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Blood Disorders Flashcards

Test 3 (83 cards)

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1
Q

vWF =

A

Von Williebrand factor

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2
Q

What is vWF?

A

A glycoprotein that plays a critical role in platelet adherence

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3
Q

How does vWF disorder present?

A

-Easily bruising
-Recurrent epistaxis (nosebleeds)
-Menorrhagia (heavy/long periods)

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4
Q

What is the most common hereditary bleeding disorder?

A

vWF disorder

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5
Q

vWF disorder has a strong _____ component

A

genetic

if parents have it –> child probably has it

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6
Q

Some types vWF disease will respond to ________. Which types?

A

DDAVP = Deamino-8-D-arginine Vasopressin

Type 1
Type 2A
Type 2M
Type 2B
(the less severe types)

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7
Q

what is the most mild type of vWF disease?

A

Type 1

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8
Q

What is the most rare/severe type of vWF disease?

A

Type 3

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9
Q

Which vWF disease types don’t respond to DDAVP?

A

Type 2N
Type 3
(the more severe types)

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10
Q

vWF disease will most likely require specific factor ____ concentrates

A

VIII (factor 8)

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11
Q

what do we need to do if a patient has vWF disease before taking them to the OR?

A

Consult hematology

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12
Q

How do labs look with vWF disease?

A

PT/aPTT normal
BT prolonged (bleeding time)

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13
Q

What is the Tx of vWF disease? (3)

A
  1. Desmopressin
  2. Specific factors
  3. Cryoprecipitate
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14
Q

What is the dosage for desmopressin? How is it given?

A

0.3 - 0.8 mcg/kg

In 50 ml of NS

Give over 15 - 20 mins (slowly)

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15
Q

What exactly is DDAVP? What does it do?

A

Synthetic analogue of vasopressin

Stimulates release of vWF by endothelial cells

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16
Q

You see the max affects of DDAVP in ______ mins and it last up to ______ hours.

A

30 mins

6-8 hrs

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17
Q

What are the main SE of DDAVP administration?

A

-HA
-Tachycardia
-Hyponatremia
-Water intoxication

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18
Q

Water intoxication –> _________

A

seizures

or

hyponatremia –> seizures

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19
Q

PO and IV hydration should be restricted for ______ after the use of DDAVP

A

4-6 hrs

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20
Q

What will pts taking DDAVP crave? What considerations should we have?

A

To drink water

They will even drink from the sink and toilet bc they are desperate for water. watch them closely.

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21
Q

CNS/ECG changes: Na+ 120

A

CNS: confusion; restlessness

ECG: widening of QRS

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22
Q

CNS/ECG changes: Na+ 115

A

CNS: Somnolence; Nausea

ECG: elevated ST; widen QRS

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23
Q

CNS/ECG changes: Na+ 110

A

CNS: seizures; coma

ECG: vtach; vfib

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24
Q

Chronic hyponatremic patient do ______ than acute hyponatremic patients

A

better

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25
DDAVP is _______ hyponatremia
acute
26
Cryoprecipitate has an increased risk of ________. Why?
Infection pooled together from multiple donors & Not submitted to viral attenuation/testing
27
Cryo is the ______ Tx for vWF disease.
secondary
28
1 unit of cryoprecipitate raises _______ levels by ________.
fibrinogen 50mg/dL
29
What does factor VIII concentrate consist of?
Factor 8 vWF
30
T/F: factor VIII concentrate doesn't go through viral attenuation
F It does --> decreases risk for infection **pulled from multiple donors**
31
When do you give factor VIII?
Preop Periop
32
When should DDAVP be administered?
60 Mins before Sx
33
What should you do if you find out your pt has vWF disease the morning of Sx? Why?
Cancel --> need to consult hematology Normalized BT & FVIII before Sx
34
What type of anesthesia do you do with vWF disease? Why?
GA Don't want to poke --> increase risk of bleeding --> hematoma/hemorrhage
35
What anesthesia considerations should we have with vWF disease?
-avoid trauma (including traumatic intubations) -arterial/CVC puncture not recommended --> use ultrasound if really needed -avoid IM
36
what is acquired bleeding? What causes this? What is the most common cause?
Bleeding that is caused by medications: **Heparin/ lovenox** (most common) Warfarin Fibrinolytics Antiplatelets
37
Heparin is ______ charged
Negatively
38
Describe heparin structure
CHO containing glucuronic acid residue
39
What is heparin's MOA?
Activates antithrombin III --> **inhibits thrombin** --> prevents conversion of fibrinogen to fibrin
40
T/F: heparin will work if you don't have antithrombin III
F Need antithrombin III to work
41
What lab should you monitor with heparin? How does it affect them?
PTT and ACT Increases
42
what is ACT? What are normal ranges? Therapeutic ranges?
Seconds it takes to clot from the time the blood is pulled Normal: <150 seconds Therapeutic: 350-400 secs
43
The reversal for heparin is ______
Protamine
44
LMWH is _______ effective at VTE prophylaxis than UFH
more (Lovenox)
45
Why is LMWH more predictable than UFH?
-fewer effects on platelet function -reduced risk for HIT
46
How often do we monitor for systemic heparin?
PTT/ACT q8-12 hrs
47
What is Coumadin's MOA?
Interferes with hepatic synthesis of vit K coag factors --> II, VII, IX, X
48
what are the vitamin K dependent coagulation factors?
II, VII, IX, X
49
What are the reversals for Coumadin? What are the differences between them?
Vitamin K: takes 6-8 hrs to work Prothrombin complex concentrates (PCC), recombinant factor VIIa, FFP: works faster than vitamin K --> used in acute situations to stop bleeding fast
50
Fibrinolytics work on _______ clots
Existing
51
What medications are Fibrinolytics?
tPA (tissue plasminogen activator) SK (streptokinase) UK (urokinase)
52
What is the MOA of Fibrinolytics?
Convert plasminogen to plasmin --> cleves fribrin --> dissolves clot
53
What drugs are antifibrinolytics?
-TXA -aminocaproic acid (cardiac Sx) -aprotinin (renal pts)
54
How does anti-fibrinolytic affect clots?
Stops the breakdown of clots
55
What was TXA originally designed for?
Prolonged/heavy periods Epitaxis with nose surgery
56
What is an AE of TXA toxicity?
Color vision loss
57
What consideration should I have with anti-platelets?
-DC drug on time -I can transfuse platelets -get platelet function panel
58
What is DIC?
Disseminated intravascular coagulopathy Systemic activation of coagulation system --> consumption of platelets --> thrombus formation and bleeding simultaneously
59
What causes DIC?
Trauma Amniotic fluid embolus Malignancy Sepsis Incompatible blood transfusions Tumors
60
T/F: DIC has an extremely high mortality
T
61
How does DIC affect your labs?
Increased pT/ptt/TT/concentration of soluble fibrin degradation products Decreased platelets
62
How is DIC treated?
**1st treat the underlying condition** -Replace coagulation factors/platelets -Plasmapheresis -exchange transfusion
63
Antifibrinolytic therapy is ________ in DIC. Why?
Contraindicated Potential catastrophic from thrombotic complications
64
What are two prothrombic disorders?
F V Leiden HIT
65
What is Factor V Leiden?
Mutations in factor V --> resistant to activation of protein C --> factor V continues to clot --> widespread clotting
66
what does protein C do in the clotting cascade?
Inactivates factor V when enough fibrin has been made to stop clots from growing larger than necessary
67
What is Factor V Leiden puts patient at an increased risk for?
DVT (w or w/o PE)
68
Factor V Leiden is normally silent until _______. How will this present?
Pregnancy DVT repeated missed abortions recurrent late fetal losses
69
How is Factor V Leiden treated?
Prophylactic anticoagulants: Warfarin UFH LMWH (lovenox)
70
T/F: Lovenox is heparin
T Lovenox is a type of LMWH
71
What type of anesthesia is used for pts w/ Factor V Leiden?
GA
72
What is HIT?
Heparin induced thrombocytopenia Autoimmune mediated drug reaction to any type of heparin.
73
HIT occurs in as many as ____% of pts getting heparin
5%
74
Thrombocytopenia in HIT occurs ______ after initial therapy
5-14 days
75
What is the Hallmark AE in HIT?
Decrease in platelets <100,000
76
What is the pathophysiology for HIT?
Platelet activation --> Decrease in platelets (thrombocytopenia) & widespread thromboses (hypercoaguable state)
77
What immune complexes is HIT mediated by?
IgG antibody platelet factor 4 (PF4) heparin
78
What is Tx for HIT?
**1. D/C ALL HEPARIN** 2. Administer an alternative: direct thrombin inhibitor --> bivalirudin, lepirudin, argatroban
79
What medication are direct thrombin inhibitor? (3)
Bivalirudin Lepirudin Argatroban
80
With HIT, what medication is commonly given for VTE?
Fondaparinaux (synthetic Factor Xa inhibitor) **Has a similar structure to heparin**
81
The immune complexes mediated during HIT clear within _____ months
3 months
82
T/F: HIT pts should avoid UFH
T **But idk I think I would just avoid heparin in general including LMWH**
83
What should you consider giving if administration of heparin in uneffective?
FFP --> has antithrombin III heparin cant work w/o antithrombin III

Assessment (22 decks)

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