Difference between revisions of "Coagulopathy (main)"

Revision as of 13:26, 7 January 2014

PT prolongation
- Decreased synthesis of vitamin K-dependent factors (II, VII, IX, X)
Thrombocytopenia
- Portal hypertension -> congestive hypersplenism -> splenic sequestration
Fibrinolysis increased
- Due to decreased synthesis of alpha2 plasmin inhibitor
- Low fibrinogen level, mild elevation of FDP and D-dimer

Authors:

@@ Line 41: / Line 41: @@
 ==[[Renal Disease Induced Coagulopathy]]==
-===Background===
-*Uremic toxins inhibit platelet aggregation
-*Dialysis filter may cause thrombocytopenia
-===Treatment===
-#Acute dialysis
-##pRBCs
-###Raising hct to above 25-30% improves bleeding time
-##Desmopressin
-###Simplest and least toxic acute treatment
-###Increases release of factor VIII:von Willebrand factor multimers
-###0.3 mg/kg IV (preferred) or SC (max 20mg)
-###Onset of action ~1hr, duration of action ~4-24hr
-#Estrogen
-##Unclear mechanism of action
-##Onset of action within 1d
-##Options
-###Conjugated estrogen 0.6mg/kg IV or 2.5-25mg PO daily
-#Cryoprecipitate
-##Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion
-#Plt transfusion
-##Minimally effective b/c infused plts quickly acquire the uremic defect
 ==Managment==