Hemostasis 2 Flashcards
types of hemophilia
hemophilia a: factor 8
hemophilia b: factor 9
clinically indistinguishable
t/f in males, just having 1 x chromosome will make the patient express the trait
true
if the father has hemophilia and the mother is not a carrier
all sons are normal
all daughters are obligatory carriers
if the father does not have hemophilia and the mother is a carrier
all sons have a 50% chance of being affected
all daughters have a 50% change of being carriers
symptoms of hemophilia
hemarthrosis
sites of bleeding: knees, iliopsoas, gluteal area, soft tissue, intracranial bleed
mild bleeding severity for hemophilia
5-<40% of normal clotting factor level
episodes: spontaneous bleeding with major trauma or surgery, rare spontaneous bleeding
moderate bleeding severity for hemophilia
1-5% of normal CFL
occasional spontaneous bleeding, prolonged bleeding with minor trauma or injury
severe bleeding severity for hemophilia
<1% of normal CFL
spontaneous bleeding without hemostatic challenge
treatment for hemophilia
factor replacement
antifibrinolytic therapy (txa)
rehabilitation
types of factor replacement for hemophilia
factor 8 (for a) factor 9 (for b) cryoprecipitates (a) and cryosupernates (b)
cryoprecipitEIGHTS
cryosuBernates
principle of rehabilitation for hemophilia
patients develop target joints –> always swollen –> joints will be destroyed
characteristics of dic
- uncontrolled generation of thrombin due to tissue factor being activated
- widespread intravascular fibrin formation due to excess blood protease activity
pathophysio of dic
- high fibrin + thrombin -> ischemic damage -> multiple organ failure
- rbc damage and hemolysis due to fibrin clots
- excess fibrin -> secondary fibrinolysis -> fdp production d-dimer
most sensitive test/marker for dic
fdp d-dimer
common causes of dic
sepsis (cocci) immunologic disorders trauma and tissue injury drugs vascular disorders envenomation (snake/insects) OB complications liver disease cancer (APL) misc
symptoms of dic
thrombocytopenia
prolonged pt and ptt (consumed coagulation factors both in intrinsic and extrinsic pathway)
diagnosis of dic
low platelet count
low fibrinogen level
prolonged ptt
increased d-dimer or fibrin degradation products
differential diagnosis for dic
itp = labs are normal ttp = closer to dic labs
treatment for dic
treat underlying cause transfusion - fresh frozen plasma - cryoprecipitates - platelet concentrates heparin
arterial vs venous thrombosis
arterial: atherosclerosis
venous: due to immobility, surgery, or underlying medical condition
what is unprovoked thrombosis
not caused by immobility, drugs, surgery, or underlying conditions
strongest predictor in recurrence
treated with anticoagulant indefinitely
virchow’s triad
blood: hypercoagulable
vessel: vascular damage
flow: circulatory stasis
risk factors for thrombosis
history: provoked/unprovoked?
age and gender
family history (factor v leiden)
malignancy
inherited venous risk factors for thrombosis
factor v leiden
protein c deficiency
protein s deficiency
elevated factor 8
acquired venous and arterial risk factors for thrombosis
malignancy (should be given anticoagulants)
acquired venous risk factors for thrombosis
previous thrombosis
immobilization
major surgery
obesity
