Lecture 10 - coagulation abnormalities Flashcards Preview

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Flashcards in Lecture 10 - coagulation abnormalities Deck (43):
1

__ disorders of coagulation are more common than congenital disorders of coagulation

aquired (DIC, hypercoagulable states, liver dz, vitamin K antagonism or deficiency, snake envenomation)

2

What is the most common coagulation abnormality

von willebrand's dz

3

__ is seen in critically ill patients and is ALWAYS secondary to another dz

DIC (must treat BOTH primary dz and DIC)

4

DIC is uncontrolled continued activation of __ and __

BOTH coagulation and fibrinolysis

5

why does DIC lead to uncontrolled bleeding

depletes coagulation factors and platelets

6

why does DIC lead to microvasculare obstruction

produces excess intravascular clots

7

phase 1 of DIC

Hypercoagulable phase (organ dysfucntion due to lack of O2/perfusion)

8

During the hypercoagulable phase death may occur before hemorrhage bc

multiple organ dysfunction (ischemia/low perfusion)

9

outward clinical signs of DIC are limited an may go unrecognized with out doing __ test

coagulation

10

hypercoagulable phase (phase 1 DIC) is characterized by __ leading to organ dysfunction

thromboses (many thrombi from primary site)

11

Phase 2 DIC is the __ phase

consumptive phase

12

Consumptive phase (Phase 2 DIC) is characterized by uncontrolled consumption of __ and __

platelets and coagulation factors

13

What are the consequences of Phase 2 DIC

Bleeding

14

What are the consequences of Phase 1 DIC

organ dysfunction

15

Consumptive phase (phase 2) is a mixture of __ and __ bleeding

platelet type and coagulopathy type

16

platelet type bleeding is characterized by

petichea and ecchymosis

17

coagulopathy type bleeding is characterized by

bleeding into cavities (abdomen, thorax, joints)

18

4 pathologies that can cause DIC

1. tissue factor and procoags released from dead or cancerous tissue
2. vasculitis
3. proteolytic enzymes activate coag factors (envenomation, pancreatitis)
4. stagnant blood flow

19

severe tissue damage and inflammation can cause

DIC

20

Be on the lookout early for DIC in __

ill patients (lots of causes for DIC)

21

__ is a common blood film finding for DIC

Fragmentation hemolysis (microangiopathic hemolytic anemia) - schystocytes, keratocytes

22

5 lab findings for DIC

1. Anemia
2. thrombocytopenia
3. acanthocytes
4. schistocytes (fragmentation)
5. prolonged coagulation factors (PT, PTT, ACT)
6. Decreased fibrinogen and AT3
7. increased FDPs and d-dimers

23

Coagulation tests can be __ due to the dynamic nature of DIC

Variable (typically prolonged)

24

will see increased ___ due to plasmin breaking down fibrin

FDPs

25

__ is helpful in early recognition of DIC but is a send out test that is not readily available

thromboelastography

26

__promotes clot formation by stimulating platelet aggregation

thrombin

27

__ activates multiple coagulation factors (1, 5, 8, 11, 13)

thrombin

28

thrombin promotes clot persistence via __ and also decreases clot formation via __ activation.

TAFI (thrombin-activatable fibrinolysis inhbitor), activates protein C and TFPI

29

Check and balance coagulation factor is __

antithrombin 3 (anticoagulant factor, if lose this can become hypercoagulable)

30

In protein losing nephropathy proteins leak out of kidneys, lose __ causing hypercoagulability (prone to forming clots)

antithrombin 3 (small protein, anticoagulation factor)

31

petechiation and mucosal hemorrhages are __ type bleeding

platelet

32

coagulation factors are made in the __ so need to screen for coagulation abnormalities prior to biopsy or surgery with dz

liver

33

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)

34

5 Causes of vitamin K def or antagonism

1. anticoagulant rodenticide intoxication
2. moldy sweet clover
3. gut sterilization
4. fat malabsorption or maldigestion (bile obstruction)
5. dietary def (rare)

35

vitamin K def will see __ coagulation tests

prolonged (PT first)

36

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

37

__ is a very large, multimeric protein important to platelet adhesion and aggregation (primary hemostasis)

von Willebrand factor

38

von willebrand dz is the most common hereditary bleeding disorder effecting

primary hemostasis/platelet function = bleeding tendency

39

vWD have various types that relate to degree of bleeding. Name some predisposed breeds

dobermans, german pointers, scottish terriers, shelties

40

a __ state has vWF concentration around 30-70%

vWD carrier

41

a __ state has a vWF concentration less than 35%

vWD symptomatic

42

vWD clincal signs

petechiae and mucosal bleeding
cutaneous bruising
prolonged hemorrhage and BMBT

43

Test of choice for vWD is

BMBT (if BMBT is normal can send out for vWF test)