HemeLymphE1/Matching Update at main · Tayner35/HemeLymphE1 · GitHub

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
### Hemostasis Essentials (Matching Game Format)

**Term ➝ Answer Card (scannable + one-best-match)**

---

## 1) Packed RBCs

**Use for:** Symptomatic anemia / acute blood loss
**Trigger:** Hgb **<7 g/dL** (often higher if ischemia/CAD/ongoing hemorrhage)
**Goal:** Improve **oxygen delivery** (not clotting)

---

## 2) Platelets

**Use for:** Thrombocytopenia causing bleeding risk
**Trigger:**

* **<10k/µL** = prophylaxis
* **<50k/µL** = active bleeding / procedure
* **<100k/µL** = neurosurgery/eye (high risk)
  **Goal:** Fix **platelet number**

---

## 3) Fresh Frozen Plasma (FFP)

**Use for:** **Multiple clotting factor replacement** (global coagulopathy)
**Trigger:** **PT/INR and/or PTT elevated + bleeding** (liver disease, DIC, massive transfusion)
**Also:** Warfarin major bleed **if PCC unavailable**
**Goal:** Replace **missing clotting factors**

---

## 4) Cryoprecipitate

**Use for:** **Low fibrinogen** replacement
**Trigger:** Fibrinogen **<100–150 mg/dL** (DIC, massive hemorrhage, postpartum hemorrhage)
**Contains:** **Fibrinogen, VIII, vWF, XIII**
**Goal:** Restore **fibrinogen → stable clot formation**

---

## 5) Tranexamic Acid (TXA)

**Use for:** **Antifibrinolytic** (prevents clot breakdown)
**Best for:** Mucosal bleeding, menorrhagia, dental bleeding, trauma (early), postpartum hemorrhage protocols
**Goal:** Keep clots from being **lysed too quickly**

---

## 6) Desmopressin (DDAVP)

**Use for:** Boost endogenous **vWF + Factor VIII**
**Best for:** **vWD (type 1)**, **mild Hemophilia A**
**Use case:** Minor bleeding / procedural prophylaxis
**Goal:** Rapid **temporary factor/adhesion boost**

---

## 7) Vitamin K

**Use for:** Reverse **warfarin** by restoring factor production
**Targets:** Factors **II, VII, IX, X** (+ proteins **C, S**)
**Timing:** **Hours** (requires new synthesis)
**Major bleed:** **IV vitamin K + PCC** (FFP if PCC unavailable)
**Goal:** Restore vitamin K-dependent **coagulation capacity**

---

## 8) Protamine

**Use for:** **Heparin reversal**
**Best for:** **Unfractionated heparin**
**Note:** **Partial reversal** for LMWH (enoxaparin)
**Goal:** Neutralize **heparin immediately**

---

## 9) Increased PT, normal PTT

**Pattern:** **Extrinsic pathway** abnormality
**Points to:**

* **Warfarin** (Factor VII drops early)
* **Factor VII deficiency**
* Early **vitamin K deficiency**
  **Key clue:** “PT only” → **VII/warfarin**

---

## 10) Increased PTT, normal PT

**Pattern:** **Intrinsic pathway** abnormality
**Points to:**

* **Hemophilia A (VIII deficiency)**
* **Hemophilia B (IX deficiency)**
* **Heparin effect** (context dependent)
  **Key clue:** “PTT only” → **hemophilia/heparin**

---

## 11) Increased PT and Increased PTT

**Pattern:** **Global/common pathway** factor deficiency
**Points to:**

* **DIC** (consumption)
* **Severe liver failure** (low synthesis)
* **Massive transfusion** (dilutional)
* Severe vitamin K deficiency (less common)
  **Key clue:** “everything prolonged” → **system-wide factor depletion**

---

## 12) Normal PT/PTT + Increased Bleeding Time

**Pattern:** **Primary hemostasis defect** (platelet function / vWF)
**Points to:**

* **vWD** (adhesion defect, PTT may be mildly ↑ sometimes)
* **Uremia**
* **Aspirin/NSAIDs**
* Inherited platelet dysfunction (Glanzmann, Bernard-Soulier)
  **Key clue:** “factors fine, bleeding still happening” → **platelet/vWF problem**

---

## 13) Increased PTT that does NOT correct (mixing study fails)

**Pattern:** **Inhibitor present** (not simple deficiency)
**Points to:**

* **Lupus anticoagulant** (thrombotic clinically; prolonged PTT in lab)
* **Factor VIII inhibitor** (acquired hemophilia)
  **Mixing rule:**
* **Corrects** = factor deficiency
* **Does not correct** = inhibitor
  **Key clue:** “mixing fails” → **inhibitor**

---

## 14) Hydroxyurea

**Use for:** Increase **HbF** + reduce sickling; cytoreduction for PV
**Best for:**

* **Sickle cell disease** (↓ VOC, ↓ acute chest)
* **Polycythemia vera** (↓ thrombosis via ↓ cell counts)
  **Goal:** HbF up (SCD) / counts down (PV)

---

## 15) Granulocytes

**Use for:** Rare support in **severe neutropenia + life-threatening infection**
**Consider when:**

* Profound neutropenia (very low ANC)
* Serious infection
* Not responding to antimicrobials (specialty-dependent)
  **Goal:** Temporary **neutrophil boost** in extreme cases