Assessment of Hemostasis Flashcards
what are some things that you are looking at when you assess hemostasis?
- history (personal, family, medications, clinical conditions)
- take the history first
- physical exam
- lab testing
when looking at bleeding history, what are we looking at? (4)
age of onset type of bleeding all surgical procedures (blood loss/transfusion required) all transfusion history other family member affected
when looking at thrombosis history, what are we looking at? (8)
age of onset location type (arterial or venous) documentation (CT, MRI, etc) concurrent risk factors (diabetes, smoking, pregnancy, obestiy, meds, stasis) anticoagulation history other clinical conditions other family members affected
Medication History that is relevant to assessment of hemostasis (6)
- aspirin and aspirin containing products
- NSAIDs
- SSRIs antidepressants
- ADP receptor antagonists
- anticoagulants
- alternative agents such as ginkgo, ginger, ginseng, feverfew
lab assessment of platelet function
- CBC (complete blood count) includes platelet count dn cell morphology
- Platelet function to look at bleeding time, PFA 100, and platelet aggregation
Thrombelastography
TEG
- measures clot formation process
- monitors changes in viscoelastic properties of clot such as clot strength and clot kinetics
- primarily used in OR or lab
- indicate need for transfusion, particularly platelet transfusion
thrombin leads to
fibrinogen activation
what does the ROTEM measure?
- measures clot formation process
- monitors changes in viscoelastic properties of clot such as clot strength and kinetics
- primarily used in OR or lab
- indicate need for transfusion, particularly platelet transfusion
thromboelastometry device description
- blood is added to disposable cuvette in a heated cuvette holder
- disposable pin sensor is fixed on the tip of the rotating shaft axis
- shaft rotates back and forth
- data obtained from the reflected light and goes into computer and converted to a graphical output
ROTEM Clotting Time CT (sec)
speed of fibrin formation, influenced by clotting factors, anti-coagulants
Clot Formation Time CFT (sec)
kinetics of clot formation, influenced by platelet level/ function and fibrinogen level/ ability to polymerize
Maximum Clit Firmness MCF
firmness of clot such as clot quality, influenced by platelets, fibrinogen, Factor XIII, fibrinolysis
Maximum Lysis ML (% of MCF)
abnormal ML at 30 minutes likely indicates fibrinolysis
Helena Plateletworks
- device measure platelet number (EDTA sample and sample containing agonist)
- difference between the two is calculated as % aggregation
Made PFA 100
measures in-vitro closure in a high shear system
-measures time to membrane closure by activate platelets
