Blood Disorders (Exam III) Marcus's Cards Flashcards
What are the S/S of vWF disorder?
- Easy bruising
- epistaxis
- menorrhagia
- Patients usually unaware until surgery
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
- Cryoprecipitate
- Factor VIII
How does DDAVP work in regards to treatment of vWF?
- A synthetic analogue of vasopressin
- Stimulates vWF release from endothelial cells
What is the dose for DDAVP?
0.3 mcg/kg-0.8mcg/kg in 50 mL over 15-20 mins (Do not bolus)
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
1 unit of Cryo raises the ____ level by ___?
Fibrinogen by 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?
- Prepared from pool of plasma from a large number of donors
- Undergoes viral attenuation, still high risk for infection
When is Factor VIII given?
Preop or intraop
When should DDAVP be given prior to surgery?
60mins before Sx
What blood product poses an increase risk for infection? Why?
- Cryoprecipitate
- Not sent for viral attenuation
Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?
- Spinal and epidural hematoma
- Nerve compression
What four things to avoid?
What are the anesthesia considerations for someone with vWF deficiency?
- Avoid trauma (particularly airway)
- avoid IM sticks
- avoid arterial lines (if feasible)
- avoid spinals
How does heparin work?
- Thrombin inhibition
- Antithrombin III activation
What labs are monitored with heparin?
PTT &/or ACT
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?
6-8hrs
3
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 lysis
How do tranexamic acid (TXA) and aminocaproic acid work?
Inhibit conversion of plasminogen to plasmin
What is the best way to treat DIC?
Treat the underlying cause
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
Prothrombin disorder
What is factor V Leiden?
- Protein for clotting.
- When enough fibrin has been made, activated protein C inactivates factor V thus stopping clot growth*.
What is Factor V Leiden disease?
- Genetic mutation in factor V
- Abnormal version of factor V that is resistant to activated protein C —> excessive fibrin and clotting
Factor V Leiden is usually silent until?
- Pregnancy
- First presention of DVT, repeated late-stage abortions/fetal losses occurs
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
What is HIT?
- An autoimmune-mediated drug reaction
- HIT activates platelets –> causes clotting –> depletes platelet count
Non-heparin anticoagulants used after HIT?
Direct-thrombin inhibitors
* Agratroban
* Bivalirudin
Factor Xa Inhibitor
* Fondaparinaux in place of lovenox
Diagnosis of HIT should be entertained when?
- For any patient experiencing thrombosis or thrombocytopenia during/after heparin administration
