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Extra resources for Chirurgia Washington Manual Of Surgery
In patients with less than 1% activity, frequent hemarthroses and severe bleeding episodes develop. The diagnosis is suggested by an elevated PTT, normal PT, and normal bleeding time. Factor activity assays confirm the diagnosis. a. Treatment of hemophilia A is based on the degree of bleeding and the severity of the disease. 1. Minor bleeding often is controlled locally without factor replacement therapy. ) stimulates the release of vWF, which complexes with factor VIII, thereby sheltering it from the circulation.
B. Diagnosis. Although the cause of metabolic alkalosis is usually apparent in the surgical patient, measurement of urinary chloride concentration may be useful for differentiating these disorders. Urine Cl – concentration of less than 15 mmol/L suggests inadequate fluid resuscitation, ongoing GI loss from emesis or nasogastric suctioning, diuretic administration, or posthypercapnia as the cause of the metabolic alkalosis. Urine Cl – concentration greater than 20 mmol/L suggests mineralocorticoid excess, alkali loading, concurrent diuretic administration, or the presence of severe hypokalemia.
Acquired a. Lupuslike inhibitors are IgG, IgA, or IgM immunoglobulins that are targeted against antigens composed in part of platelet and endothelial cell phospholipids. , chlorpromazine, procainamide, or hydralazine). Approximately half of patients with lupuslike inhibitors have no identifiable predisposing conditions and are said to have antiphospholipid antibody syndrome. The diagnosis is suggested by a prolonged PTT and can be confirmed using specific tests, such as Russell's viper venom clotting time (for lupus anticoagulant) and anticardiolipin antibody immunoassay.