Flashcards in Week 4 Mo Parturient with Systemic Diseases Deck (149)
Maternal Gestational Diabetes Tx?
Avoid oral hypoglycemic agent (can cause fetal hypoglycemia)
Gestational Diabetes Complications Maternal?
C/S for macrosomia
DM type II
Gestational Diabetes Complications Fetal?
Perinatal mortility 2-5%
Dilutional Anemia during Pregnancy is due to what?
Due to 50% increase in plasma volume
If Maternal Hb falls below what level, you should look for another cause (not dilutional anemia due to pregnancy)
Most common hereditary bleeding disorder?
Von Willebrand's’s disease
What are signs and symptoms of Von Willebrand's dz?
Prolonged BT despite normal platelet count (cannot stick to injured area)
A functional deficiency of factor VIII (pseudo-hemophilia) occurs as a result of deficit of vWF, its carrier protein. Deficiency is manifested clinically by prolonged PTT
Mucous membrane bleeding
Prolonged bleeding from wounds
Menorrhagia– very heavy period
Treatment of Von Willebrand's dz?
Desmopressin (dDAVP) increases vWF level
Cryoprecipitate is rich in factor VIII:vWF
Estrogen and OCP
Labs performed on a Mom with gestational Diabetes?
Glycosuria, fasting hyperglycemia
Glucose Tolerance Test?
Hemophilia A is a deficiency in what factor?
Second most common X-linked Coagulation defect? This mean what sex is rarely affected?
Hemophilia A, and females are rarely affected.
Clinical findings with Hemophillia A?
Soft tissue and joint bleeding
Dangerous CNS bleeding with minor trauma
Spontaneous hematuria leading to ureteral colic
Labs with Hemophilia A?
Prolonged PTT (intrinsic pathway)
Low factor VIII
Normal vWF , therefore normal BT
Treatment for Hemophilia A?
FFP and cryo (low in VIII)
Factor VIII replacement
Hepatitis C and HIV infection very common due to tinted blood transfusion
What factor is deficient in Hemophilia B?
Vitamin C deficiency is a coagulation defect (apparently), what will you lack?
Lack of stable collagen (elderly, alcoholics)
Hepatic failure is a coagulation defect, why is this?
Almost all clotting factors are made in the liver.
What clotting factors ARE NOT made in the LIVER?
Factor III ( tissue factor thromboplastin)
Factor IV ( Ca++)
Vitamin K deficiency is considered a coagulation defect. Tell me why?
Yes, Vit K is fat-soluble vitamin and is required for II (prothrombin), VII, IX, and X formation (also protein C and protein S)
What issues would cause a deficiency in Vitamin K?
Fat malabsorption due to lack /obstruction of bile secretion leads to fatty diarrhea causing deficiency of Vit K
What will you give to all surgical patients with liver dz?
What is Thrombocytopenia?
Platelets of less than 150,000
What does Thromboccytopenia cause?
Bleeding from small capillaries and blood vessels Mucosal, skin bleeding.
What is aplastic anemia?
Low number of platelets, you stop producing new blood cells.
Idiopathic thrombocytopenic purpura (ITP), what is it and what does it cause?
Due to antiplatelet antibodies.
decreased anti-GPIIb/IIIa antibodies causeing peripheral platelet destruction
Thrombotic thrombocytopenic purpura (TTP), what is it associated with?
Associated with chemo, liver disease, splenomegaly, DIC pre- eclampsia
Tell me about DIC?
Abnormal bleeding and clot formation
Critically ill patients
Coagulation and clot lysis in uncontrolled manner
Due to massive tissue damage
Depletion of clotting factors
Anesthesia considerations with coagulation disorders? (what do you want to know, what are they likely to receive?)
Careful history about bleeding disorders
Massive blood transfusion causes
Functional deficiency of platelets
Packed RBCs infusion leading to dilution of V & VIII
FFP contains all clotting factors (except platelets)
What is AIDS? (very basically what does it do)
HIV infect and kill T-helper lymphocytes resulting suppression of cell mediated immunity. Host will develop opportunistic infections (Pneumocystis pneumonia) and various tumors