DILUTIONAL COAGULOPATHY.pptx

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1. DILUTIONAL COAGULOPATHY AHMAD ULLAH BS ANESTHESIA 6 TH SEMSTER KMU IPMS

2. OBJECTIVES AFTER THIS PRESENTATION THE STUDENT WILL LEARN ABOUT THAT ; WHAT IS COAGULOPATHY WHAT IS DILUTIONAL COAGULOPATHY PATHOPHYSIOLOGY OF DILUTIONAL COAGULOPATHY TREATMENT OF DILUTIONAL COAGULOPATHY WHY DOES HYPOTHERMIA CAUSE COAGULOPATHY

3. COAGULOPATHY DEFINITION Coagulopathy (also called a bleeding disorder) is a condition in which the blood's ability to coagulate (form clots) is impaired . This condition can cause a tendency toward prolonged or excessive bleeding (bleeding diathesis), which may occur spontaneously or following an injury or medical and dental procedures.

4. DILUTIONAL COAGULOPATHY DEFINITION Dilutional coagulopathy is usually defined as loss, consumption, or dilution of coagulation factors and occurs when blood is replaced with fluids that do not contain adequate coagulation factors . Dilutional Coagulopathy refers to the coagulopathy seen during massive transfusion for major trauma and/or hemorrhaging. 

5.  Large volumes of crystalloid fluid used for resuscitation in these cases can also contribute to thrombocyptoenia .  Packed red blood cells contain few platelets when stored for over 24 hours, and the platelets that packed red blood cells do contain are typically damaged and removed from circulation upon transfusion. 

6. HOW DILUTIONAL COAGULOPATHY DEVELOP The important aspect of developing dilutional coagulopathy is the use of colloids and the combined interaction with hemostasis. There is fair evidence that colloids, especially high molecular solutions and dextrans , were linked to severe disturbance of clot formation By manufacturing new low molecular starches, impact on clot formation was significantly reduced, but depending on the amount of fluid given a marked impairment of hemostasis can be observed

7. TREATMENT OF DILUTIONAL COAGULOPATHY Adequate fibrinogen levels are essential in managing dilutional coagulopathy . After extensive hemodilution , fibrin clots are more prone to fibrinolysis because major antifibrinolytic proteins are decreased .  Fresh frozen plasma, platelet concentrate, and cryoprecipitate are considered the mainstay hemostatic therapies .

8. HOW WE CAN PREVENT DILUTIONAL COAGULOPATHY The key to preventing coagulopathy is plasma infusion before PT becomes subhemostatic . The optimal replacement ratios were 2:3 for plasma and 8:10 for platelets . Concurrent transfusion of plasma with blood is another effective strategy for minimizing coagulopathy.

9. COAGULOPATHY IN LIVER DISEASE PATIENT Coagulopathy in patients with liver disease results from   impairments in the clotting and fibrinolytic systems, as well as from reduced number and function of platelets . Parenteral vitamin K replacement corrects coagulopathy related to biliary obstruction, bacterial overgrowth, or malnutrition.

10. WHY DOES HYPOTHERMIA CAUSE COAGULOPATHY ? Hypothermia inhibits fibrinogen synthesis, whereas acidosis accelerates fibrinogen degradation, leading to a potential deficit in fibrinogen availability . In addition, coagulation complications caused by acidosis cannot be immediately corrected by pH neutralization alone.

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