icu lecture coagulopathy and bleeding

• related: ICU, massive transfusion protocol
• tags: #icu

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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