Heme Emergencies Flashcards
WHat are the 3 phases of hemostasis?
- primary: vasoconstriction and platelet plug
- secondary: coagulation (factors)
- tertiary: fibrinolysis
Kids who get their wisdome teeth pulled and get dry sockets, what type of disorder is most likely?
-vonWillebrands
they are oozers, usually vWF deficient.
When would we check the D-dimer levels? What is D-dimer?
-when we think we are clotting, D-dimer is the measure of fibrinolysis
Where are all pro-coagulants synthesized?
all pro-coagulants are synthesized in the liver, EXCEPT for vWF this is synthesized in the endothelium)
What is the only thing to break down clots?
tPA
What does protein C do? S?
- acts as an anticoagulant by inactivating factors V and VIII
- S breaks down fibrin into fibrin degredation products(D-dimer) that act as anticoagulants
Physiology of Fibrinolysis
- plasminogen binds firbin and tissue plasminogen activator (tPA)»> leading to conversion of plasminogen to active plasmin.
- plasmin cleaves fibrin strand at multiple sites and releases fibrin degradation products (D-dimer)
Hemophilia
Signs
What pathway is impaired?
what test will be prolongated? normal?
- *Swollen, painful joints
- local bleeding out of proportion with injury
- any other bleeding
Impaired synthesis of functioning of the intrinsic pathway (VIII, IX, XI, and XII)
Prolongation of the aPTT and the Pt will remain normal
-Patients with hemophilia do not bleed more profusely or more quickly but bleed for a longer time.
Hemophilia A=VIII
Hemophilia B=IX
(x-linked recessive)
Lab findings of Hemophilia A
hemophilia b?
A:
PTT prolonged
reduced factor VIII
Normal vWF
B:
PTT prolonged
reduced factor IX
Physical Exam findings in -Platelet Defects/Deficiences
- Coagulataion Factor Defects
- Any bleeding disorder
Platelet:
-prolonged superficial bleeding, epistaxis, gingival and mucosal bleeding, purpura, petechiae
Coagulation:
-cannot effectively reinforce platelet-initiated hemostasis, recurrent bleeding into deep structures, muscles, joints, and retroperitoneum.
Any:
-ecchymosis, GI bleeding, Menorrhagia
Physical exam findings of anemic pt
- pallor, skin and conjunctiva
- tachycardia
- systolic murmurs (Cardiac output is higher b/c you are compensating for lack of O2)
- tachypnea at rest
- hypotension
Vitamin K Source required for synthesis of? Most commonly seen in? (who) Antidote for what drug?
green veggies
required for synthesis of factors II, VII, IX, X, and Protein C and S
extrinsic
Alcoholics! and chronic kidney disease, poor diet, malabsorption
Warfarin! (managing high INR values)
Von Willebrands Disease
signs and symptoms
Lab findings
excessive menstrual and postpartum bleeding GI bleeding epistaxis gingival bleeding easy bruising UNCOMMON for joints to be involved
Lab- prolonged bleeding time PTT may be prolonged PT and platelets normal Factor VIII decreased vWF levels low
- ingestion of aspirin can precipitate bleeding that may not have occurred otherwise
- some pts remain asymptomatic
Vitamin K Source required for synthesis of? Most commonly seen in? (who) Antidote for what drug?
green veggies
required for synthesis of factors II, VII, IX, X, and Protein C and S
extrinsic
Alcoholics! and chronic kidney disease, poor diet, malabsorption
Warfarin! (managing high INR values)
Aspirin
inhibits what?
effects last for how long
IRREVERSIBLY inhibits cyclooxygenase in platelets
Effects last for 7 days
