DIC

Question 1

Thrombosis Neuro s/s (3)

Answer 1

• AMS
• Delirium
• Coma

Question 2

Thrombosis Integumentary (2)

Answer 2

• focal ischemia

- gangrene

Question 3

Thrombosis Renal (2)

Answer 3

• oliguria

- azotemia

Question 4

Thrombosis Pulmonary (1)

Answer 4

• ARDS

Question 5

Thrombosis GI (1)

Answer 5

• Paralytic Ileus

Question 6

Fibrinolysis Neuro (2)

Answer 6

• Intracerebral bleeding

- AMS

Question 7

Fibrinolysis Integumentary (3)

Answer 7

• Petechiae
• Echymoses
• Bleeding from IV site

Question 8

Fibrinolysis Renal (1)

Answer 8

• Hematuria

Question 9

Fibrinolysis Pulmonary (3)

Answer 9

• respiratory congestion
• dyspnea
• hemoptysis

Question 10

Fibrinolysis Mucous Membranes (2)

Answer 10

• epistaxis

- gingival oozing

Question 11

Fibrinolysis GI (1)

Answer 11

• massive bleed

Question 12

Thrombin generation leads to 3 activities

Answer 12

• intravascular fibrin deposition
• plasminogen activation
• platelet consumption

Question 13

DIC Diagnostics - prolonged (3)

Answer 13

• PT
• INR
• aPTT
  Related to clotting factor depletion

Question 14

DIC Diagnostics - decreased (4)

Answer 14

• Platelets
• Factor Assay
• Fibrinogen
• Anti-thrombin

Question 15

DIC Diagnostics - increased (2)

Answer 15

• FDP (byproduct of fibrinolytic activity)

- D Dimer (presents with fibrinolysis)

Question 16

When to transfuse platelets

Answer 16

• bleeding and < 50,000

- high risk of bleeding and < 20,000

Question 17

When to transfuse FFP

Answer 17

• bleeding and PT/aPTT > 1.5 normal

- fibrinogen < 1.5 g /dL

Question 18

When to transfuse fibrinogen concentrate or cryoprecipitate

Answer 18

• bleeding and hypofibrinogenemia < 1.5 g/dL despite FFP replacement

Question 19

Normal Fibrinogen

Answer 19

• Clotting Factor 1
• Non-vitamin K dependent
  200-400 mg/dL

Question 20

When is Fibrinogen increased?

Answer 20

In sepsis (because inflammation causes clotting!), burns, inflammatory and collagen diseases

Question 21

Normal D Dimer

Answer 21

• Fibrin-split product
• Presence represents fibrinolysis specific to DIC, PE, DVT, and arterial thrombosis (MI)
• Normally not present

Question 22

Normal Fibrinogen Degradation split Product (FDP)

Answer 22

• Byproduct of fibrinolytic activity
• Reflects primary fibrinolysis
  < 10 mcg / mL

Question 23

Normal PT

Answer 23

• clotting factor 2
• vitamin K dependent
• think COUMADIN!
  11-16 seconds