver disease, vitamin K deficiency, and renal failure.
Chronic Disorders
Accounts for most instances of fatal hemorrhage, and 3000 to 4000 hemorrhage-related deaths can be prevented through coagulopathy management
Trauma-induced coagulopathy (TIC)
Defined as any single or multiple coagulation factor or platelet deficiency, and TIC is triggered by the combination of injury-related acute inflammation, hypothermia, acidosis, and hypoperfusion
Coagulopathy
Poor distribution of blood to tissues associated with low blood pressure
Hypoperfusion
Leads to acute reduction of ADAMTS13 with a related rise in ultra-large VWF multimers and VWF-triggered platelet activation.
Systemic shock
ADAMTS13 means
a-disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13
ADAMTS13 is also known as
vWF cleaving protease
Also leads to tissue factor release, coagulation factor activation, loss of coagulation control proteins, and hyperfibrinolysis.
Shock
Defined as blood loss exceeding total blood volume within 24 hours, loss of 50% of blood volume within a 3-hour period, blood loss exceeding 150 mL/min, or blood loss that necessitates plasma and platelet transfusion
Massive Hemorrhage
Trauma center MTPs specify that unmatched ___ or ___ be warmed and administered to the victim en route or immediately on hospital arrival
Thawed group AB or group A plasma
T/F: Clinicians may continue administering equal amounts (1:1:1) of warmed red blood cells (RBCs), plasma, and single (random) donor platelet concentrate, approximating the makeup of whole blood
TRUE
A key TIC management component.
Plasma
Donor services separate and freeze plasma within 24 hours of collection, officially naming the product
FP-24
FP-24 may be subsequently thawed and stored at
1-6degC for up to 5 days
FP-24 plasma product officially named
Thawed Plasma
These components decline to approximately 60% after 5 days of refrigerator storage, so thawed plasma may require supplementation with factor concentrates, especially in patients with VWD or hemophilia
VWF and coagulation factor V and VIII activities
Generally ineffective when the patient has immune thrombocytopenia, thrombotic thrombocytopenic purpura, or heparin-induced thrombocytopenia
Platelet concentrate therapy
TACO means
Transfusion-Associated Circulatory Overload
TRALI means
Transfusion-Related Acute Lung Injury (TRALI)
Shows promise in early TIC intervention and may reduce the need for MTP
ADAMTS13
May be used at a dosage of 50 units/kg every 12 hours, not to exceed 200 units/kg in 24 hours
Activated prothrombin complex concentrate
T/F: Nonactivated prothrombin complex concentrates (PCCs) such as four-factor concentrate Kcentra (CSL Behring) are safer and may also be employed.
TRUE
Either activated or non-activated, may be used in conjunction with the antifibrinolytic lysine analog tranexamic acid
ADAMTS13 concentrate and PCCs
is effective and commonly employed for TIC, though this too is an off-label application
Trenexamic Acid (TXA)
