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Physical & Health Assessment 24 > Blood Disorders (Exam II) > Flashcards

Blood Disorders (Exam II) Flashcards

1
Q

What are the S/S of vWF disorder?

A

Easy bruising
epistaxis
menorrhagia

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2
Q

What would lab values be for someone with vWF deficiency?

A
  • Normal PT & aPTT
  • Bleeding time is prolonged
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3
Q

What are the treatments for vWF deficiency?

A
  • Desmopressin
  • Cryoprecipitate
  • Factor VIII
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4
Q

How does DDAVP work in regards to treatment of von Willebrand deficiency??

A

Stimulates vWF release from endothelial cells

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5
Q

What is the dose for DDAVP?

A

0.3 mcg/kg in 50 mL over 15-20 mins (Do not bolus)

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6
Q

What is the onset & duration of DDAVP?

A
  • Onset: 30mins
  • Duration: 6-8hrs
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7
Q

What are side effects of DDAVP?

A
  • HA
  • Stupor
  • hypotension
  • tachycardia
  • hyponatremia
  • water intoxication (excessive water retention)
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8
Q

What is the most major side effect of DDAVP?

A

Hyponatremia

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9
Q

Someone that gets DDAVP needs to be on what?

A

Fluid restriction 4-6hrs before & after DDAVP

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10
Q

What blood product can be utilized for vWF disease if the patient is unresponsive to DDAVP?

A

Cryoprecipitate

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11
Q

1 unit of Cryo raises the ____ level by ___?

A

Fibrinogen by 50 mg/dL

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12
Q

What is a potential risk factor with cryoprecipitate?

A

Increased risk of infection (not submitted to viral attenuation)

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13
Q

How is Factor VIII concentrate made?

A

Pool of plasma from a large number of donors.

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14
Q

When is Factor VIII given?

A

Preop or intraop

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15
Q

When should DDAVP be given prior to surgery?

A

30-60mins before Sx

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16
Q

What blood product poses an increase risk for infection? Why?

A
  • Cryoprecipitate
  • Not sent for viral attenuation
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17
Q

Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?

A
  • Hematoma
  • Nerve compression
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18
Q

What are the anesthesia considerations for someone with vWF deficiency?

A
  • Avoid trauma (particularly airway)
  • avoid IM sticks
  • avoid arterial lines (if feasible)
  • avoid spinals
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19
Q

How does heparin work?

A
  • Thrombin inhibition
  • Antithrombin III activation
20
Q

What labs are monitored with heparin?

A

PTT &/or ACT

21
Q

What is the mechanism of action of Coumadin?

A

Inhibition of vitamin K-dependent factors.

22
Q

Which factors are vitamin-K dependent?

A

II, VII, IX & X

23
Q

What is the onset for Vitamin K administration?

A

6-8hrs

24
Q

What drugs/products can be given to reverse coumadin faster than Vit K?

A
  • Prothrombin complex concentrates
  • Factor VIIa
  • FFP
25
Q

What is the mechanism of action for fibrinolytics (UK, streptokinase & tPA)?

A

Convert plasminogen to plasmin, which cleaves fibrin

26
Q

How do tranexamic acid (TXA) and aminocaproic acid work?

A

Inhibit conversion of plasminogen to plasmin

27
Q

What is the best way to treat DIC?

A

Treat the underlying cause

28
Q

What will labs show for someone in DIC?

A
  • ↓Platelet count
  • Prolonged PT, PTT & TT.
  • ↑ fibrin degradation products
29
Q

When is antifibrinolytic therapy given to someone in DIC?

A

Trick question, it shouldn’t. Can lead to catastrophic thrombotic complications

30
Q

What is factor V Leiden?

A
  • Protein for clotting.

Activated protein C inactivates factor V thus stopping clot growth.

31
Q

What is Factor V Leiden deficiency?

A

Genetic mutation where Activated protein C cannot stop factor V Leiden thus excessive fibrin.

32
Q

What does Activated Protein C do?

A

Inactivates factor V when enough fibrin has been made.

33
Q

Who is usually tested for Factor V Leiden?

A

Pregnant women. Especially ones with unexplained late stage miscarriages

34
Q

What anticoagulant medications could someone with Factor V Leiden be put on?

A
  • Warfarin
  • LMWH & unfractionated heparin
35
Q

What is the hallmark sign of HIT?

A

Plt count <100,000

thrombocytopenia

36
Q

HIT results in ____ activation and potential____?

A

platelet; thrombosis

37
Q

What is heparin replaced with when HIT is diagnosed?

A

Argatroban or bivalirudin (direct-thrombin inhibitors)

38
Q

What is Fondaparinux & when is it used?

A
  • A synthetic Factor Xa inhibitor
  • used to treat VTE in HIT
39
Q

CNS s/s of sodium level 120

A

Confusion and restlessness

40
Q

CNS s/s of sodium level 115

A

Somnolence/nausea

41
Q

CNS s/s of sodium level 110

A

Coma/seizure

42
Q

ECG s/s of sodium level 120

A

Widening QRS

43
Q

ECG s/s of sodium level 115

A

Widening QRS and ST elevation

44
Q

ECG s/s of sodium level 110

A

V Tach/V fib

45
Q

What is the most common type of vWF disease and what is the treatment

A

Type 1 is the mildest and most common form. Responsive to DDAVP Tx.
Cause: partial deficiency of vWF

Physical & Health Assessment 24 (26 decks)

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