The Hip: Preservation, Replacement and Revision

Management of Coagulopathy / Bleeding


 - Anticoagulant Induced Bleeding:
 - Coags
 - Coag Pathway
 - Platlet abnormalities:
 - Transfusion Rx 

 - Dilution Coagulopathy: 
      - may result from massive transfusions;
      - rarely occurs w/ < 12 units of transfused pRBC, but occurs in nearly all pts that have received > 20 units of pRBC; 
      - note: coagulopathy associated with pelvic fractures may have a mortality rate of greater than 85 %; 
      - thrombocytopenia and platlet dysfunction;

Bleeding due to Platlet abnormalities
      - most common caused by thrombocytopenia, but decreased platelet function & rapid dilution of plasma clotting factors are also common;       
      - DIC:
           - Anticoagulant Induced Bleeding
           - Platlet abnormalities:
           - Diagnosis: - prolongation of PT, PTT; - decrease in serum Fibrinogen to < 100 mg/dl (norm 160 mg/dl); - rise in fibrin degradation products to > 40 mg/dl;
           - Treatment:
                 - treat underlying cause (eg. sepsis, incompatible blood transfusion)
                 - support platlets/coags;
                 - consider Fresh Frozen Plasma/Cyroprecipitate/platlets 
                 - ? whether HEPARIN Rx is effective in oncology
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Extracorporeal hemolysis in orthopedic patients. Report of two cases

Concepts in Emergency and Critical Care: Pathogenesis of Disseminated Intravascular Coagulation in Sepsis




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 3:53 pm