CABS Coagulopathies Flashcards
CBC indices give information on what clinically?
Information about size, weight, hemoglobin concentration of the RBC’s - assists with classifying anemia
When do you transfuse a patient?
7
When do you transfuse someone with a cardiac condition?
8
What can cause thrombocytopenia?
Can result from severe infection and increased destruction or disseminated intravascular coagulation (DIC)
At what level of platelets will spontaneous bleeding occur?
< 15,000 (<15)
How long does it take for a clot to form via the extrinsic and common pathway when exposed to tissue factor?
Normally 11-13 seconds
What is international normalized ratio (INR) measuring?
Ratio of the prothrombin time measured and a control prothrombin time
INR = (Patient PT/ Control PT)
What is INR typically used for?
Monitoring Warfarin
What are the PT and INR uses?
Unusual bleeding
Concern for DIC
Baseline prior to starting anticoagulation
Monitoring Warfarin
Monitoring liver function
What are the uses of PTT?
Unexplained bleeding
DIC
Baseline before coagulation
Monitoring unfractionated heparin
What are the uses of D-Dimer?
Deep vein thrombosis
Pulmonary embolism
Disseminated intravascular coagulation
Tracking progress throughout a disease course (COVID)
Not specific
What is Virchow’s Triad?
Stasis, Hypercoagubility, and endothelial triad
What is a provoked clot?
You know WHY the clot happened!
One of the corners of Virchow’s triad - trauma, recent surgery, immobilization, cancer, estrogen use
What is an unprovoked clot?
We don’t know the source of clot, these patients need to go to hematology
What is the presentation of deep vein thrombosis (DVT)?
Increased swelling, distended (varicose) veins, pain, skin hyperpigmentation
What is Phlegmasia alba dolens?
White swollen leg associated with proximal DVT, concern for limb loss due to increased compartment pressures (compartment syndrome)
What is Phlegmasia cerulea dolens?
Dusky or blue leg associated with proximal DVT, concern for limb loss due to increased compartment pressures (compartment syndrome)
Who gets arterial thrombotic events?
Sick people- Diabetics, CHF, aFib, coronary heart disease
What is the pathophysiology (cause) of a pulmonary embolism?
Virchow’s triad causes clot.
Clot becomes loose and travels through the circulation to lodge in the pulmonary vasculature.
What conditions increases the risk of bleeding?
Von Willebrand Disease
Hemophilia
Platelet Disorders
Hemophilia A is a deficiency in what factor?
VIII
Hemophilia B is a deficiency in what factor?
IX
What does the deficiency in Hemophilia A and B going to cause?
Deficiency in these factors will decrease the ability to form the fibrin mesh over the platelet plug
What lab is going to be ordered to diagnose Hemophilia?
PTT
Viral illness in kids is most commonly associated with what bleeding disorder?
Immune Thrombocytopenia Purpura (ITP)
What does Immune Thrombocytopenia Purpura (ITP) normally present with?
Bleeding (mucosal)
Purpura, petechia
In a shocked state like hemorrhagic shock what is the cause of shock?
Loss of oxygen, ischemia
What is the pathophysiology of Heparin Induced Thrombocytopenia (HIT)?
IgG mediated response to Heparin resulting in platelet activation, platelet consumption
How does estrogen increase platelet aggregation?
Increases circulating fibrinogen, increases factors X, VII
What is Protein C dependent on?
Vitamin K
What factors does Protein C degrade?
Va and VIIa
The effects of Protein C Deficiency are pronounced on Warfarin, what is the common presenting symptom in this case?
Skin necrosis
How do you diagnose Hemophilia A and B?
aPTT (prolonged)
What type of genetic disorder is protein C and S deficiency?
Autosomal Dominant
