patho 2 coag
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| What causes disorders of coagulation | defects or deficiencies of one or more clotting factors or CV problems leading to thromboembolic disease
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| Vit K is indispensable in the synthesis and regulation of normal production of | coag factors 2,7,9,10,and anticoag factors protein C and S
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| Two things can cause abnormal formation of factors or deficiency | liver disease(hepatitis, cirrhosis, and acute yellow atrophy)and deficiency of vit. K
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| One of the most prevalent causes of VIT K deficiency | failure of the liver to secrete bile > decreased absorption of vit K
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| pretreatment with vit K for surgery w/ pts w/ liver disease..route and time frame? | 4-8 h before surg, injected
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| Hemophilia A (classic) | most common, def. of factor 8(anti-hemphilic factor)X-linked recessive. affects males transmitted by females
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| Hemophilia B(Christmas disease) | deficiency of factor 9, X linked recessive trait clinically indistinguishable from factor 8 def
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| hemophilia C | factor 11 deficiency, autosomal recessive, both males and females, bleeding less severe
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| Treatment for bleeding Hemophiliac | Plasma, cryo, and factor 8
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| Thrombocytopenia..platelet count? | <100K
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| platelet count <50K | increased risk of hemorrhage with minor trauma
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| platelet count <10-15K | spontaneous bleeding occurs (petechiae, ecchymosis, purpuric spots, bleeding from mucous membranes
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| platelet count <10K | severe bleeding-fatal in GI tract, CNS or resp system
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| causes of decreased platelets | massive blood trans(>10units in 24h)or secondary to other cond. Bone marrow rep.or hypoplasia. also HIT
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| Thrombocytopenia interferes with hemostasis by | preventing the formation of the platelet plug but also stopping the coag cascade
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| Thrombocytopenic purpura | small purplish blotches on the skin, bleeding from many venules or capillaries resulting in small hemmorhages,idiopathic or dev after blood trans.
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| Immune thrombocytopenic pupura(ITP) | common in adult females, sx..bleeding, wt loss, h/a, fever---HIV increase risk for the disease
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| Treatment for ITP | fresh whole blood transfusion, predisone, splenectomy
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| Thrombocythemia (thrombocytosis) | platelet ct >400K asymptomatic until count reaches 1 mil w/ intravasc.thrombosis, hemorhage, or other patho cond appear
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| primary thrombocynthemia | myeloproliferative condition w/ splenomegaly, periodic thrombosis or hemorrhage, h/a, and paresthesia
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| secondary thrombocynthemia | freq. seen in lung, colon, and stomach CA
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| treatment of thrombocynthemia | platelet pheresis together w/ myelosuppresive therapy
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| In sickle cell anemia what causes increased thrombosis? | HbS is exposed to low O2, RBC's sickle and crystals form,can't pass through capillaries, cells rupture=>icterus=>^thromb.=>hemolytic anemia=>decreased O2 transport=>dec.[O2]=>more sickle cells form
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| DIC | acquired clinical syndromew/ increased protease activityin the blood caused by unregulated release of thrombin w/ subsequent fibrin formation and accelerated fibrinolysis
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| DIC results from | large amounts of traumatized or dying body tissue that release great quantities of tissue factor into the blood thus activating clotting.
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| clinical conditions assoc w/ DIC | Arterial hypot, hypoxemia, acidemia, stasis of capillary BF
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| DIC is precipitated by | endothelial damage, tissue damage, direct activation of coag. factor X, but most common cause is infection..gram - bact, fungi, protozoa and viruses
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| Why does DIC cause hemorrhage? | The amt of thrombin entering the circulationduring DIC exceeds the ability of the body's antithrombins(prot C and S and AT 3) to regulate it which results in an unrestricted clot formation that uses up all clot. factors=>hemorrhage
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| clinical manifestations of DIC | simultaneous bleeding at least at 3 unrelated sites with microvascular thrombosis=>improper perfusion and organ system dysfunction
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| thromboembolic disease effects on arterial system | forward occlusion, ischemia, necrosis, gangrene
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| Thromboembolic disease effect on venous system | Deep vein thrombosis=>pulmonary thromboembolism
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| DIC treatment | remove underlying cause, restoration of proper coag-fibrinolysis balance(heparin, platelets, other coag factors)and maintenance of organ viability
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| Major Etiologies of DIC | OB complications, trans rxn, infections, leukemia,crush injuries, acute liver disease, IABP, vascular disorders
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