Coagulation 7 Flashcards
Which coagulopathies present with a prolonged PTT and normal PT? (select 2)
a. hemophilia A
b. hemophilia B
c. factor 10 deficiency
d. factor 2 deficiency
a & b
Hemophilia A is
factor 8 deficiency
Hemophilia A is most common in
males
Severe hemophilia A is associated with
spontaneous bleeding in the joints, muscles, and vital organs
________ is prolonged with hemophilia A
PTT
Treatment options for hemophilia A include
factor 8 concentrate, FFP, cryo, and DDAVP
Hemophilia _ is usually more severe than hemophilia _
A; B
Hemophilia B is a _______ deficiency
factor 9
Anesthetic considerations for hemophilia B are
the same as with hemophilia A
________ is prolonged with hemophilia B
PTT
_____________ can be used to replace factor 9 in hemophilia B
factor 9 prothrombin complex
Factor-9 prothrombin complex concentrate is associated with
thromboembolic complications
____________ is a treatment option for hemophilia A & B
recombinant factor 7
Risks for recombinant factor 7 include
MI
embolic stroke
PE
DVT
Recombinant factor 7 is used as a
last ditch tx. for bleeding without an identifiable cause
The dose of recombinant factor 7 is
20-40 mcg/kg
Hemophilia A is a __________ chromosomal disorder
X linked
Mild disease of hemophilia A
does not cause spontaneous bleeding but is associated with increased surgical bleeding
The half-life of factor 8 is
8-12 hours so redosing may be required
All of the following can be used to reduce bleeding in the hemophilia A patient
factor 8
FFP
cryo
DDAVP (mild-moderate dx.)
antifibrinolytics
Factor 9 has a half-life of
18-24 hours
The dose of recombinant factor 7 for hemophilia patients is
90-120 mcg/kg
For a patient with severe form of hemophilia, what should always be performed before surgery?
Type and cross
A septic patient undergoing exlap has developed bleeding from the wound and around his IV sites. He has a platelet count of 40,000, fibrinogen of 95, and an elevated D-dimer. What is the BEST treatment for this patient?
a. heparin infusion
b. tranexamic acid
c. FFP
d. albumin
c. FFP
DIC is characterized by
disorganized clotting and fibrinolysis that leads to the simultaneous occurrence of hemorrhage and systemic thrombosis
Conditions with the highest risk of developing DIC include
sepsis
obstetric complications
malignancy
the definitive treatment for DIC is
reversing the underlying cause
supportive- treat hypovolemia with fluids, replaced consumed blood products with FFP, platelets, and Cryo, and consider IV heparin or LMWH for severe microvascular thrombosis
Signs of DIC include
ecchymosis, petechiae, mucosal bleeding, bleeding at IV puncture sites, prolonged PT & PTT, increased D-dimer and fibrin split products
Lab values for patients with DIC will include
increased PT/PTT
increased D-dimer
decreased platelets
decreased fibrinogen
The highest risk of sepsis related DIC is
gram-negative bacilli
The highest risk of obstetric related DIC is
preeclampsia
Highest risk of malignancy related DIC is
adenocarcinoma
A patient with a history of type 2 heparin-induced thrombocytopenia requires anticoagulation for cardiopulmonary bypass. What is the BEST treatment?
a. enoxaparin
b. heparin test dose
c. warfarin
d. bivalirudin
d. bivalirudin
Thrombotic disorders include
antithrombin deficiency
heparin-induced thrombocytopenia
protein C & S deficiency
Factor 5 Leiden mutation
Antithrombin inactivates factors
9a, 10a, 11a, and 12a which ultimately leads to thrombin factor 2a inhibition
Patients with antithrombin deficiency are unresponsive to
heparin
Treatment for antithrombin deficiency includes
AT concentrate & FFP
Heparin-induced thrombocytopenia causes
clot formation throughout the body
How many types if HIT are there?
2 types
Type 1 HIT resolves
spontaneously
Type 2 HIT causes
a hypercoaguable state
Complications of type 2 HIT include
amputation and death
Protein C and S work as a team to
inhibit factors 5a and 8a
A deficiency of protein C or S can produce
a hypercoaguable state, increasing the risk of thrombosis
For the patient with protein C and S deficiency, thromboembolism is treated with
heparin and the patient is transitioned to warfarin
Factor 5 Leiden causes a
resistance to the anticoagulant effect of protein C
____________________ is unwarranted with Factor 5 Leiden mutation unless
lifelong anticoagulation; the patient experiences recurrent thrombotic events
