Oncogic Emergencies Flashcards
the inappropriate, systemic activation of the regulation Cascade that results in thrombosis and bleeding / hemorrhage is what oncologic emergency
disseminated intravascular coagulation
clot formation is also known as
thrombosis
clot breakdown is also known as
fibrinolysis
how is the process of thrombosis initiated?
through the destruction of the endothelial membrane and tissue injury.
tissue injury causes the release of_______ _______ into the circulation which leads to coagulation
tissue thromboplastin
what enzyme digests the components of a fibrin clot?
plasmin
what is the proteolytic enzyme that is responsible for both coagulation and fibrinolysis?
thrombin
what underlying conditions in the oncology patient may lead to excess circulating thrombin?
infection, malignancy, or trauma
excess thrombin results in what problem in the circulation?
multiple fibrin clots
excess clots in the circulatory system results in platelet traps which then causes what condition?
microvascular and macrovascular thrombosis
clot lodged in the vascular system leads to what problem?
ischemia, impaired organ perfusion, end-organ damage
the excess use of the coagulation factors in DIC is unable to be replaced which then leads to what problem?
excessive bleeding
excess plasmin in the circulatory system leads to what symptoms in DIC
shock, hypotension, increased vascular permeability
what diagnostic tests are done to diagnose disseminated intravascular coagulation,?
platelet count, fibrinogen level, D-dimer assay, FDP ( fibrin degradation products) titer
what tests are done to determine if accelerated quag ulation is a problem?
antithrombin III level, fibrinopeptide A level, prothrombin activation peptides, thronbin- antithrombin complexes
what tests are done to determine if accelerated fibrinolysis is a problem?
plasminogen level, plasmon Alpha 2 anti plasmin complex levels
what is the main goal of treatment related to DIC?
treatment of the underlying condition causing DIC, supporting the hemodynamics, manage the bleeding or thrombosis
how is the underlying condition for DIC typically treated?
chemotherapy for malignancy, antibiotics for infection
what hemodynamic support is often used in the patient with the DIC?
fluid replacement, oxygen therapy, administration of platelets, red blood cells, fresh frozen plasma, fibrinogen, cyroprecipitate
what treatment is used to replace quag ulation factors?
plasmapheresis
what does plasmapheresis do to help the patient with DIC?
it removes the triggers of coagulation
what lab values are decreased in the patient with DIC?
platelet count, fibrinogen level, antithrombin 3 level, plasminogen level, plasmon Alpha 2 antiplasmin complex
what lab values are increased in the patient with DIC?
D-dimer assay, fdp tighter, fibrinopeptide A, prothrombin activation peptides, thrombin antithrombin complex
What patients are at increased risk for developing DIC?
acute leukemia, mucin producing solid tumors, infection and sepsis, liver disease, hemolytic transfusion reactions, transplant reactions, Burns, trauma, pregnancy and obstetric complications, peritoneovenous shunts