Card Set Information
DPAP2012 Hemostasis Hematology
-Vitamin K deficiency
-Von Willebrand's Disease (vWB)
-Idiopathic Thrombocytopenia Purpura (ITP)
-Thrombotic Thrombocytopenia Purpura (TTP)
-Hemolytic-Uremic Syndrome (HUS)
Management of Bleeding Complications
: hold warfarin, PO vit K if INR reversal required
: hold warfarin, IV vit K, supplement with FFP, factor 7a, or prothrombin complex concentrates
: reverse prolonged INR with IV vit K and with factor 7a or prothrombin complex concentrates (PCC's)
Vitamin K deficiency
: oral Vitamin K 5-10 mg PO daily x 3 days
: MVI with vit K daily.
Vitamin K Clinical PEARLS
-mildly elevated INR without bleeding- VK not always indicated.
-little bit is usually enough
: oral Vit K
: IV vit K
-Avoid SC/IM administration
Fresh Frozen Plasma (FFP)
-liver dx, Vit K deficiency, DIC, immediate short term reversal of over-anticoagulation with Coumadin.
-1/2 life- 3-5 hours. factor 7 difficult to replace without volume overload. Vit K AND FFP indicated in patients with high INR and bleeding.
-FFP not indicated unless PT or PTT is >1.5 x the mean of normal range. (not for mildly prolonged PT or PTT)
-acquired deficiencies. due to DIC or thrombolytic therapy, congential hypofibrinogenemia or dysfibrinogenemia.
-CRYO- only source of concentrated fibrinogen
Prothrombin Complex Concentrates
-Profilnine- non-activated Factor 9, 2, 10 and low level of factor 7.
-FEIBA- non-activated Factor 2, 9, and 10, and Factor 7a (activated).
-alternative for pts who don't respond to other replacement methods
-major bleeding associated w/ warfarin overdose or hepatic failure who require fast hemostasis
-must have stores of 10, 2, and 1 (common pathway)
Von Willebrand Disease
-defect of primary hemostasis (platelets)
-qualitative vs quantitative deficiency of VWF.
-frequency of mild vWD 1 in 200
-symptoms depend on severity.
Von Willebrand Factor
-bridge between platelets and subendothelium
-bridge between platelets
-carrier protein for factor 8.
-defects quantitative (type 1,3), qualitative (type 2)
-defects result in decreased platelet aggregation and adhesion.
vWD therapeutic management
-Desmopressin (DDAVP) increases circulating vWF. useful for minor bleeding in type 1.
-Factor VIII preps
: intermediate-purity factor 8. used for major bleeding and patients with type 2 and 3.
-vWD is dosed on RISTOCETIN COFACTOR activity.
Idiopathic Thrombocytopenic Purpura (ITP)
-autoimmune antibodies form and alter platelets.
-platelet removal by spleen increased
-increased bone marrow production, can't keep up with destruction.
ITP Treatment Rationale
-platelet transfusions not usually given unless pt acutely bleeding.
-therapy aimed at eliminating antibodies.
ITP Treatment Options
-IV Ig= more intermediate effect for severe thrombocytopenia/bleeding.
ITP second line agents
-Rituximab (monoclonal antibody)
-WinRho (RhoD positive patients)
Thrombotic Thrombocytopenic Purpura (TTP)
-result of lack of enzyme (ADAMSTS13) responsible for cleaving vw factor.
-causes formation of many small blood clots
-high number of platelets consumed- decreased platelet count
-Schistocytes on blood film.
TTP Treatment options
Hemolytic-Uremia Syndrome (HUS)
-related to TTP
-caused by E. coli infections
-Hemolysis, microthrombi to brain and kidneys
-most common- infants, young children, pregnant women.
-symptomatic and supportive: