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Physical & Health Assessment COPY - Grayson > 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 (DDAVP)
  • Cryoprecipitate
  • Factor VIII
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4
Q

What is the best diagnostic lab value in vWD?

A

ACT
PT/aPTT are often normal

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5
Q

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

A

Stimulates vWF release from endothelial cells

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6
Q

What is the dose for DDAVP?

A

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

Max effect in 30min, lasts 6-8hrs

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7
Q

What is the onset & duration of DDAVP?

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

What are side effects of DDAVP?

A
  • HA
  • Stupor
  • Hypotension
  • Tachycardia
  • Hyponatremia
  • Water intoxication (excessive water retention)
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9
Q

What is the most major side effect of DDAVP?

A

Hyponatremia

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10
Q

Someone that gets DDAVP needs to be on what?

A

Fluid restriction 4-6hrs before & after DDAVP

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11
Q

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

A

Cryoprecipitate

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12
Q

What S/S would you expect with Na+ of 120?

A

Confusion, restlessness, widened QRS

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13
Q

What S/S would you expect with Na+ of 115?

A

Somnolence, nausea, elevated ST, widened QRS

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14
Q

What S/S would you expect with Na+ of 110?

A

Siezures, coma, vtach/vfib

Give hypertonic saline 3% as bolus until seizing stops

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15
Q

1 unit of Cryo raises the ____ level by ___?

A

fibrinogen, 50 mg/dL

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16
Q

What is a potential risk factor with cryoprecipitate?

A

Increased risk of infection (not submitted to viral attenuation)

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17
Q

What is Factor VIII concentrate made of?

A

Pool of plasma from a large number of donors, does undergo viral attenuation
Contains F VIII and vWF

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18
Q

When is Factor VIII given?

A

Preop or intraop

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19
Q

When should DDAVP be given prior to surgery?

A

60mins before SX

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20
Q

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

A
  • Hematoma
  • Nerve compression
21
Q

What are the anesthesia considerations for someone with vWF deficiency?

A
  • Avoid trauma (particularly airway)
  • Avoid IM/SQ sticks
  • Avoid arterial lines (if feasible)
  • Avoid spinals
22
Q

Medications that can cause aquired bleeding

A
  • Heparin
  • Warfarin
  • Fibrinolytic
  • Antiplatelets
23
Q

How does heparin work?

A
  • Thrombin inhibition
  • Antithrombin III activation

Heparin won’t work on patients with antithrombin III deficiency

24
Q

What does thrombin do?

A

Converts fibrinogen to fibrin

25
Q

What labs are monitored with heparin?

A

PTT & ACT

26
Q

Reversal for Heparin

A

Protamine

27
Q

What is the mechanism of action of Coumadin?

A

Inhibition of vitamin K-dependent factors

28
Q

Which factors are vitamin-K dependent?

A

II, VII, IX & X

29
Q

What is the onset for Vitamin K administration?

A

6-8 hrs

30
Q

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

A
  • Prothrombin complex concentrates
  • Factor VIIa
  • FFP
31
Q

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

A

Convert plasminogen to plasmin, which cleaves fibrin causing clot dissolution

32
Q

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

A

Inhibit conversion of plasminogen to plasmin

33
Q

What is the best way to treat DIC?

A

Treat the underlying cause

…can also replete coag factors and platelets

34
Q

What is systematic activation of the coagulation system that simultaneously leads to thrombus formation and exhaustion of platelets and coagulation factors?

A

DIC

35
Q

What will labs show for someone in DIC?

A
  • ↓Platelet count
  • Prolonged PT, PTT & TT.
  • ↑ fibrin degradation products
36
Q

When is antifibrinolytic therapy given to someone in DIC?

A

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

37
Q

What is factor V Leiden?

A
  • Protein for normal clotting

Activated protein C inactivates factor V thus stopping clot growth.

38
Q

What is Factor V Leiden deficiency?

A

Genetic mutation where activated protein C cannot stop factor V Leiden, thus excessive fibrin

39
Q

What does activated protein C do?

A

Inactivates factor V when enough fibrin has been made.

40
Q

Anesthesia implication for Factor V Leiden

A

↑ risk of DVT/PE
Pt will probably be on anticoagulants

41
Q

Who is usually tested for Factor V Leiden?

A

Pregnant women. Especially ones with unexplained late stage abortions

42
Q

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

A
  • Warfarin
  • LMWH & unfractionated heparin
43
Q

What is the hallmark sign of HIT?

A

Plt count <100,000

thrombocytopenia

44
Q

HIT results in ____ activation and potential for____?

A

platelet; thrombosis

45
Q

What is heparin replaced with when HIT is diagnosed?

A

Agratroban, lepirudin, bivalirudin (direct-thrombin inhibitors)

46
Q

What is Fondaparinux & when is it used?

A
  • A synthetic Factor Xa inhibitor
  • Used to treat VTE in HIT
47
Q

What is the most common hereditary bleeding disorder?

A

vWF

48
Q

What is the most common reason for epistaxis?

A

Hypertension

…per Dr. C in class

49
Q

Which classification of vWF requires factor concentrates?

A

Type 3

Physical & Health Assessment COPY - Grayson (24 decks)

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