1) Factor VIII replacement - Recombinant (synthetic) or plasma-derived - Still a moderate transfusion infection risk due to frequency of blood product requirements - Degree of replacement based on clinical need
2) Genetic Counseling
Unfractionated Heparin will lead to elevated PTT. What will excessive, continuous heparin infusion will also eventually lead to?
An elevated PT
Low molecular weight heparin does not typically elevate the PTT but will reduce ________
Factor Xa levels
How is the Effectiveness of anticoagulation with low molecular weight heparins is usually measured by?
Factor Xa levels
T or F. Fibrinogen, prothrombin, Factor V, Factor VII, Factor X, Factor XI, Factor XIII can all cause elevated PTT
What coagulation inhibitors increase PTT?
Antibodies against a particular coagulation factor or Von Willebrand's factor - Potentially related to antigenic stimulation from plasma factor replacement therapy and a particularly complicated problem in hemophilia and severe Von Willebrand's disease
- Increased frequency in autoimmune and lymphoproliferative disorders
What is the treatment for acute bleeding episodes?
It is very complicated, but it Usually involves immunosuppression (Cyclophosphamide, prednisone) & Immune tolerance therapy
This disorder causes an elevation of PTT and is described as the following:
- The "Classic Example
- Antibody to phospholipids which results in benign prolongation of the PTT since phospholipids play a small but necessary role in the coagulation cascade
- Counterintuitive predisposition towards thrombosis instead of bleeding in context of the antiphospholipid antibody syndrome
This drug Antagonizes vitamin K and therefore reduces production of factors II, VII, IX, X
- which in turn elevates the PT
How are the effects of Coumadin often potentiated by other medications?
1) Antibiotics often alter gut flora which results in decreased in vivo vitamin K production
2) Frequent cause of iatrogenic coagulopathies
Vitamin K deficiency elevates the PT, how does this happen?
1) Vitamin K usually found in green, leafy vegetables like spinach
2) Most common setting for vitamin K deficiency in US is the hospitalized patient, especially complicated postoperative patients
What is the treatment for vitamin K deficiency?
1) Vitamin K replacement (oral, SQ or IV)
2) Fresh Frozen Plasma in severe cases
3) This is also the treatment for excess Coumadin
Does Coagulopathy of liver disease cause an elevated PT?
This is Reduced hepatic function first leads to reduced production of coagulation factors, especially factor VII due to its very short half-life
Coagulopathy of liver disease
As liver disease progresses, what else is also decreases aside from coagulation factors?
T or F thrombopoietin will further complicate coagulopathy?
True. Especially if underlying liver disease leads to portal hypertension and splenomegaly, which will lead to platelet sequestration as well
Are both PT & PTT elevated in Coagulopathy of liver disease?
What is considered a better marker for hepatic synthetic function in liver disease:
a. Liver disease b. Albumin c. Total Protein d. Liver enzymes e. Prothrombin Time (PT)
Prothrombin Time (PT)
T or F. Coagulation inhibitors are more typically associated with PTT prolongation, occasional inhibitors can develop towards the factors of the extrinsic system and lead to PT prolongation as well
What are some examples of inhibitors that elevate PT?
Factor V inhibitors and certain types of lupus anticoagulant
What can cause elevated PT & PTT?
1) Coagulopathy of liver disease
2) Excessive unfractionated heparinization
3) Disseminated intravascular coagulation - Widespread activation of coagulation resulting in intravascular fibrin formation and thrombotic occlusion of small vessels - Widespread coagulation creates a state of "consumptive" coagulopathy which thereby leads to bleeding
What are the clinical features of Disseminated intravascular coagulation (DIC)?