Blood Disorders (Exam II) Flashcards
What are the S/S of vWF disorder?
- Easy bruising
- Epistaxis
- Menorrhagia
What would lab values be for someone with vWF deficiency?
- Normal PT & aPTT
- Bleeding time is prolonged
What are the treatments for vWF deficiency?
- Desmopressin (DDAVP)
- Cryoprecipitate
- Factor VIII
What is the best diagnostic lab value in vWD?
ACT
PT/aPTT are often normal
How does DDAVP work in regards to treatment of von Willebrand deficiency??
Stimulates vWF release from endothelial cells
What is the dose for DDAVP?
0.3 mcg/kg in 50 mL over 15-20 mins (Do not bolus)
Max effect in 30min, lasts 6-8hrs
What is the onset & duration of DDAVP?
- Onset: 30mins
- Duration: 6-8hrs
What are side effects of DDAVP?
- HA
- Stupor
- Hypotension
- Tachycardia
- Hyponatremia
- Water intoxication (excessive water retention)
What is the most major side effect of DDAVP?
Hyponatremia
Someone that gets DDAVP needs to be on what?
Fluid restriction 4-6hrs before & after DDAVP
What blood product can be utilized for vWF disease if the patient is unresponsive to DDAVP?
Cryoprecipitate
What S/S would you expect with Na+ of 120?
Confusion, restlessness, widened QRS
What S/S would you expect with Na+ of 115?
Somnolence, nausea, elevated ST, widened QRS
What S/S would you expect with Na+ of 110?
Siezures, coma, vtach/vfib
Give hypertonic saline 3% as bolus until seizing stops
1 unit of Cryo raises the ____ level by ___?
fibrinogen, 50 mg/dL
What is a potential risk factor with cryoprecipitate?
Increased risk of infection (not submitted to viral attenuation)
What is Factor VIII concentrate made of?
Pool of plasma from a large number of donors, does undergo viral attenuation
Contains F VIII and vWF
When is Factor VIII given?
Preop or intraop
When should DDAVP be given prior to surgery?
60mins before SX
Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?
- Hematoma
- Nerve compression
What are the anesthesia considerations for someone with vWF deficiency?
- Avoid trauma (particularly airway)
- Avoid IM/SQ sticks
- Avoid arterial lines (if feasible)
- Avoid spinals
Medications that can cause aquired bleeding
- Heparin
- Warfarin
- Fibrinolytic
- Antiplatelets
How does heparin work?
- Thrombin inhibition
- Antithrombin III activation
Heparin won’t work on patients with antithrombin III deficiency
What does thrombin do?
Converts fibrinogen to fibrin
What labs are monitored with heparin?
PTT & ACT
Reversal for Heparin
Protamine
What is the mechanism of action of Coumadin?
Inhibition of vitamin K-dependent factors
Which factors are vitamin-K dependent?
II, VII, IX & X
What is the onset for Vitamin K administration?
6-8 hrs
What drugs/products can be given to reverse coumadin faster than Vit K?
- Prothrombin complex concentrates
- Factor VIIa
- FFP
What is the mechanism of action for fibrinolytics (UK, streptokinase & tPA)?
Convert plasminogen to plasmin, which cleaves fibrin causing clot dissolution
How do tranexamic acid (TXA), aminocaproic acid, and aprotinin work?
Inhibit conversion of plasminogen to plasmin
What is the best way to treat DIC?
Treat the underlying cause
…can also replete coag factors and platelets
What is systematic activation of the coagulation system that simultaneously leads to thrombus formation and exhaustion of platelets and coagulation factors?
DIC
What will labs show for someone in DIC?
- ↓Platelet count
- Prolonged PT, PTT & TT.
- ↑ fibrin degradation products
When is antifibrinolytic therapy given to someone in DIC?
Trick question, it shouldn’t. Can lead to catastrophic thrombotic complications.
What is factor V Leiden?
- Protein for normal clotting
Activated protein C inactivates factor V thus stopping clot growth.
What is Factor V Leiden deficiency?
Genetic mutation where activated protein C cannot stop factor V Leiden, thus excessive fibrin
What does activated protein C do?
Inactivates factor V when enough fibrin has been made.
Anesthesia implication for Factor V Leiden
↑ risk of DVT/PE
Pt will probably be on anticoagulants
Who is usually tested for Factor V Leiden?
Pregnant women. Especially ones with unexplained late stage abortions
What anticoagulant medications could someone with Factor V Leiden be put on?
- Warfarin
- LMWH & unfractionated heparin
What is the hallmark sign of HIT?
Plt count <100,000
thrombocytopenia
HIT results in ____ activation and potential for____?
platelet; thrombosis
What is heparin replaced with when HIT is diagnosed?
Agratroban, lepirudin, bivalirudin (direct-thrombin inhibitors)
What is Fondaparinux & when is it used?
- A synthetic Factor Xa inhibitor
- Used to treat VTE in HIT
What is the most common hereditary bleeding disorder?
vWF
What is the most common reason for epistaxis?
Hypertension
…per Dr. C in class
Which classification of vWF requires factor concentrates?
Type 3
