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Acquired Coagulopathies Flashcards

1
Q

What triggers Acquired Coagulopathies of Trauma and Shock (ACOTS)?

A

Acute inflammation, platelet activation, tissue factor release
Hypothermia, acidosis, hypoperfusion

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2
Q

What role does systemic shock play in ACOTS?

A

Exacerbates coagulopathy by worsening hypoperfusion and inflammation

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3
Q

What is the initial management strategy for ACOTS?

A

Use of colloid plasma expanders like 5% dextrose

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4
Q

How is massive transfusion defined?

A

Based on the number of RBC units administered

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5
Q

What are the indications for massive transfusion?

A

Low systolic BP
Prolonged PT

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6
Q

What clinical guidelines determine RBC transfusion?

A

Based on hemoglobin levels

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7
Q

What plasma products are used in trauma management?

A

FP-24 or Fresh Frozen Plasma (FFP)

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8
Q

When should plasma transfusion be used?

A

Prolonged PT/PTT
Known factor deficiencies

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9
Q

What are the major risks of plasma transfusion?

A

TACO (Transfusion-Associated Circulatory Overload)
TRALI (Transfusion-Related Acute Lung Injury) → Can lead to ARDS

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10
Q

What are other complications of plasma transfusion?

A

Thrombosis, anaphylaxis, multiple organ failure

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11
Q

When should platelet concentrate be administered?

A

Low platelet count
Surgery requiring hemostasis

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12
Q

What are the limitations of platelet transfusion?

A

Ineffective in ITP, TTP, or HIT

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13
Q

What is the role of prothrombin complex concentrates (PCCs) in ACOTS?

A

Contain activated and nonactivated coagulation factors
Help restore clotting function in trauma patients

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14
Q

How is tranexamic acid (TXA) used in conjunction with PCCs?

A

Prevents excessive fibrinolysis
Enhances clot stability in trauma patients

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15
Q

When should cryoprecipitate and fibrinogen be administered?

A

Low fibrinogen levels
Dosage based on severity of coagulopathy

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16
Q

Why does liver disease cause coagulopathy?

A

The liver produces most plasma coagulation factors and regulatory proteins

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17
Q

What conditions can cause liver-related coagulopathy?

A

Hepatitis, cirrhosis, obstructive jaundice
Liver cancer, poisoning, congenital disorders

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18
Q

Which clotting factors are affected in liver disease?

A

Vitamin K-dependent factors: 2, 7, 9, and 10
Control proteins: C, S, Z

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19
Q

What is an early marker of liver disease-related coagulopathy?

A

Decreased Factor VII activity
Prolonged prothrombin time (PT)

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20
Q

How does vitamin K deficiency affect clotting factors?

A

Similar PT prolongation as liver disease
Does NOT affect Factor V

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21
Q

How can liver disease be distinguished from vitamin K deficiency?

A

Factor V assay alongside Factor VII assay

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22
Q

How does fibrinogen behave in early or mild liver disease?

A

Often elevated as an acute phase reactant

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23
Q

What is dysfibrinogenemia in liver disease?

A

Fibrinogen is coated with excessive sialic acid
Leads to poor clot formation

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24
Q

What lab findings indicate dysfibrinogenemia?

A

Prolonged thrombin time
Prolonged reptilase clotting time

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25
What happens to fibrinogen levels in end-stage liver disease?
May fall below 100 mg/dL Indicates liver failure
26
What triggers chronic disseminated intravascular coagulation (DIC) in liver disease?
Decreased production of regulatory proteins Release of activated procoagulants from liver cells
27
What are the key lab findings in acute DIC?
Prolonged prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time Reduced fibrinogen levels Increased D-dimers
28
What is the treatment approach for DIC in liver disease?
Red blood cell (RBC) transfusion, plasma, prothrombin complex concentrate (PCC), tranexamic acid (TXA) Platelet concentrates, antithrombin concentrates
29
What are the key hemostasis tests for liver disease?
PT, PTT, thrombin time Fibrinogen concentration, platelet count, D-dimer concentration
30
How is liver disease differentiated from vitamin K deficiency?
Factor V and Factor VII assays
31
What lab findings confirm systemic fibrinolysis?
Plasminogen deficiency Elevated D-dimer concentration
32
When is vitamin K therapy effective in liver disease?
When nonfunctional des-gamma-carboxyl factors are present Short-lived effect
33
How does plasma transfusion help in liver disease?
Provides all coagulation factors Typically 2 units for adults
34
What is used to manage fibrinogen deficiency in liver disease?
Cryoprecipitate Fibrinogen concentrate if levels drop below 50 mg/dL
35
What are the risks of plasma-containing products?
Transfusion-associated circulatory overload (TACO) Virus transmission Allergic reactions
36
What is a common bleeding issue in chronic renal failure (CRF)?
Platelet dysfunction Mild to moderate mucocutaneous bleeding
37
What factors contribute to suppressed platelet function in CRF?
Reduced adhesion and aggregation Harmful compounds coating platelets
38
What are the examples of harmful compounds coating platelets?
Guanidinosuccinic acid, dialyzable phenolic compounds
39
How do anemia and thrombocytopenia contribute to bleeding in CRF?
Decreased red blood cell (RBC) mass affects hemostasis
40
What is a primary management option for bleeding in CRF?
Dialysis
41
What hemostasis disorders are associated with chronic renal failure?
Disseminated intravascular coagulation (DIC) Hemolytic uremic syndrome (HUS) Thrombotic thrombocytopenic purpura (TTP)
42
What are the impacts of hemostasis syndromes in CRF?
Thrombocytopenia Mucocutaneous bleeding
43
What happens when fibrin deposits in the renal microvasculature?
Reduces glomerular function May lead to renal failure
44
What condition can worsen bleeding disorders in CRF?
Renal transplant rejection
45
What are the key laboratory tests for assessing bleeding in CRF?
Bleeding time Platelet aggregometry (PT) and (PTT)
46
What is the primary focus in managing bleeding in CRF?
Severity of hemorrhage
47
How does renal dialysis help in CRF-related bleeding?
Temporarily activates platelets Improves platelet function by controlling anemia
48
What medication is used to manage bleeding in CRF?
Desmopressin acetate (DDAVP)
49
What is the primary pathophysiological change in nephrotic syndrome?
Increased glomerular permeability
50
Name one condition associated with nephrotic syndrome.
Chronic glomerulonephritis
51
What systemic autoimmune disease is linked to nephrotic syndrome?
Systemic lupus erythematosus
52
Which kidney-related vascular disorder is associated with nephrotic syndrome?
Renal vein thrombosis
53
What type of proteins are lost in urine due to nephrotic syndrome?
Low-molecular-weight proteins
54
What are coagulation factors and regulatory proteins that can be lost in urine due to nephrotic syndrome.
Factor 2, 7, 9, 10, 12 Antithrombin and Protein C
55
What is the role of vitamin K in coagulation?
γ-carboxylation of glutamate residues on coagulation factors
56
What is a rich dietary source of vitamin K?
Green leafy vegetables
57
Name one cause of vitamin K deficiency related to digestion.
Fat malabsorption
58
How can long-term parenteral nutrition lead to vitamin K deficiency?
Lack of dietary intake
59
How can broad-spectrum antibiotics contribute to vitamin K deficiency?
Reduction of gut flora
60
Why do newborns have naturally low vitamin K levels?
Sterile intestines and low levels in human milk
61
What has significantly reduced the incidence of hemorrhagic disease of the newborn?
Routine administration of vitamin K
62
How can breastfeeding contribute to prolonged vitamin K deficiency in newborns?
Delayed gut flora development
63
What is often the first laboratory sign of vitamin K deficiency?
Prolonged prothrombin time (PT)
64
What laboratory test confirms vitamin K deficiency by correcting PT/PTT?
Mixing studies
65
Which coagulation factor is first affected in vitamin K deficiency?
Factor 7
66
What is the standard treatment for vitamin K deficiency?
Oral or intravenous vitamin K
67
What is the most common coagulation factor targeted by autoantibodies in acquired hemophilia?
Factor 7
68
In which two patient groups is acquired hemophilia most commonly observed?
Older patients and postpartum women
69
What laboratory test typically shows abnormal results in acquired hemophilia?
Prolonged partial thromboplastin time (PTT) with normal PT
70
What treatment is used for acute bleeding in acquired hemophilia?
Activated prothrombin complex concentrates (PCC) Recombinant factor 7a (rFVIIa)
71
Name one medical condition associated with acquired von Willebrand disease.
Hypothyroidism
72
What is the primary symptom of acquired von Willebrand disease?
Mucocutaneous bleeding
73
What laboratory finding is characteristic of acquired von Willebrand disease?
Diminished von Willebrand factor (VWF) activity and antigen levels
74
What is a common treatment for acquired von Willebrand disease?
Desmopressin acetate (DDAVP)

Hematology 2 (8 decks)

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