Term
| ETP has a (better/worse) prgnosis than IMHA. |
|
Definition
|
|
Term
| Are vWF deficiency and thrombocytopathia common or uncommon auses of defects in primary hemostasis? |
|
Definition
|
|
Term
| What are the Vit K dependent factors? |
|
Definition
|
|
Term
| In general, what is an ACT? |
|
Definition
| -a bedside PTT but NOT as sensitive as a PTT |
|
|
Term
| What would happen if you UNDER-filled the blue citrate tube for PT and PTT evaluation? |
|
Definition
| -falsely prolonged result |
|
|
Term
| Give 3 examples of congenital secondary hemostasis disrords. |
|
Definition
-Hemophilia A: factor 8 deficiency
-Hemophilia B: factor 9 deficiency
-Factor 12 deficiency: in cats |
|
|
Term
| Give 3 examples of acquired secondary hemostasis disorders. |
|
Definition
-Vit K deficiency: anticoagulant rodenticide toxicity, obstructive cholestasis, malabsorptive GI dz
-liver dysfunction
-DIC |
|
|
Term
| Describe how PT, PTT, and ACT are affected by vitamin K deficiency or antagonsim. |
|
Definition
| -PT affected first b/c FActor VII has the shortes half-life but all three will be affected |
|
|
Term
| What are a few examples of Vitamin K antagonistic rodenticides? |
|
Definition
| -Warfarin, Diphacinone, Brodifacoum, Bromadiolone |
|
|
Term
| How do Vit K antagonist rodenticides work? |
|
Definition
| -inhibit vitamin K epoxide reductase, hence blocking the regeneration of NVit K |
|
|
Term
| When do clinical signs due to Vit K antagonism occur? |
|
Definition
| -2-4 days AFTER ingestion |
|
|
Term
| How do we diagnose Vit K antagnonist rodenticide poisoning? |
|
Definition
-history of exposure
-bleeding ANYWHWERE, but often cavitary
-prolonged PT and PTT
-inc PIVKA |
|
|
Term
| How do we trat Vit K antagonist rodenticide poisoning? |
|
Definition
-induce vomiting if recently ingested
-give activated charcoal
-give vitamin K: typically for 4-6w
-plasma trasfusion
-blood transfusion if anemic |
|
|
Term
| Does liver disease commonly or uncommonly results in spontaneous hemorrhage? |
|
Definition
|
|
Term
| What are the two forms of liver disease that count as acquired secondary hemostatic disorders? |
|
Definition
-Dysfunction: need advanced liver failure before we see prolongation of PT/PTT
-Cholestasis: need bile to absorb fat soluble vitamins live vitamin K |
|
|
Term
| What are some of the potential resons for bleeding due to liver disease? |
|
Definition
-liver failure may cause decrease in clotting factors
-cholestasis may reduce vitamin K absorption
-abnormal platelet function may occur with liver disease
-DIC may occur with liver disease |
|
|
Term
| How do we treat liver disease as an acquired secondary hemostatic disorder? |
|
Definition
-treat undelrying cause if possible
-supplement with Vitamin K1 SC
-plasma if needed such as before a liver biopsy |
|
|
Term
| What causes disseminated Intravascular Coagulation (DIC)? |
|
Definition
| -caused by inappropriate activation of the coagulation system, resulting in an imbalance between coagulation and fibrinolysis: endothelial damage due to vasculitis, hemangiosarcoma, sepsis, etc & activation of tissue factor due to neoplasia, hemolysis, heat stroke, pancreatitis, etc |
|
|
Term
| In DIC, there is initially a (hyper-/hypo-coagulable phase that advances to what? |
|
Definition
-hypercoagulable phase
-advances to the depletion of clotting factors and platelets and results in hypocoagulable phase |
|
|
Term
| DIC is a mixed order of coagulaiton. Describe what this means. |
|
Definition
-one of only diseases that affects BOTH primary and seecodary hemostasis
-primary: thrombocytopenia
-secondary: prolonged PT and/or PTT |
|
|
Term
|
Definition
-hypocoagulable phase: thrombi formation, organ failure
-followed by hypocoagulable phase: can result in hemorrhage |
|
|
Term
|
Definition
-clinical signs
-thrombocytopenia
-prolonged PT/PTT
-dec antithrombin
-inc FDPs or D-dimers (D-dimers better)
-with or without schistocytes |
|
|
Term
|
Definition
-treat underlying condition
-IV fluids
-/+ plasma or whole blood
-/+ heparin |
|
|
Term
| What is Virchow's Triad? Give examples of each components. |
|
Definition
1)Endothelial injury: valv dz, endothelial damage due to endotoxins, HW dz, neoplasia, vasculitis
2) changed in blood flow (stasis or turbulence): heart dz, poor perfusion from shock or hypotension
3) hypercoagulability of glood (loss of natural anticoagulants): antithrombin loss with glomerular or GI dz |
|
|
Term
|
Definition
| -an intravascular deposit of fibrin and blood elements (a clot) |
|
|
Term
|
Definition
| -obstruction of a vessel by a transported clot, mass, bactria, fat, etc |
|
|
Term
| Definition: Thromboembolism |
|
Definition
| -a fragment of a thrombus that breaks free, circulates, and lodges in a vessel too small to permit passage |
|
|
Term
| What is fibrinolysis testing? |
|
Definition
-Fibrin-degradation products (FDPs): breakdown in products of fibrin and fibrinogen & increased in states of accelerated fibrinolysis
-D-dimers: breakdown of crosslinked D fragments of the fibrin protein; inc in states of accelerated fibrinolysis |
|
|
Term
| What are some examples of blood products? |
|
Definition
-fresh whole blood
-stored whole blood
-packed red blood cells
-fresh frozen plasma
-frozen plasma
-platelet-rich plasma
-platelet concentrate
-cryoprecipitate |
|
|
Term
| What is Fresh Frozen Plasma? What is its shelf life? |
|
Definition
-frozed within 6-8 hrs of collection
-shelf life of 1 year |
|
|
Term
| What is in fresh frozen plasma? |
|
Definition
| -everything except RBC's and platelets: Albumin, vWF, clotting factors, fibrinogen, antithrombin |
|
|
Term
| How is fresh frozen plasma different than frozen plasma? |
|
Definition
-frozen is frozen after 8h after blood collection
-if fresh frozen plasma is stored greater than 1 year it becomes frozen plasma
-frozen has a shelf life of 5 years
-frozen has same components as fresh frosen except Factor V, VIII, and vWF |
|
|
Term
| What are the clear indications for a plasma transfusion? |
|
Definition
-coagulopathy in the presence of hemorrhage
-coagulopathy in patients requiring surgery or other invasive procedure
-consider the CAUSE of your coagulopathy when deciding b/n FFP and FP |
|
|
Term
| What are some controversial indications of plasma transfusions? |
|
Definition
-DIC
-hypoalbuminemia
-severe acute pancreatitis |
|
|
Term
| How do we administer plasma transfusions? |
|
Definition
-thaw plasma in warm water bath
-give through a filter
-complete infusion within 4-5 hours to prevent bacterial contamination an preserve labile coagulation factors
-monitor for reactions |
|
|
Term
| What does a plasma transfution reaction look like? |
|
Definition
| -vomiting, diarrhea, fever, tachycardia, tachypnea, urticaria, etc |
|
|
Term
| How do you make platelet-rich plasma? |
|
Definition
| -FWB centrifuged at higher temp and stored at room temp under agitation for up to 5 days |
|
|
Term
| How do you make platelet concentrate? |
|
Definition
| -Platelet rich plasma is further centrifuged to concentrate platelets and are preserved with DMSO |
|
|
Term
| What are indications for platelet product (PrP or PC) transfusions? |
|
Definition
| -severe thrombocytopenia or thrombocytopathia with life-threatening hemorrhage OR planned surgical or invasive procedure |
|
|
Term
|
Definition
| -thaw and then centrifuge fresh frozen plasma and the precipitate at the bottom of bag after centrifugation is cryorecititae |
|
|
Term
| What are the components of cryoprecipitate? |
|
Definition
|
|
Term
| What are the indications for use of cryoprecipitate? |
|
Definition
| -treatment of vWF or hemophilia A (factor VIII deficiency) |
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