Coagulation Disorders Flashcards
Bleeding Disorder Presentation
Increased bruising bleeding with trauma more than expected frequent nosebleeds bruising without trauma Menstrual blood is abnormally clotted
Coagulation Disorder Labs
CBC with PLT count Blood smear PT aPTT thrombin time fibrinogen level plt fucntion analysis
PT
measures the extrinsic system and common coagulation pathway
-factors VII, X, V, II, and fibrinogen
aPTT
Measures function of intrinsic and common pathway
Preallikrein, Factors XII, X, IX, V, II and fibrinogen
Prolonged PT or INR
Liver disease Early Vitamin K deficiency Warfarin therapy Factor VII deficiency Factor Xa inhibitors
Prolonged aPTT
Factor VIII, IX, XI, XII deficiency
von Willebrand Disease
Heparin therapy
Dabigatran effects
Prolonged PT and aPTT
DIC
Advanced liver disease
Severe vitamin K deficiency or warfarin
Negative Bleeding History but abnormal blood tests
Consider effects of meds such as NSAIDs, ASA, anticoagulants, allergies, concurrent illness
Bleeding Disorder Lab Testing Instructions
Free of medications for 2 weeks
Overnight fasting
Hematology Refer
Patients with bleeding disorder required hematology evaluation unless it is definitive result of excess warfarin or heparin / aspirin
von Willebrand Disease
Most common congenital bleeding disorder Defect in vWF CBC usually normal PT/aPTT usually normal vWF antigen decreased
Requires extensive testing to confirm, dont rely on one test
Hemophilia
Low levels of Factor VIIi - Type A Hemophilia (A rhymes with 8 sorta)
Low levels of Factor IX - Type B Hemophilia
Hemophilia Symptoms
Delayed bleeding
Hypertrophy and joint inflammation
Psoas muscle bleeding can cause diffuse abdominal or hip pain
aPTT is usually delayed and further investigation shows low Factor VIII or Factor IX
Hemophilia Categories
Mild - little spontaneous bleeding
Moderate - some spontaneous bleeding
Severe - Often spontaneous bleeding
Moderate and Severe require infusions of missing factor, may respond to DDAVP temporarily
Thrombosis Risks
Arterial = atherosclerosis is the biggest risk
Venous = smoking, obesity, diabetes, chronic inflammatory state, immobility
Virchow Triad
Pathogenesis for VTE
Changes in blood vessel walls, blood flow, coagulability of blood
Superficial v. Deep Thrombi
Thrombi in the superficial veins manifest with localized tenderness at the site, redness, a feeling of warmth, and possible swelling of the affected limb. Because the vein is close to the surface, it may feel hard or ropelike when examined.
The clinical features of DVT include pain, swelling, and erythema of the affected extremity.
Pulmonary Embolus Warning Signs
May be asymptomatic
Dyspnea, chest pain, palpitations, syncope, feeling of impending doom
D-Dimer Test
Test for suspected VTE
Negative can rule out a VTE, but positive does not rule it in!
DVT Diagnostics
D-Dimer test
Ultrasound for limbs, but not good in calf
CT with contrast is best
V/Q scan no longer recommended
DVT Management
Is suspected PE or risk, refer to ED
Heparin (LMW) is given and warfarin started. Heparin is used to bridge until warfarin effectiveness, usually 5 days.
If a patient reports taking too much warfarin for the last five days, what should you do?
Vitamin K antagonizes warfarin. If INR is greater than 5, they need treatment
Normal INR is 1, Warfarin treatment goal is 1-2.
A patient with diagnosed vWD reports bleeding episodes, what is the treatment?
Desmopressin and refer to the ED or hematology
Treatment for Hemophilia A bleeding issues
Factor VIII infusion
