The Management of Coagulopathys Presented by: SM van Deventer CASE STUDY 1 (I) Patient Profile: A 20 months old child, was scheduled for a Tetralogy of Fallot Repair The child had severe cyanosis (S A O 2 of 54%). His Hb was 22.1 Coming off bypass the Hb was And now the patient is bleeding what can be done? CASE STUDY 1 (II) Factors that may influence coagulation: Platelet function Coagulation factors Hypothermia Haemodilution Cardiopulmonary Bypass CASE STUDY 1 (III) Treatment and Handling of the patient: Administration of FFP (Fresh Frozen Plasma) Administer Platelets But why will this help stop the bleeding? CASE STUDY 2 (I) Mr. J is a 67 years old male and is scheduled for an aortic valve replacement. He has severe aortic stenosis, the gradient over the valve is 50mmHg. He does not have ischemic heart disease. He received an aortic bioprosthesis. The bypass was uneventful with very little complications .the patient is bleeding severely post bypass. WHY? CASE STUDY 2 (II) Factors that have an effect: Aortic Stenosis Fragmentation of clotting factors Platelet function von Willebrand Factor CASE STUDY 2 (III) Treatment and Handling of the patient: Cryoprecipitate DDAVP (Desmopressin) Platelets CASE STUDY 3 (I) Patient profile: 34 year old, Mrs R is suffering from a severe case of infective endocarditis and she is scheduled for emergency mitral valve replacement. Post bypass she keeps on bleeding severely. How will this be treated? CASE STUDY 3 (II) Factors having an effect: Tests:Urea levels Inflammatory Markers: IL-1,6 and 8 Platelet count Liver function MODS DIC Endothelium dysfunction CASE STUDY 3 (III) Treatment and handling of the patient: Cyclocapron DDAVP FFP Platelets Cryoprecipitate Factors: IX, VIII, rVII (novo 7) CASE STUDY 4 (I) Patient profile: 45 year old Mr. N has an aortic arch aneurysm, he received CPB with circulatory arrest and antegrade cerebral perfusion. Patient was hemodynamically unstable. There was no sign of any clot formation post CPB and protamine administration. What would be the reason? CASE STUDY 4 (II) Factors having an effect: Hypothermia(CPB) Platelet fx Coagulation factors Endothelial dysfx Decreased liver fx CASE STUDY (III) Treatment and handling of the patient: Administer platelets FFP Coagulation factors: IX VIII rVII THANK YOU!