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Q1 ) . Restrictive strategy of transfusion in acute GI bleed all are true except?
A. Should be started at a hemoglobin < 7 g/dl B. Will not alter the risk of re bleed C. Child A and B patients had significantly lower risk of gi bleed
It alters the risk of rebleed. It was significantly lower in restrictive group
In the subgroup of patients with cirrhosis, the risk of further bleeding was lower with the restrictive transfusion strategy than with the liberal transfusion strategy among patients with Child–Pugh class A or B disease and was similar in the two groups among patients with Child–Pugh class C disease.
Q2) Patient on Clopidogrel has Intraop bleeding. Which component will you transfuse to control it
a) Platelets
b) FFP
c) Cryoprecipitate
d) PRBC
2) A, platelets
Patients on clopidogrel who are actively bleeding and undergoing major surgery may require almost continuous infusion of platelets during the course of the procedure. Arginine vasopressin or its analogues (DDAVP) have also been used in this patient group
Platelet shelf life is 5 days and stored at temp of -24
Bailey 27th page
Q3) In a patient who is on warfarin for mechanical heart valve, prostatectomy is to be done. When will you stop warfarin?
a) 1 day back
b) 2 days back
c) 3 days back
d) 5 days back
Answer 3) d
Recommendations concerning warfarin anticoagulant management Low-risk procedures No adjustment to anticoagulation required Check INR within the week before procedure
Avoid elective procedures when anticoagulation is above the therapeutic range
High-risk procedure in a patient with a low-risk condition Discontinue warfarin 5 days before the procedure Check INR on day of procedure to ensure <1.5 Restart warfarin on evening after procedure if uncomplicated and recheck INR in 1 week
High-risk procedure in a patient with a high-risk condition Discontinue warfarin 5 days before the procedure Start low molecular weight heparin (LMWH) 2 days after stopping warfarin
Check INR on day of procedure to ensure <1.5
Omit LMWH on day of procedure
Warfarin may be resumed the night of the procedure
LMWH should be continued until INR adequate
The decision to administer intravenous heparin should be individualized
ref BAiley 27th edition page 220-221
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