Hemodynamics II Lecture (Dr. Galbraith) TEST 1 Flashcards
1
Q
Defects of Secondary Hemostasis
A
- Often present with BLEEDING into Joints (Hemarthrosis) or soft tissue
- Due to Coagulation factor DEFICIENCIES, which may be Hereditary or acquired
2
Q
PT
A
- Extrinsic Pathway
- VII, X, V, II, Fibrinogen
3
Q
PTT
A
- Intrinsic Pathway
- XII, XI, IX, VIII, X, V, II, Fibrinogen
4
Q
Acquired Coagulation Protein Deficiencies
A
- Consumptive Coagulopathy (DIC)
- Liver Disease
- Vitamin K Deficiency
- Massive Transfusion
- Coagulation Protein Inhibitors
5
Q
Disseminated Intravascular Coagulation
A
- Activation of the Coagulation and Fibrinolysis Systems –> simultaneous production of THROMBIN and PLASMIN
a) Widespread Microthrombi
b) Consumption of Coagulation factors
c) Consumption of platelets - Is not a single disease, but rather, a complication arising from different causes:
a) Sepsis, complications related to childbirth, massive trauma, malignancy - Lab studies show ELEVATED PT and PTT, Low Fibrinogen, Increased Fibrin Degradation products (D-Dimers), and THROMBOCYTOPENIA
- What begins as widespread Thrombosis may evolve into Widespread Hemorrhage, due to consumption of factors and platelets
- May also result in Intravascular Hemolysis
a) Schistocytes
** Mostly occurs is SEPSIS!!!!!!**
6
Q
Liver Disease
A
- Most coagulation factors are made in the Liver
- Severely Decreased liver function —> Decreased Synthesis
a) ELEVATION of PT and PTT - Abnormal factors may be Synthesized
a) Dysfibrinogenemias
7
Q
Vitamin K Deficiency
A
- Lipid soluble vitamin, found in Leafy greens and synthesized by Gut Flora
- Essential for production of functional factors X, IX, VII, II (Prothrombin) (“1972”), Proteins C and S
Deficient:
a) In patients receiving WARFARIN/ Coumadin
b) Malnourished or prolonged parenteral Nutrition
c) Prolonged antibiotics
8
Q
Massive Transfusion
A
- Has been defined as replacement of 1.5x blood Volume in 24h
- Results from DILUTION of factors by replacing with packed RBC and Normal Saline
a) Increased PT and PTT, Decreased Fibrinogen and Platelets
9
Q
Acquired Factor Inhibitors
A
- Antibody to a coagulation factor
- Most common factor to be clinically significantly INHIBITED is Factor VIII !!!!!!!!!!!!!
- May occur in Multiple Clinical scenarios, such as:
a) B Cell Lymphoma/ Plasma Cell Neoplasms
b) Amyloidosis - Mixing study may help determine whether abnormal clotting times are due to a decreased amount of actor, or presence of an Inhibitor
10
Q
Embolism
A
- DEFINITION:
“An Embolus is a detached Intravascular Solid, Liquid, or Gaseous mass that is carried by the blood from its point of Origin to a distant site, where it often causes tissue dysfunction or infarction” - Most arise from a THROMBUS
- Clinical importance depends on the size and the location of the Embolus
a) It will travel until it reaches a vessel with a Lumen too small to admit its passage
11
Q
Pulmonary Embolism (PE)
A
- Embolus lodged within the Pulmonary Arterial Vasculature
- Greater than 95% arise from DEEP VENOUS THROMBI (DVT) of the Legs
a) The Embolus travels through the Venous System to the right side of the Heart and out of the Pulmonary Artery - The Embolus can be a single large fragment of Thrombus or a shower of smaller fragments
- History of having a PE is a risk factor for RECURRENCE
- Most are silent, due to SMALL SIZE
- Sudden death or Right Heart Failure may occur when at least 60% of the Pulmonary Arterial circulation is obstructed
- Multiple small Emboli over time may organize and lead to Pulmonary Hypertension and subsequent Right Heart Failure
12
Q
Systemic Thromboembolism
A
- Approximately 80% arise from the HEART
- Other sources include:
a) Thrombi from AORTIC ANEURYSM
b) Thrombi from ATHEROSCLEROTIC Plaques
c) CARDIAC Valves (“Vegetations”)
d) PARADOXICAL Emboli
- May lodge in a variety of sites:
a) Major go to LOWER EXTREMITIES
b) Brain
13
Q
Fat and Marrow Embolism
A
- Usually caused by BONE FRACTURE, the trauma of which translocates Marrow/ Fat globules into Venous Sinuses and then travel to the LUNGS
- In the vast majority of cases it is Subclinical, but a MINORITY (about 10%) experience FAT EMBOLISM SYNDROME
Results:
a) PULMONARY INSUFFICIENCY
- Dyspnea, Tachypnea, Tachycardia
b) NEUROLOGIC SYMPTOMS:
- Irritability, Delirium, Coma
c) ANEMIA and THROMBOCYTOPENIA (Diffuse PETECHIAL RASH)
- Platelets and Erythrocytes through to aggregate around FAT GLOBULES and become Sequestered/ removed in the Spleen or otherwise OCCLUDE MICROVASCUALTURE in the Lungs and Brain
14
Q
Air Embolism
A
- Gas Bubbles can OBSTRUCT Small Vessels
- May be introduced Surgically
a) Vascular, Neurosurgical, Laparoscopic - Decompression Sickness
a) The Bends, seen in divers who ascend too quickly
15
Q
Amniotic Fluid Embolism
A
- RARE but serious complication of Childbirth
a) Incidence 1 in 40,000 deliveries, mortality up to 80% - Amniotic fluid and/or fetal tissue enter Maternal Circulation and may cause Obstructive Effects, but much of the MORBIDITY may be due to development of DIC
