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19 Cards in this Set

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What is the most important side effect of heparin?
Heparin can cause thrombocytopenia that in some unlucky patients is associated with arterial thrombosis.

Measure complete blood counts to monitor for this side effect, which usually occurs on day 3-7 of heparin administration. Discontinue heparin immediately if platelet counts begin to fall.
How is the effect of heparin monitored?
Heparin is monitored with PTT (partial thromboplastin time), a measure of the internal coagulation pathway
How is the effect of warfarin monitored?
Warfarin is monitored with the PT (prothrombin time), a measure of the external coagulation pathway
How do you keep PTT and PT straight?
PTT has a "T" inside, intrinsic, internal coagulation pathway.

PT is the other
Memorize:
Measure heparin with ______
Measure warfarin with ______
Measure heparin with PTT
(Hep to the PTT!)

Measure warfarin with PT
(War with the PT)
How is the effect of aspirin monitored?
Aspirin prolongs bleeding time, a measure of platelet function. Clinically, the effect of aspirin is not monitored with lab testing, but be aware that it prolongs bleeding time test.
How are the effects of low-molecular-weight heparin monitored?
LMW Heparin does not affect any of the coagulation parameters (PT or PTT or bleeding time), and its effect is not clinically monitored. Rarely, a special type of factor X assay (anti-Xa) is used to measure the effect.
In an emergency, how can you reverse the effects of heparin?
Heparin and LMW heparin can be reversed with protamine.
In an emergency, how can you reverse the effects of warfarin?
Warfarin with fresh frozen plasma (contains clotting factors; immediate effect) and or vitamin K (takes a few days to work).
In an emergency, how can you reverse the effects of aspirin?
Platelet transfusions
Condition: Hemophilia A

PT
PTT
Bleeding time
Inheritance
Condition: Hemophilia A

PT: normal
PTT: prolonged (low levels of factor 8)
Bleeding time: normal
Inheritance: X-linked
Condition: Hemophilia B

PT
PTT
Bleeding time
Inheritance
Condition: Hemophilia B

PT: normal
PTT: prolonged (low levels of factor 9)
Bleeding time: normal
Inheritance: X-linked
How do you keep Hemophilia A and B straight?
Hemophilia A is 8A (eight = ate = A) missing factor 8), the more common form.

Hemophilia B is 9B
Condition: vWF deficiency

PT
PTT
Bleeding time
Inheritance
Condition: vWF deficiency

PT: normal
PTT: prolonged
Bleeding time: prolonged
Inheritance: autosomal dominant

***Normal levels of factor 8 and factor 9
Condition: Disseminated intravascular coagulation

PT
PTT
Bleeding time
Inheritance
What else is elevated in terms of labs?
When do you encounter DIC?
What do you see on the blood smear?
Condition: DIC

PT: prolonged
PTT: prolonged
Bleeding time: prolonged
Inheritance: N/A

Positive D-dimer or FDPs (fibrin degradation products); postpartum, infection, malignancy; schistocytes and fragmented cells on peripheral smear.
Condition: Liver Disease

PT
PTT
Bleeding time
Inheritance
Condition: Liver Disease

PT: Prolonged
PTT: normal or prolonged
Bleeding time: normal
Inheritance: N/A

All factors but 8 are low, you see stigmata of liver disease; no correction with vitamin K
Condition: vitamin K deficiency

PT
PTT
Bleeding time
Inheritance
Condition: vitamin K deficiency

PT: prolonged
PTT: slightly prolonged
Bleeding time: normal
Inheritance: N/A
** low levels of factors 2,7,9,10, proteins C and S; look for neonate who did not receive prophylactic vitamin K; malabsorption, alcoholism, or prolonged antibiotic use (which kills vitamin K-producing bowel flora)
MEMORIZE:

PT (extrinsic): 2,5,7,10: increased with warfarin use, vit K deficiency, liver disease

PTT (intrinsic): 8,9,11,12: increased with heparin use, hemophilia A, B, vWF deficiency
PT (extrinsic): 2,5,7,10: increased with warfarin use, vit K deficiency, liver disease

PTT (intrinsic): 8,9,11,12: increased with heparin use, hemophilia A, B, vWF deficiency
Remember that uremia causes a qualitative platelet defect and that vitamin C deficiency and chronic steroid therapy can cause bleeding tendency with normal coagulation tests.
Remember that uremia causes a qualitative platelet defect and that vitamin C deficiency and chronic steroid therapy can cause bleeding tendency with normal coagulation tests.