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These are most important in trauma patients!!!

Platelet Disorders

  • Symptoms of SUPERFICIAL bleeding
    • Mucosal bleeding
    • GI bleeding
    • Recurrent epistaxis
  • Thrombocytopenia
    • When the platelets ARE LOW
      • Refer to THIS episode
  • Von-Willebrand disease
    • When the platelets CAN’T BIND
    • Treatment
      • Desmopressin (DDAVP)
        • Causes increase in amount of von-willebrand factor (vWF) available
        • Also causes free water retention
          • Treatment of diabetes insipidus
      • Replace vWF
        • Transfuse factor VIII
          • Contains vWF (factor VIII binds vWF)
        • Transfuse cryoprecipitate

The Hemophilias

  • Symptoms of DEEP bleeding
    • Hemarthrosis
    • Hematomas
    • Intracranial Bleeding
  • Factor IX deficiency (Christmas disease)
    • Treat by replacing factor IX
      • Rate the “severity” of the bleeding on a scale of 1-100
        • Dosing equals the severity score in milligrams
          • For example
          • 25 = 25mg/kg factor = mild bleeding (mild hematuria with stable hemoglobin, painful but contained hemarthrosis)
          • 50 = 50mg/kg factor = moderate bleeding = (rapid nose bleeds, rapid bleeding that won’t resolve)
          • 75 = 75mg/kg factor = severe bleeding = (GI bleeds with dropping hemoglobin, retroperitoneal hematoma)
          • 100 = 100mg/kg factor = deadly bleeding = (intracranial hemorrhage)
  • Factor VIII deficiency (Hemophilia A)
    • Treat by replacing factor VIII
      • Dosing similar to factor IX but you take severity score and divide by 2
        • For example
        • 25 = 12mg/kg factor = mild bleeding (mild hematuria with stable hemoglobin, painful but contained hemarthrosis)
        • 50 = 25mg/kg factor = moderate bleeding = (rapid nose bleeds, rapid bleeding that won’t resolve)
        • 75 = 37mg/kg factor = severe bleeding = (GI bleeds with dropping hemoglobin, retroperitoneal hematoma)
        • 100 = 50mg/kg factor = deadly bleeding = (intracranial hemorrhage)

Additional Reading