TAILIEUCHUNG - A manual of intensive care medicine (Sixth edition): Part 2

(BQ) Continued part 1, part 2 of the document A manual of intensive care medicine (Sixth edition) has contents: Surgical problems in the intensive care unit, hematologic problems in the intensive care unit, neurologic problems in the intensive care unit, transplantation,. and other contents. Invite you to refer. | SECTION 9 Hematologic Problems in the Intensive Care Unit Patrick F. Fogarty Disorders of Hemostasis Adam Cuker and Suman L. Sood I. THE BLEEDING PATIENT GENERAL PRINCIPLES A. Etiology. 1. Bleeding disorders Table 88-1 may be secondary to the following a. Defects in the activity of platelets. b. Defects in the activity of one or more coagulation factors coagulopathy . c. Congenital causes. d. Acquired causes. 2. Hematology consultation is often necessary if the cause of bleeding is not immediately apparent and or if specialized laboratory testing is required for diagnosis. B. Di nosis. 1. Clinical presentation. a. Identify the site of bleeding. i. Platelet disorders tend to cause mucocutaneous bleeding . epistaxis oral gastrointestinal GI genitourinary ecchymosis . ii. Coagulopathies . deficiencies in the activity of coagulation factors tend to cause deep soft tissue bleeding . into joints and muscles . iii. Bleeding from a single site . a surgical site GI tract warrants evaluation for an anatomic cause of bleeding. 637 6 3 8 I SECTION 9 H E M AT 0 L 0 G I c p R 0 BLEMS I N THE I cu TABLE 88-1 Selected Congenital and Acquired Bleeding Disorders Mechanism Defects in platelet activity i. 2 3 Defects in coagulation Congenital Qualitative platelet disorders von Willebrand disease0 Hemophilia A Hemophilia B other factor deficiencies Acquired Medications Renal disease Myelodysplasia Myeloproliferative disorders Vitamin K deficiency Liver disease Exposure to anticoagulants DIC Trauma Acquired factor inhibitors For defects in platelet function due to thrombocytopenia see Chapter 89. Deficiency of von Willebrand factor leads to reduced binding of platelets to sites of vascular injury and to one another. DIC disseminated intravascular coagulation. b. Obtain the personal and family bleeding history. i. Congenital disorders life-long history of bleeding positive family history. Exceptions are possible . mild hemophilia . ii. Acquired disorders often no previous

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