ACT Myths 2014 / Blood Test 2

Question 1

The control of hemorrhage in hypothermic patients with platelet and clotting factor depletion is often impossible. Determining the cause of coagulopathic bleeding (CB) will enable physicians and perfusionist’s to appropriately focus on

Answer 1

Rewarming and restoring clotting factors

Question 2

Coagulation in vivo is prolonged by what ?

Answer 2

hypothermia

Question 3

Tests run at 37°C

Answer 3

underestimate the anticoagulation of the hypothermic patient

Question 4

During the study “Differential effects of serial hemodilution with hydroxyethyl starch, albumin, and 0.9% saline on whole blood”. What produced early and profound hypocoagulable effects ?

Answer 4

Albumin

Question 5

During the study “Differential effects of serial hemodilution with hydroxyethyl starch, albumin, and 0.9% saline on whole blood”. Significant hypocoagulability occurred for all three diluents at what percentage ?

Answer 5

75%

Question 6

During the study “Differential effects of serial hemodilution with hydroxyethyl starch, albumin, and 0.9% saline on whole blood”.

1. ) The study supports the use of albumin in patients at risk for what ?
2. ) What does the study recommend for use in with a need for normal hemostasis?

Answer 6

1. ) Thrombosis

2. ) Normal Saline

Question 7

Coagulation in vivo is altered by what?

Answer 7

Hemodilution

Question 8

We use ACT to monitor what ?

Answer 8

Anticoagulation

Question 9

ACT does NOT measure what ?

Answer 9

Heparin Concentration

Question 10

Observations in our laboratory suggests that the postoperative bleeding that occurs, despite neutralization of heparin with protamine, is secondary to hypothermia and dilutional anemia during bypass. What is an additional, potential mechanism for excessive bleeding following cardiopulmonary bypass ?

Answer 10

Heparin induces activation of the fibrinolytic system.

In fibrinolysis, a fibrin clot, the product of coagulation, is broken down.[2] Its main enzyme plasmin cuts the fibrin mesh at various places, leading to the production of circulating fragments that are cleared by other proteases or by the kidney and liver