Lecture 10 - coagulation abnormalities Flashcards
__ disorders of coagulation are more common than congenital disorders of coagulation
aquired (DIC, hypercoagulable states, liver dz, vitamin K antagonism or deficiency, snake envenomation)
What is the most common coagulation abnormality
von willebrand’s dz
__ is seen in critically ill patients and is ALWAYS secondary to another dz
DIC (must treat BOTH primary dz and DIC)
DIC is uncontrolled continued activation of __ and __
BOTH coagulation and fibrinolysis
why does DIC lead to uncontrolled bleeding
depletes coagulation factors and platelets
why does DIC lead to microvasculare obstruction
produces excess intravascular clots
phase 1 of DIC
Hypercoagulable phase (organ dysfucntion due to lack of O2/perfusion)
During the hypercoagulable phase death may occur before hemorrhage bc
multiple organ dysfunction (ischemia/low perfusion)
outward clinical signs of DIC are limited an may go unrecognized with out doing __ test
coagulation
hypercoagulable phase (phase 1 DIC) is characterized by __ leading to organ dysfunction
thromboses (many thrombi from primary site)
Phase 2 DIC is the __ phase
consumptive phase
Consumptive phase (Phase 2 DIC) is characterized by uncontrolled consumption of __ and __
platelets and coagulation factors
What are the consequences of Phase 2 DIC
Bleeding
What are the consequences of Phase 1 DIC
organ dysfunction
Consumptive phase (phase 2) is a mixture of __ and __ bleeding
platelet type and coagulopathy type
platelet type bleeding is characterized by
petichea and ecchymosis
coagulopathy type bleeding is characterized by
bleeding into cavities (abdomen, thorax, joints)
4 pathologies that can cause DIC
- tissue factor and procoags released from dead or cancerous tissue
- vasculitis
- proteolytic enzymes activate coag factors (envenomation, pancreatitis)
- stagnant blood flow
severe tissue damage and inflammation can cause
DIC
Be on the lookout early for DIC in __
ill patients (lots of causes for DIC)
__ is a common blood film finding for DIC
Fragmentation hemolysis (microangiopathic hemolytic anemia) - schystocytes, keratocytes
5 lab findings for DIC
- Anemia
- thrombocytopenia
- acanthocytes
- schistocytes (fragmentation)
- prolonged coagulation factors (PT, PTT, ACT)
- Decreased fibrinogen and AT3
- increased FDPs and d-dimers
Coagulation tests can be __ due to the dynamic nature of DIC
Variable (typically prolonged)
will see increased ___ due to plasmin breaking down fibrin
FDPs
__ is helpful in early recognition of DIC but is a send out test that is not readily available
thromboelastography
__promotes clot formation by stimulating platelet aggregation
thrombin
__ activates multiple coagulation factors (1, 5, 8, 11, 13)
thrombin
thrombin promotes clot persistence via __ and also decreases clot formation via __ activation.
TAFI (thrombin-activatable fibrinolysis inhbitor), activates protein C and TFPI
Check and balance coagulation factor is __
antithrombin 3 (anticoagulant factor, if lose this can become hypercoagulable)
In protein losing nephropathy proteins leak out of kidneys, lose __ causing hypercoagulability (prone to forming clots)
antithrombin 3 (small protein, anticoagulation factor)
petechiation and mucosal hemorrhages are __ type bleeding
platelet
coagulation factors are made in the __ so need to screen for coagulation abnormalities prior to biopsy or surgery with dz
liver
vitamin K deficiency causes coagulopathy (clotting issues) due to decreased production of __. What is a good test to screen for this?
vitamin k dependent factors 2, 7, 9, 10. TP (7 has shortest half life)
5 Causes of vitamin K def or antagonism
- anticoagulant rodenticide intoxication
- moldy sweet clover
- gut sterilization
- fat malabsorption or maldigestion (bile obstruction)
- dietary def (rare)
vitamin K def will see __ coagulation tests
prolonged (PT first)
coagulopathic patients with vitamin K def will need __ and __ STAT and __ if severe hemorrhagic anemia. If bleeding into cavities may need __. Avoid __. Will need to be put on __ for at least a month
fresh frozen plasma and fresh whole blood.
O2 cage.
thoracocentesis
traumatic things and drugs that inhibit platelet function
vitamin K replacements
__ is a very large, multimeric protein important to platelet adhesion and aggregation (primary hemostasis)
von Willebrand factor
von willebrand dz is the most common hereditary bleeding disorder effecting
primary hemostasis/platelet function = bleeding tendency
vWD have various types that relate to degree of bleeding. Name some predisposed breeds
dobermans, german pointers, scottish terriers, shelties
a __ state has vWF concentration around 30-70%
vWD carrier
a __ state has a vWF concentration less than 35%
vWD symptomatic
vWD clincal signs
petechiae and mucosal bleeding
cutaneous bruising
prolonged hemorrhage and BMBT
Test of choice for vWD is
BMBT (if BMBT is normal can send out for vWF test)
