Exam 3 Blood Disorders Flashcards
What are the S/S of vWF disorder?
Easy bruising
epistaxis
menorrhagia
What would lab values be for someone with vWF deficiency?
- Normal PT & aPTT
- Bleeding time is prolonged
What is the treatment for vWF deficiency?
- Desmopressin
- Cryoprecipitate
- Factor VIII
How does DDAVP work?
Stimulates vWF release from endothelial cells
What is the dose for DDAVP?
0.3 mcg/kg in 50 mL over 15-20 mins (Do not bolus)
What is the onset & duration of DDAVP?
- Onset in 30mins
- duration is 6-8hrs
What are side effects of DDAVP?
- HA
- hypotension
- tachycardia
- hyponatremia
- water intoxication(excessive water retention)
Someone that gets DDAVP needs to be on what?
Fluid restriction 4-6hrs before & after DDAVP
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?
Pool of plasma from a large number of donors.
When is Factor VIII given?
Preop or intraop
When should DDAVP be given?
30-60mins before Sx
Pts with coagulopathies undergoing neuraxial anesthesia are at increased risk for what?
- Hematoma &
- compression of neurological structures
What are the anesthesia considerations for someone with vWF deficiency?
- Avoid trauma
- avoid IM sticks
- avoid arterial lines (if feasible)
- avoid spinals,
How does heparin work?
- It inhibits thrombin
- activates antithrombin III
What labs are monitored with heparin?
PTT &/or ACT
What factors are affected by Coumadin?
Vitamin K-dependent factors II, VII, IX & X
What is the onset for Vitamin K?
6-8hrs
What can be given to reverse coumadin faster than Vit K?
- Prothrombin complex concentrates
- Factor VIIa
- FFP
How do UK, streptokinase & tPA act?
Convert plasminogen to plasmin, which cleaves fibrin
How do TXA, aminocaproic acid & aprotinin work?
Inhibit conversion of plasminogen to plasmin
What will labs show for someone in DIC?
- Reduced Plt.
- Prolonged PT, PTT & TT.
- Elevated fibrin degradation products
When is antifibrinolytic therapy given to someone in DIC?
It shouldn’t, it can lead to catastrophic thrombotic complications
What is Factor V Leiden?
- Genetic mutation that leads to increased fibrin production.
- Activated protein C cannot stop factor V
What does Activated Protein C do?
Inactivates factor V when enough fibrin has been made.
Who is usually tested for Factor V Leiden?
Pregnant women. Especially ones with unexplained late stage abortions
What anticoags could someone with Factor V Leiden be put on?
- Warfarin
- LMWH & unfractionated heparin
What is the hallmark sign of HIT?
Plt count <100,000
HIT results in ____ activation and potential____?
- Platelet activation
- venous & arterial thrombosis
What is heparin replaced with when HIT is identified?
Agratroban or bivalirudin
What is Fonaparinaux & when is it used?
- A synthetic Factor Xa inhibitor
- used to treat VTE in HIT
