Layers of vessel
outer to inner
- Tunica Adventitia
- Tunica media
- Tunica Intima
Name the coag factors
Antihemophiliac factor (and vWf)
What is normal PT/INR?
What pathways does PT/INR measure
both common & Extrensic
what factors does PT/INR measure
III, VII (extrensic)
X, V, II,I (common)
what pathways does aPTT monitor
both common and Intrinsic
so what factors does aPTT monitor
XII, XI, IX, VIII (INTRENSIC)
X, V, II, I (COMMON)
what are normal values for Fibrinogen?
what pathway does fibrinogen monitor
what factors are monitored w/ fibrinogen
X, V, II, I
A fibrinogen level of what is associated w/spontaneous bleeding
< 100 mg/dL
what is normal fibrin split products
< 10 mg/L
Fibrin split products is a direct indication of what?
direct indication of activity of fibrinolytic activity
what is normal Bleeding time
what does bleeding time evaluate
platelet function/quality and vascular constriction capability
Bleeding time does not provide accurate _____ count
what is a wider-encompassing test of clot formation, stability, and lysis
name the main components of the TEG
during the fluid resucitation or massive blood transfusion, that is ___ fluid volume in 24 hrs, or ___ fluid volume in 3 hours, causes coagulation factors and platelets to become significantly diluted
what is the depletion of platelets secondary to markedly increased platelet consumption from coagulation pathway activity?
Thrombocytopenia may lead to microthrombi, resulting in purpura called what?
what can occur if the entire coagulation pathway is activated
What is platelet levels with DIC for
- MILD- 70,000-150,000
- MODERATE- 40,000-70,000
- SEVERE- 20,000-40,000
vascular occlusion by thrombi formation is unusual w/DIC, and the typical manifestation is what?
HELLP follows the same pathway as DIC, but is also combined with what?
elevated liver enzymes
what is the only effective treatment?
treatment of teh underlying cause
what is supportive therapy
Plasma and Platelet transfusions
What are 2 types of Autoimmune Coagulopathy
- Posttransfusion Purpura
- Drug induced Autoimmune Thrombocytopenic Purpura
what causes posttranfusion purpura
Exposure to blood products or some drugs that may induce antibody formation
in DIATP the drugs can act what?
a binding agent for the antibodies to adhere to platelets
What are the 2 types
- Tyoe I- nonimmune HIT- Seen on 1st day of heparim therapy (transient an dclinically insignificant
- Type II- Immune mediated HIT- formation of antibodies to heparin-platelet factor 4 complex
HIT tyoe 2 occurs when
5-10 days after heparin use
and can been seen if heparin therapy is restarted w/in 20 days of previous exposure
- Poss platelet transfusion
- D/C precipitating drug
- Hold Warfarin and oral contraceptives
- Delay CV sx
if thrombotic even occurs, administer what?
direct thrombin inhibitor
(argatroban and bivalirudin)
Coagulopathy in SIRS:
this is caused by what?
arises w/ the initiation of the imflammatory responses secondary to infection and decreased blood flow secondary to vasodilation
(AKA coag cascade activated)
Coagulopathy in SIRS:
what is management ?
- keep Hgb 7-9
- FFP for sx
- Keep platelets > 50,000
- ? hx of bleeding
- ? hx of bleeding gims w/ dental sx
- ? hx of liver insufficiency or malnutrition
- Coag workup
- Discuss transfusion possibility