bleeding disorders Flashcards
what happens in the common pathway?
10 converted to thrombin (2) using 5
extrinsic pathway involves
10 - 10a in the presence of factor 7 and TF
the intrinsic/propagation pathway involves
12-11-9-10 with the help of 8
what 2 factors help activate factor 12
prekallikrein and HMWK
Do you need PK and HMWK or factor 12 to control bleeding?
NO
PTT assesses
intrinsic (inside) and common pathway (have to get to the end)
PT assesses
extrinsic and common
Protein C and S (cofactor)
antithrombin
degrade 5 and 8
preferentially neutralizes 10 and 10a
INR is
PT in sec/ geo mean in sec
non-enzymatic co factors include
5, 8, TF
which factors are NOT made in the liver
- tPA
- VWF
- thrombomodulin
- factor 8 made by endoth as well
Factors with the shortest half life
7
5 and 8
VWF is synthesized by
endothelial cells and megs
VWF extends the half life of
factor 8
Primary hemostatic disease is
VWF disease
can impact secondary hemostasis because less factor 8 around
3 clinical components of VWF disease
1 - mucocutaneous bleed
2- autosomal inheritance
3- CBC INR/PTT often normal
how do we treat mild VWF disease
- DDAVP - desmopressin- increase hemostasis - due to stress
-
more moderate severe VWF - how do you treat
- give VWF/Factor 8 concentrate
- humate - wilate
- OCP
In Hemophilia A and B which lab finding is commonly found
Prolonged PTT -
intrinsic pathway is delayed
treating hemophilia –>
TREAT IMMEDIATED
then scan
Severe hemophilia how do you treat?
- factor 8 or 9 concentrate can be given
or
DDAVP if moderate- mild
in patients with liver disease most commonly present with
- esophageal/GI varices
gastritis
ulcers
risk for bleeding and clotting
Clues that a patient has liver disease from lab tests include
- Thrombocytopenia
- prolngation of INR and PTT
- decreased factors except factor 8
treating coagulopathy of liver disease -
treat liver disease
vitamin K not effective
DDAVP
anti fibrinolytics
Features of DIC
- prolonged INR PTT
- Thrombocytopenia
- Low fibrinogen
Uncontrolled generation of what 2 factors results in DIC
- thrombin
- plasmin
with DIC you can get excessive release of what factor
tissue factor release
how do you treat DIC
treat the underlying cause -
protein C and antithrombin may help
what are some causes of a vitamin K deficiency
- nutritional deficiency
- warfarin
- Antibiotics
- Biliary obstruction/malabsorption
- hemorrhagic disease of newborn
what lab tests will you find with a vitamin K deficiency?
- prolonged PT/INR
- PTT prolonged in more severe cases
reduced factors 2,7,9,10
INR/PTT for following diseases
VWF Factor 8 or 9 or 12 deficiency Drug induced heparin, thrombin inhibitor Inherited/acquired factor 7 deficiency vitamin k deficiency/early liver disease Severe vitamin K deficiency Severe liver disease
INR/PTT often normal Isolated PTT deficiency normal INR Isolated PTT deficiency normal INR prolonged INR/normal PTT prolonged INR/normal PTT Prolonged INR and PTT Prolonged INR and PTT
