Coagulation PPT- Josh Flashcards Preview

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Flashcards in Coagulation PPT- Josh Deck (40):
1

Layers of vessel

outer  to inner

 

  • Tunica Adventitia
  • Tunica media
  • Tunica Intima

2


Name the coag factors

 

  • I
  • II
  • III
  • IV
  • V
  • VII
  • VIII
  • IX
  • X
  • XI
  • XII
  • XIII

  1. fibrinogen
  2. Prothrombin
  3. Tissue factor
  4. Calcium
  5. Proaccelerator
  6. nothing
  7. Procovertin
  8. Antihemophiliac factor (and vWf)
  9. Christmas Factor
  10. Stuart-power factor
  11. Plasma thromboplastin
  12. Hageman factor
  13. Fibrin-stabalizing factor

3

Lab Testing:

What is normal PT/INR?


11-12.5 sec

0.8-1.1

4

Lab Testing:

What pathways does PT/INR measure


both common & Extrensic

5


Lab Testing:

what factors does PT/INR measure


III, VII (extrensic)

X, V, II,I (common)

6


Lab Testing:

normal aPTT


30-40 sec

7

Lab Testing:

what pathways does aPTT monitor


both common and Intrinsic

8


Lab Testing:

so what factors does aPTT monitor


XII, XI, IX, VIII (INTRENSIC)

X, V, II, I (COMMON)

9


Lab Testing:

what are normal values for Fibrinogen?


200-400 mg/dL

10


Lab Testing:

what pathway does fibrinogen monitor

common pathway

11


Lab Testing:

what factors are monitored w/ fibrinogen


X, V, II, I

12


Lab Testing:

A fibrinogen level of what is associated w/spontaneous bleeding


< 100 mg/dL

13

Lab Testing:

what is normal fibrin split products

 


< 10 mg/L

14


Lab Testing:

Fibrin split products is a direct indication of what?


direct indication of activity of fibrinolytic activity

15


Lab Testing:

what is normal Bleeding time


1-9 min

16


Lab Testing:

what does bleeding time evaluate


platelet function/quality and vascular constriction capability

17


Lab Testing:

Bleeding time does not provide accurate _____ count

 

platelet count

18


Lab Testing:

what is a wider-encompassing test of clot formation, stability, and lysis


Thromboelastography

(TEG)

19

TEG:

name the main components of the TEG

 

Q image thumb

  1. Coagulation
  2. fibrinolysis
  3. Clotting time
  4. clot kinetics
  5. Clot strength
  6. Lysis time

A image thumb
20

TEG pic

A image thumb
21


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


1

1/2

22

what is the depletion of platelets secondary to markedly increased platelet consumption from coagulation pathway activity?


thrombocytopenia

23


Thrombocytopenia may lead to microthrombi, resulting in purpura called what?

thrombocytopenic purpura

24


what can occur if the entire coagulation pathway is activated

DIC

25


What is platelet levels with DIC for

MILD

MODERATE
SEVERE

 

  • MILD- 70,000-150,000
  • MODERATE- 40,000-70,000
  • SEVERE- 20,000-40,000

26


thrombocytopenia:

vascular occlusion by thrombi formation is unusual w/DIC, and the typical manifestation is what?


hemorrhage

27


thrombocytopenia:

HELLP follows the same pathway as DIC, but is also combined with what?


RBC hemolysis

and

elevated liver enzymes

28


DIC:

what is the only effective treatment?


treatment of teh underlying cause

29


DIC:

what is supportive therapy


Plasma and Platelet transfusions

30


What are 2 types of Autoimmune Coagulopathy

 

 

  • Posttransfusion Purpura
  • Drug induced Autoimmune Thrombocytopenic Purpura

31

Autoimmune

what causes posttranfusion purpura

Exposure to blood products or some drugs that may induce antibody formation

32


Autoimmune Coagulopathy:

in DIATP the drugs can act what?


a binding agent for the antibodies to adhere to platelets

33


Autoimmune Coagulopathy:

Heparin-Induced Thrombocytopenia

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

34


Autoimmune Coagulopathy:

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

35

Autoimmune Coagulopathy:

Anesthestic management

 

  • Poss platelet transfusion
  • D/C precipitating drug
  • Hold Warfarin and oral contraceptives
  • Delay CV sx

36


Autoimmune Coagulopathy:

if thrombotic even occurs, administer what?


direct thrombin inhibitor

(argatroban and bivalirudin)

37


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)

38



Coagulopathy in SIRS:

what is management ?

 

  • keep Hgb 7-9
  • FFP for sx
  • Keep platelets > 50,000
  •  

39


Coagulopathy:

Preop interview

 

 

  • ? hx of bleeding
  • ? hx of bleeding gims w/ dental sx
  • ? hx of liver insufficiency or malnutrition
  • Coag workup
  • Discuss transfusion possibility

40