3 - Hemostasis and Transfusion 2024 (Rush Surgery)

1:1:1

A ratio of ______ is the ideal ratio of pRBC, FFP, and platelets in patients undergoing massive transfusion

Platelet adhesion

This occurs as a result of increased circulating levels of prostacyclin and altered binding to exposed vWF on the vascular endothelium. This generally becomes clinically evident in patients with a creatinine level above 6.7 mg/dL. At this level, upper gastrointestinal (GI) bleeding is a major cause of mortality.

Patients with uremia will clinically present with impaired _________ resulting in increased bleeding time

Positive (clotting factors); negative (proteins)

This means clotting factor levels rise while protein levels fall in response injury

In times of acute stress, most clotting factors are ______ acute-phase reactants while proteins such as albumin are _____ acute-phase reactants

1. Vasoconstriction

2. Platelet activation, adherence, and aggregation

3. Generation of thrombin with conversion of fibrinogen to fibrin

Three physiologic reactions that mediate initial hemostasis of vascular injury include:

1.

2.

3.

1. Trial of factor VIII therapy

2. Compression dressings

3. Cold packs

4. Rest followed by active range-of-motion exercises

Overall goal of treatment is to maintain range of motion with factor VIII therapy serving to limit hemorrhage

In a patient with known factor VIII deficiency, what therapeuticoptions can be done if one suspects hemarthrosis? (4)

Von Willebrand disease

Affects 1% of the general population

______________ is the most common congenital bleeding disorder

Factor VIII:C (factor 8 pro coagulant activity)

Factor VIII:C is not produced by hepatocytes but by reticuloendothelial cells and is typically increased in cirrhosis. Decreased levels are seen in DIC due to it being consumed along with other coagulation factors

Factor _____ levels is used to differentiate coagulopathy of end-stage liver disease from DICin actively bleeding cirrhoticpatients