icu lecture coagulopathy and bleeding

Definition

  • Coagulation: bleeding when you should; clotting when you should; no more and no less
  • Coagulopathy: bleeding when you should not; clotting when you should not; more than less

Intrinsic and extrinsic pathway do not exist in real life. Real life is more complex

  • immunothrombosis: activation of platelets and coagulation through PAMP and DAMP while using innate immune cells as inducers and regulators
  • you have to have functional immune system to have coagulation
  • leukocytes also line endothelium to maintain laminar flow. Lack of it can cause thrombosis and bleeding

txa

  • TXA: aminocaproic acid. Changes blinding site of plasmin
  • TEG tracing

TTP

  • TTP: therapeutic plasma exchange
  • plasma exchange: replace plasma and ADAMTS13
  • plasmaphresis: just filters plasma
  • don’t tranfuse
  • TTP patients tend to not bleed. Few thousand plts left seem to be hyperactive. If pt ooze a lot when catheter in, probably not TTP. If not bleeding when place catheter, probably not TTP.
  • not based on trials
  • transfuse during procedure
  • plt increase by 30k (15-45) for single unit, peaks in 10 min - 1 hour

CTS induced

  • recheck plt
  • heparin induced antibodies post CT surgery

HIT

  • work up for HIT with A-E
  • duplex in all extremities
  • calculate 4T
  • nadir, go back up and then drop again instead of continue to recover
  • other causes: CRRT, cancer

Heyde

  • Heyde’s syndrome
  • angiodysplasia and cleavage of vW multimers

surgical

  • prolene deficiency: surgical problems. Call surgery