Icm Winter 10 Sheets

Front 1

what are the 4 phases of hemostasis

Back 1

1. Vascular Phase: vasoconstiction to decrease bleeding. vWF and PGI2 is released

2. Platelet Phase: platelets adhere and form a plug. Plateslets are activated and release- ADP, Ca, 5HT

3. Coagulation- form a clot. Extrinsic path required endo damage (TF, 7) intrinsic has it all in the cyto (12, 11, 9, 8)

Fibrinolysis: plasmin breaks up the fibrin that holds the clot together.

Front 2

are defects in the vascular phase of coagulation usually acquired or inherited

Back 2

Acquired

trauma, sepsis, steroids, aging

**congenital vascular disorders are rare

Front 3

are defects in the platelet phase of coagulation usually acquired or inherited

Back 3

Acquired (like vascular defects), common

ASA
ITP- idiopathic thrombocytopenia

Front 4

are defects in the coagulation phase of coagulation usually acquired or inherited

Back 4

either, this is really the one time we see CONGENITAL is in the coagulation

Congenital: deficit in clotting factor function or production (hemophilia or vWF)

Acquired- drugs like heparin, coumadin, AB or liver disease

Front 5

are defects in the fibrinolysis phase of coagulation usually acquired or inherited

Back 5

acquired

**DIC

Front 6

if you pt has a bleeding disorder what q's do you want to ask in the history

Back 6

C: how much, petechia, purpura,
O: recent or life long, length of episode
L: mucosal, GI. GU, intracranial, hemarthrosis
D:
E: liver disease, EtOH. meds, uremia, infection, malignancy, ASA, anticoagulants
R:
A: previous episode, previous transfusion- any reactions, why need the transfusion,
S:

Fx

Front 7

if your pt has a bleeding disorder what should we look for on PE

Back 7

Gen: rarely leads to dx but often gives an idea of extent of bleeding

Vitals: asses blood loww(HR, BP)

Gen: mental status change

BLood loss: examine site, it is oozing or gushing

SKin: ecchymosis, petechia, prupura

Mucoas: bleeding?

LN: can be indicative of AIDS, lymphoma, infectinon when supraclavicular or inguinal nodes are palpated

HSM: Liver- infiltrative process. Spleen- hypersplenism, myeloproliforative disorder, lymphoma

Joints: hemarthrosis

Pelvic and rectal exam

Front 8

why is a LN exam important in your pt w/bleeding

Back 8

Supraclavicular or inguinal nodes can suggest infection, lymphoma or AIDS

Front 9

if your pt is bleeding bc of lymphoma whay might you expect on PE

Back 9

splenomegaly
Supraclavicular or inguinal nodes

Front 10

what are two exams that can be done to better asses bleeding

Back 10

DRE
pelvic

Front 11

if your pt has a bleeding disorder what are the first 2 q's you ask yourself

Back 11

1. How much blood have they lost, how are they tolerating it.

2. Do they have a disorder in platelets, coagulation or mixed. Usually more bleeding in a congenital coagulation disorder seen in a man

Front 12

in a primary platelet disorder what is ...

1. congenital or acquired
2. who
3. whats the bleed like
4. what ppt it?
5. whats PE

Back 12

Primary Platelet

1. acquired
2. seen in kids and women
3. mild bleed
4. seen after trauma, procedure or spontaneous
5. see petechiea, purpura, mucosal bleed

Front 13

on PE your pt has petechia, purpura, and mucosal bleed

is this platelet or coagulation

who gets this adn what ppt it?

Back 13

its a primary platelet thing

seen in women and kids, its a more mild bleed. its an acquired problem Seen after procededure or trauma

Front 14

in a primary coagulation disorder what is ...

1. congenital or acquired
2. who
3. whats the bleed like
4. what ppt it?
5. whats PE

Back 14

1. congenital
2. males
3. moderate to profuse hemorrhage
4. post traumatic or spontanoues (like the platelet)
5. Deep MM, joint, UT, intracranial hemorrhage

Front 15

a man comes in with a congenital bleeding disorder. is it likely platelet or coagulation proble,. whats PE like

Back 15

coagulation

**lots of blood. deep mm, joint, UT, and intracranial bleed

contrast w/primary platelt disorders which are more common in women and kids and are characterized by mild hemorrhage and petechia, purpura and mucosal bleeding. these are acquired

Front 16

in mixed platelet and coagulative disorders what is....

1. who gets it
2. congenital or acquired
3. how bad is the bleed
4. when does it happen
5. what is PE like

Back 16

1. who gets it. lots of ppl
2. ACQUIRED
3. bleed varies in severity
4. caused by trauma, sepsis, OB hemorrhage, transfusion, insect bite,
5. see signs of multi organ failure, purpura, bleeding

Front 17

is the following caused by platelet, coaguation or mix dosorder

1. acquired
2. congential
3. seen in men
4. seen in women
5. LOTS of blood
6. see multi organ failure
7. seen as a result of OB hemorrhage
8. seen after trauma
9. mucosal bleed
10. seen after transfusion
11. mild bleed
12. intracranial hemorrhage
13. deep mm/joint bleed
14. UT bleed

Back 17

1. acquired: platelet and mixed
2. congentia: coagulationl
3. seen in men: coagulation
4. seen in women: platelet
5. LOTS of blood: coagulation
6. see multi organ failure: mix
7. seen as a result of OB hemorrhage: mix
8. seen after trauma: all 3!!
9. mucosal bleed: platelet
10. seen after transfusion: mix
11. mild bleed: platelet
12. intracranial hemorrhage: coagulation
13. deep mm/joint : coagulation
14. UT bleed: coagulation

Front 18

summarize primary platelet disorders

Back 18

1. seen in kids and women, mild bleeding, its acquired. Bleeding occurs in mucosa, see petechia,
Splenomegaly indicates sequestration of platelets or other blood products

HALLMARK is petechia that occurs spontaneously, after trauma/procedure

Front 19

summarize primary coagulation disorders

Back 19

seen more in men bc of x linked inheritance
*can also be acquired with anticoagulatn tx

bleeding is usually significant, deep and delayed by like 6-12 hours

**intracranial bleed, hemarthralgia, ecchymosis

can have signs of liver failure (jaundice), telangiectasia, HSM,

Lymphadenopathy can suggest lymphoma, leukemia, or infectious disease, AIDS

Front 20

what is teh most common acquired mixed platelet coagulation mixed disorder

Back 20

DIC

Front 21

summarize platelet/coagulation mixed disorders

Back 21

1. no sex/age predlication
2. DIC is most common

initiating factors include- trauma, sepsis, OB hemorrhage, transfusion reaction, snake bites.

Multi-organ faliure, unusual bleeding tendencies,

**if an initial presentation is not platelet or coagulation its considered mixed until proven otherwise

Front 22

your pt comes in with abnormal bleeding, what tests do you run

Back 22

Pt
PTT
bleed time
platelets

Front 23

what 4 thigns cause thrombocytopenia

Back 23

1. decreased BM productino of platelets
2. increased platelet destruction
3. dilutional- seen after massive transfusion, hemorrhage
4. Combination- increased destriction and decreased production seen in liver disease

Front 24

thrombotic thrombocytopenic purpura

how does it present?

Back 24

microangiopathic hemolytic anemia, thrombocytopenia, purpura, fever, renal failure, neurological sx

seen in young women

peripheral smear shows schistocytes

medical emergency

Front 25

your 27 yo female presents with microangiopathic hemolytic anemia, thombocytopenia, purpura, and schistocytes. whats the deal

Back 25

TTP

**can also have fever, renal failure, and neuro sx.

medical emergency

Front 26

whats ITP

how is it dx

Back 26

dx of EXCLUSION

IgG AB to platelets is made and platelets are destroyed

Kids: preceded by virus, self limited in kids

Adults: chronic form, more common in women. insiduous onset and unpredictable course

Front 27

how is ITP diff in kids and adults

Back 27

Kids: self limited, follows virus. its when you have IgG against platelets

Adults: chronic form, insidious onset, unpredictable course

**more common in women

Front 28

does hemophilia A paint a representative picture of a coagulation disorder

Back 28

yep

male, congenital, deep bleeds into mm and joints, UT, intracranial bleeds

Hemophilia has factor 8 deficit so PTT is long. they dont get GI or nose bleeds often

Front 29

whats vWF

Back 29

coagulation disorder
AD- decrease in vWF

see lots of mucosal and cutaneous bleeds, menorrhagia nad GI bleeds are common

simliar to hemophilia A but also has a platelet defecit

increased bleed time, normal platelet count, increased PTT

Front 30

is hemophilia a coagulation disorder or platelet

what is the only lab that is increased?

Back 30

coagulation
only the PTT is increased, its a factor 8 dificit

its in males and is sex linked recessive

deeo mm/joint bleeds. UT and intracranial bleeds (yep, sounds like a coagulation disorder, men, congenital, deep bleeds)

bleed can be delayed after injury. Nose bleed and GI bleed is RARE

Front 31

what are all of the primary coagulation disorders

Back 31

1. hemophilia
2. vWF
3. acquired coagulation defects

Front 32

how are vWF and Hemophilia A distinguised via labs

Back 32

Hemophilia A: PTT is long

vWF- PTT and bleed time is long, platelets are normal

Front 33

what is the promary coagulation disroder that is characterized by cutaneous and mucosal bleeds

what about the coagulation that is more deep bleeds in mm and joints, intracranial bleeds and UT

Back 33

vWF

Hemophilia A

Front 34

what does liver do to bleeding

Back 34

cant make clotting factors so will be a coagulation disorder

**seen in EtOH, CA, hepatitis, meds, toxins

Front 35

what clotting factors are part of

1. extrinsic path
2. intrinsic path
3.
3. made by liver
4. not made by liver
5. vit K dependent

Back 35

1. extrinsic path- TF, 7
2. intrinsic path- 12 11 9 8
3. common path: 2 5 10
3. made by liver: all except vWF
4. not made by liver: vWF
5. vit K dependent: 2 7 9 10

Front 36

whats the abnormal lab in vit K deficit

Back 36

long PT and PTT

K is 2 7 9 10

Front 37

talk about DIC

Back 37

its a mixed disorder

caused by infarct, trauma, OB, Ca, transfusion,

platelets and coagulation factors are sonsumed

Front 38

does hemophilia A paint a representative picture of a coagulation disorder

Back 38

yep

male, congenital, deep bleeds into mm and joints, UT, intracranial bleeds

Hemophilia has factor 8 deficit so PTT is long. they dont get GI or nose bleeds often

Front 39

whats vWF

Back 39

coagulation disorder
AD- decrease in vWF

see lots of mucosal and cutaneous bleeds, menorrhagia nad GI bleeds are common

simliar to hemophilia A but also has a platelet defecit

increased bleed time, normal platelet count, increased PTT

Front 40

is hemophilia a coagulation disorder or platelet

what is the only lab that is increased?

Back 40

coagulation
only the PTT is increased, its a factor 8 dificit

its in males and is sex linked recessive

deeo mm/joint bleeds. UT and intracranial bleeds (yep, sounds like a coagulation disorder, men, congenital, deep bleeds)

bleed can be delayed after injury. Nose bleed and GI bleed is RARE

Front 41

what are all of the primary coagulation disorders

Back 41

1. hemophilia
2. vWF
3. acquired coagulation defects

Front 42

how are vWF and Hemophilia A distinguised via labs

Back 42

Hemophilia A: PTT is long

vWF- PTT and bleed time is long, platelets are normal

Front 43

what is the promary coagulation disroder that is characterized by cutaneous and mucosal bleeds

what about the coagulation that is more deep bleeds in mm and joints, intracranial bleeds and UT

Back 43

vWF

Hemophilia A

Front 44

what does liver do to bleeding

Back 44

cant make clotting factors so will be a coagulation disorder

**seen in EtOH, CA, hepatitis, meds, toxins

Front 45

what clotting factors are part of

1. extrinsic path
2. intrinsic path
3.
3. made by liver
4. not made by liver
5. vit K dependent

Back 45

1. extrinsic path- TF, 7
2. intrinsic path- 12 11 9 8
3. common path: 2 5 10
3. made by liver: all except vWF
4. not made by liver: vWF
5. vit K dependent: 2 7 9 10

Front 46

whats the abnormal lab in vit K deficit

Back 46

long PT and PTT

K is 2 7 9 10

Front 47

talk about DIC

Back 47

its a mixed disorder

caused by infarct, trauma, OB, Ca, transfusion,

platelets and coagulation factors are sonsumed

Front 48

what are hte lab findings in DIC

Back 48

long PT, PTT and Thrombin time (TT)

**its when platelets and coagulation facotors get eaten up adn you bleed

schistocytes are seen

Front 49

what is in FFP (fresh frozen plasma)

Back 49

coagulation factors,

good for pts w/DIC

Front 50

what are hte 3 main goals of tx for a pt w/bleeding

Back 50

1. stop the blood
2. treat the cause of bleeding
3. replace lost blood parts

Front 51

what are some benefits of blood COMPONENT tx

Back 51

1. you only give the pt what they need (DIC needs FFP bc it has coagulation factors)

2. decrease risk of transfusion reaction

3. economical

4. decreased transmission of disease

5. banked blood looses its clotting factors and platelets fast

Front 52

whats PRBC

Back 52

packed red blood cells

**replenish lost blood cell mass

Front 53

FFP

Back 53

used to replace clotting factors (2 5 7 9 10 11)

used to reverse cumadin tx

massive transfusions

tx TTP and DIC

Front 54

your pt lost TONS of blood adn you need to transfule like a zillion units, what else do you want to add

Back 54

FFP- make sure they get their clotting factors

Front 55

ut oh, we gave that guy a bit too much coumadin, now he wont stop bleed. what can we do

Back 55

FFP- it has coagulation factors

Front 56

who gets platelet transfusions

Back 56

thrombocytopenia <50,000 or abnormal bleeding

**increases the platelet count by like 10,000