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19 Cards in this Set
- Front
- Back
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What is the most important side effect of heparin?
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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. |
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How is the effect of heparin monitored?
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Heparin is monitored with PTT (partial thromboplastin time), a measure of the internal coagulation pathway
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How is the effect of warfarin monitored?
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Warfarin is monitored with the PT (prothrombin time), a measure of the external coagulation pathway
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How do you keep PTT and PT straight?
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PTT has a "T" inside, intrinsic, internal coagulation pathway.
PT is the other |
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Memorize:
Measure heparin with ______ Measure warfarin with ______ |
Measure heparin with PTT
(Hep to the PTT!) Measure warfarin with PT (War with the PT) |
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How is the effect of aspirin monitored?
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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.
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How are the effects of low-molecular-weight heparin monitored?
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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.
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In an emergency, how can you reverse the effects of heparin?
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Heparin and LMW heparin can be reversed with protamine.
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In an emergency, how can you reverse the effects of warfarin?
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Warfarin with fresh frozen plasma (contains clotting factors; immediate effect) and or vitamin K (takes a few days to work).
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In an emergency, how can you reverse the effects of aspirin?
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Platelet transfusions
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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 |
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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 |
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How do you keep Hemophilia A and B straight?
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Hemophilia A is 8A (eight = ate = A) missing factor 8), the more common form.
Hemophilia B is 9B |
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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 |
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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. |
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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 |
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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) |
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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 |
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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.
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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.
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