Bleeding and coagulopathies NEJM Flashcards
Give a clinical pathway of decision making bleeding patient in ICU?
Give classical coagulation findings of following platelet and coagulation disorders :
Review coagulation cascade ?
DIC
Def?
Diagnostic scoring system ?
Disseminated intravascular coagulation is a clinicopathological
diagnosis21 of a disorder that is defined
by the International Society on Thrombosis
and Hemostasis (ISTH) as “an acquired syndrome
characterized by the intravascular activation of coagulation
with loss of localization arising from
different causes.” This condition typically originates
in the microvasculature and can cause damage
of such severity that it leads to organ dysfunction
(Fig. 2). It can be identified on the basis of a
scoring system developed by the ISTH (Table 2).
Etiology DIC ?
Presentation>
Pathogenesis DIC ?
Management?
Thrombocytopenia approach to causes ?
Pathophysiological Mechanisms?
Thrombocytopenia may arise because of decreased
production or increased destruction (immune
or nonimmune) of platelets, as well as from
sequestration in the spleen.
Name immunologic causes ?
As a general rule, an abrupt reduction in platelet
counts with a history of recent surgery suggests
an immunologic cause or adverse transfusion reaction
(post-transfusion purpura or drug-induced
thrombocytopenia). Heparin-induced thrombocytopenic
thrombosis is an uncommon, transient,
drug-induced, autoimmune prothrombotic disorder
caused by the formation of IgG antibodies
that cause platelet activation by the formation of
antibodies to complexes of platelet factor 4 and
hepari
Post transfusion purpura ?
Post-transfusion purpura is a rare bleeding disorder
caused by a platelet-specific alloantibody
(usually, anti–human platelet antigen 1a [HPA-1a])
in the recipient. HPA-1a reacts with donor platelets,
destroying them and also the recipient’s
own platelets. The majority of affected patients
are multiparous women who have been sensitized
during pregnancy. Treatments for posttransfusion
purpura include intravenous immune
(gamma) globulin, glucocorticoids, and plasmapheresis.
High-dose intravenous immune globulin
(2 g per kilogram of body weight administered
over either 2 or 5 days) produces an increased
platelet count in about 85% of patients. Large
numbers of platelet transfusions may be required
to control severe bleeding before there is a response
to intravenous immune globulin. There is
limited evidence that the use of HPA-1a–negative
platelets is more effective than the use of platelets
from random donors.33
Thrombotic microangiopathia
Profound thrombocytopenia and microangiopathic
hemolytic anemia (red-cell fragmentation) characterize
the thrombotic microangiopathies, which
includes three major disorders: thrombotic thrombocytopenic
purpura, the hemolytic–uremic syndrome,
and the HELLP syndrome (characterized
by pregnancy-related hemolysis, elevated liverenzyme
levels, and low platelet count
Liver disease and bleeding
Renal disease in bleeding
Tabulate the following drugs
