sedationstation

Rivaroxaban: Anti-FXa activity PT and aPTT modified according to the reagent (PT more sensitive) Apixaban: Anti-FXa activity PT and aPTT not really prolonged Dabigatran: Ecarin clotting time, Haemoclott or anti-IIa PT, aPTT and TT modified according to the reagent (aPTT more sensitive) Ref. MM Samama et al Clin Chem Lab Med 2011;49,761

- Use is encouraged when expected surgical blood loss > 800 ml. - It is indicated when Hemoglobin value is between 10 and 13 without iron deficiency anemia. - Dose approved is 600 U/kg/week subcutaneously. - It is given in 3 injections.  - It should be started 3 weeks prior to surgery without exceeding hemoglobin target level of 15. - Monitor blood pressure before each injection. Ref. MAPAR 2014

Three subtypes of HIT:  1.  Typical or classical onset HIT. Typically, the platelet count falls gradually starting 5 to 10 days (up to 2 weeks) after the initiation of heparin.  Thrombocytopenic levels may not occur until several days later. 2. Early or rapid-onset HIT.   In some cases, thrombocytopenia may occur abruptly within 5 days of heparin therapy.  The rapid onset suggests exposure to heparin within the past 3 months and the presence of circulating HIT antibodies.  Since the antibodies are already present, thrombocytopenia may occur promptly with heparin administration. 3.     Delayed-onset HIT.  Although rare, thrombocytopenia may occur from several days to more than a month after cessation of heparin.  Such patients may have high titers of HIT antibody.

Bleeding continues to be the Achilles heel of systemic anticoagulation, whether the agent used is warfarin or any of the new anticoagulants entering the market. Predictive models for bleeding include the following: HAS-BLED   (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol) HEMORR2HAGES  (hepatic or renal disease, ethanol abuse, malignancy, elderly, reduced platelet count or function, rebleeding, hypertension, anemia, genetic factors, excessive fall risk, stroke)   HAS-BLED beat two other scoring systems in a comparative analysis of trial data.

                                                  PRESS on the photo for clearer details

Great review of novel oral anticoagulants, from ‘what’ to ‘how to’.. Published in BLOOD March 2012 issue... Click on the following Link..                                                                                                         Click Here please

The AABB (formerly the American Association of Blood Banks has issued guidelines on red blood cell transfusion , providing some number-based targets which may be helpful for some practitioners or organisations. Editorialist and heavyweight intensivist Jean-Louis Vincent argues for a more individual patient-based assessment, and highlights some of the weaknesses of existing studies, in particular the often quoted but now fairly old TRICC study which suffered from poor recruitment and the possible lack of applicability to modern practice now that leucodepleted products are used. Prof Vincent states: “ Transfusion decisions need to consider individual patient characteristics, including age and the presence of CAD, to estimate a specific patient’s likelihood of benefit from transfusion. The decision to transfuse is too complex and important to be guided by a single number. “ Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, tran...

" von Willebrand treatment is Desmopressin".... This what we all learned in the Med school, this statement passover important facts in von Willebrand disease.vonWillebrand disorder has many subtypes and some of these subgroups respond to Desmopressin different than we repeat  for long years.. here is the missing Facts about Desmopressin and von Willebrand Disorder: DDAVP is the treatment of choice of von Willebrand type 1..right.. But... DDAVP can be deleterious if given to patients with vWD type 2B causing thrombocytopenia. Patients with vWD type 3 do not respond to DDAVP at all... Now it is the time to change the starting statment... "Von Willebrand type 1 treatment is Desmopressin"

.   should avoid smoking on the day of donation and 3 hours after donation. should not have fever at the time of donation. should have had a good meal before donation. should disclose whether he is under any medication for malaria, jaundice, etc. should not have had any tooth extraction in the past 2 weeks. should not be pregnant. should not have had any immunization at least one month before checklist to be seen while blood donation is to be done: should not have donated blood in the last 3 months.   should not have undergone any major surgery within 3 months.   no alcohol consumption 48 hours before the donation.   should avoid smoking on the day of donation and 3 hours after donation.   should not have fever at the time of donation.   should have had a good meal before donation.   should disclose whether he is under any medication for malaria, jaundice, etc.   should not have had any tooth extraction in t...

First click on this link to see a video on the effect of blood transfusion on Microcirculation                                                                                                                            Press Here  One of the characteristic alterations in stored RBC is a change in shape from a normal biconcave to a spindly cell (echinocyte).(1) This results in lower surface ...

When you put DIC in the Differential list,be careful when you read the lab results,misleading may occur because of the following reasons: 1-Thrombocytopenia (<100,00/uL) is not always evident early in the process, but true DIC without sequential reduction in platelet count is very unlikely. 2-PT and aPTT may remain normal in spite of decreasing factor levels because of the presence of high levels of activated factors including thrombin and Xa. 3-Fibrinogen level may not be decreased, i.e., <100 mg/dL, initially. Fibrinogen is an “acute phase reactant” which increases in response to stress and the early consumption of fibrinogen may simply reduce its levels to “normal”. 4-FDPs are a sensitive measure of fibrinolytic activity although they not specific for DIC. 5-D-dimer (which is a breakdown product of the cross-linked fibrin in a mature clot) is somewhat more specific for DIC. ASA refresher courses 2009

 Press on the image for larger view