Blood Disorders (Exam 2) Flashcards
What is the most common hereditary bleeding disorder?
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vWF Disorder
What are the most common symptoms associated with vWF Disorder?
- Easy bruising
- Recurrent epistaxis
- menorrhagia
What is the most common vonWilebrand Disease?
Type 1: Parial quantitative deficiency of vWF
What is the least common vonWillebrand?
- Type 3
- Most likely to die
What lab values in a vWF patient will be abnormal? Normal?
- BT (bleeding time) is prolonged
- PT/aPTT is normal
Treatment of vWF
- Correct the deficiency of vWF
- Desmopressin (DDVAP)
- transfusion the missing specific factor
* Cryoprecipitate
What is DDAVP?
- synthetic analogue of vasopressin
- stimulates release of vWF by endothelial cells
What is the dose of DDAVP?
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- 0.3 ug/kg in 50ml normal saline
- given over 15 - 20 minutes
- Max effect in 30 minutes
- lasts 6-8 hours
Side effects of DDAVP?
- Headache
- hypotension
- hyponatremia
- water intoxication
How do you treat water intoxication and hyponatremia associated with DDAVP?
- Restrict IV and Oral intake for 4-6 hours after the use of the drug.
Name the most serious side effect associcated with hyponatremia and water intoxication?
Seizures
At what sodium level will you see confusion and restlessness? What will their EKG show?
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- 120 mEq/L
- Widening of QRS
At what sodium level will you see somulance and nausea? What will their EKG show?
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- 115 mEq/L
- Elevated ST segment
- Widening of QRS
At what sodium level will you see Seizures and death? What will their EKG show?
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- 110 mEq/L
- Vtach or V-fib
If DDAVP doesn’t work for vWF, what should you use next? What risk is associated?
- Cryoprecipitate
- Infection risk d/t multiple donors and no viral attenuation
How much does 1unit of Cryoprecipitate raise fibrinogen levels?
- 50 mg/dL
What is F VIII concentrate?
- contains Factor VIII and vWF
- given preoperatively and during surgery.
How is Factor VIII concentrate obtained?
- Prepared from a pool of plasma from multiple donors
- it UNDERGOES viral attenuation
Who needs to evaluate a patient with vWF before surgery?
A Hematologist
When should DDAVP be given before surgery? And what needs to be rechecked before starting surgery?
- 60 minutes
- Factor VIII levels should be rechecked and showing improvement before surgery.
What is not recommended for vWF and other coagulapathy patient’s during anesthesia?
- Neuoaxial blocks – hematoma & bleeding
- Arterial punctures
- laryngeal trauma– hematoma and post op obstructions
Number one anesthesia option for patients with vWF?
General Anesthesia
What medications do we give that can increased bleeding?
- Heparin
- Warfarin
- Fibrinolytics
- Antiplatelets
How does Heparin work?
- inhibits thrombin.
- Thrombin converts fibrinogen to fibrin
- Anticoagulation effect by activating antithrombin 3
What reverses Heparin?
- Protamine
- Very quick to reverse
What is LMWH? And why do we give it?
- Lovenox
- effective VTE prophylaxis
- predictable pharmacokinetic response
- fewer effect on platelet function
- Reduces risk of HITT
How does Coumadin work?
- interferes with hepatic synthesis of Vitamin K
- depends on coagulation factors 2, 7, 9,10
What medication reverses Coumadin?
- Vitamin K: 6 - 8 hours—- GIVE SLOWLY
What can you give to reverse coumadin quicker than Vitamin K?
- Prothrombin complex concentrates
- Factor 3a
- FFP
How do Fibrinolytics work
- converts plasminogen to plasmin
- Which cleaves fibrin
- causing clots to dissolve
What are some examples of fibrinolytics?
- Tissue plasminogen activator (tPA)
- Streptokinase (SK)
- Urokinase (UK)
How do Anti-fibrinolytics work?
- Inhibits the conversion of plasminogen to plasmin
Name 3 Antifibrinolytic agents
- tranexamic acid
- E-amiocaproic acid
- aprotinin
What do you do if your patient is on an antiplatelet?
- d/c drugs on time
- PLT transfusion
What is Disseminated Intravascular Coagulopathy?
- Systemic activation of the coagulation system
- simutaneously leads to thrombus formation
- exhausts platelet and coagulation factors
What underlying conditions can precipitate DIC?
- trauma
* amniotic fluid embolus - malignancy
* sepsis (except urosepsis) - incompatible blood transfusion
What lab results will you see with DIC?
- Reduction in Platelets
- Prolonged PT/PTT and thrombus time (TT)
- Elevated concentration of fibrin degradation products
How do you manage and treat DIC patients?
- alleviating underlying conditions
- blood component transfusions to replete coagulation factors and platelets.
What medication/therapy is counterindicated in DIC d/t potential for catastrophic throbotic complications?
- Antifibrinolytic
What are the 2 most common Prothombotic Disorders?
- Factor V Leiden
- HIT
When is Factor V Leiden typically discovered?
- After multiple miscarriages
- DVTs (with/without anticoagulants)
- Late fetal loses.
What is Factor V in the body?
- protein C for normal clotting
- when body produces enough fibrin, Activated Protein C inactivates Factor V
- Stops the Clot from growing larger.
Describe Factor V Leinden
- Mutations in genes for Factor V
- Factor V Leiden is an abnormal version of Factor V that is resistent to Activated Protein C.
- Activate C is not able to stop Factor V Leiden from making more fibrin.
Factor V Leiden: Anesthesia Implications
- increased risk of developing DVT
- Pts are on anticoags
What are the most common anticoagulations?
- warfarin
- unfractioned heparin
- LMWH
Describe HIT (Heparin Induced Thrombocytopenia)
- autoimmune-mediated drug reaction occuring in 5% of people after exposure to unfractioned heparin or LMWH.
In HIT, when does thrombocytopenia typically occur? And what is the hallmark finding?
- 5-14 days after intitial therapy
- decrease in plt < 100,000
- potential for arterial and venous thromboses.
If someone developes HIT, what are their chances of developing a thrombosis?
- Absolute Risk of 30 -75%
If your patient developes a clot after starting heparin, what could be the problem?
- Patient has deveolped HIT.
What should you start the patient on if they have developed HIT to reduce the risk of thrombis?
Direct Thrombin Inhibitor
* bivalirudin
* lepirudin
* argatroban
What is Fondaparinaux?
- Primary Therapy for HIT
- Treat VTE
- Synthetic Factor Xa inhibitor
After someone develops HIT, how long will it take for the heparin immune complexes to be completely out of their system?
- 30 - 60 days.
