Editing Coagulopathies (section)

== Coagulation disorders ==

=== Haemophilia A ===

** Factor VIII deficiency
** X-linked recessive
** Coagulopathy-type bleeding - haemarthrosis, bleed into muscle
** Prolonged APTT and decreased VIII assay
** Desmopressin IV raises factor VIII levels and may be sufficient for moderate bleeding
** Major bleeds require recombinant factor VIII

=== Haemophilia B (Christmas disease) ===

** Factor IX deficiency
** X-linked recessive
** Behaves clinically like Haemophilia A
** Treat with recombinant factor IX

=== Acquired haemophilia ===

** Suddenly-appearing autoantibodies that interfere with factor VIII

=== Liver disease ===

** Decreased synthesis of clotting factors, decreased absorption of vitamin K, abnormalities of platelet function

=== Malabsorption ===

** Less uptake of vitamin K, which is needed for factors 2, 7, 9 and 10
** Treat with IV vitamin K, or human prothrombin complex/FFP acutely

=== Trauma-induced coagulopathy ===

* Diagnosis
** Trauma patients should ideally have TEG on admission
** Thromboelastography (TEG)
*** Measures the physical properties of the clot in whole blood via a pin suspended in a cup, as the elasticity and strength of the clot changes
*** Allows for real-time interpretation of clot dynamics as the clot develops and is subsequently broken down
*** R-time (reaction time) is the time to clot initiation, dependent on clotting factors (normally 4-8 minutes)
*** K-time (kinetics) is the time needed to reach 20mm clot strength (normally 1-2 mins with rTEG and 1-3 mins with standard TEG - dependent on fibrinogen
*** Alpha = slope of the angle between R and K - dependent on fibrinogen, how fast does the clot build up
*** TNA = time to maximum amplitude
*** MA = maximum amplitude = the ultimate strength of the clot - dependent on platelets and fibrin
**

* Rotational Thromboelastometry
** Similar information to TEG but different mechanism (pin rotates instead of cup rotating)
* Not really clear which is better yet, but there is much more literature for TEG than ROTEM

* Treatment
** Based on coag profile
*** INR >1.2 or aPTT >30 seconds needs resus with plasma
*** Platelets <100,000 for diffuse bleeding or <50,000 for microvascular bleeding were indications for platelets
*** Hypofibrinogenaemia <229 mg/dL is an indication for cryoprecipitate (each unit of cryo should raise fibrinogen by 10mg/dL)

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[[Category:Haematology]]