QuestionSBA
QuestionChoice
Whilst a unit of blood is needed as soon as possible you should always also stop medications that will exacerbate the bleed - in this case the apixaban needs to be stopped.
50110
e
Prescribe a unit of O negative blood STAT
QuestionChoice
Stopping the apixaban would be one of the correct steps in the management of this patient. Giving vitamin K however will have no effect as this reverses the effects of warfarin NOT apixaban. You should also give a unit of blood STAT.
50109
d
Stop his apixaban, prescribe vitamin K 2mg PO STAT
QuestionChoice
These are all management options that you would do however this option is missing giving a unit of blood which is crucial in this case due to the haemodynamic instability.
50107
b
Stop his apixaban, take a group and save blood sample and continue to monitor
QuestionChoice
These are management options that you would do however this option is missing giving a unit of blood which is crucial in this case due to the haemodynamic instability. You should also get a group and save and crossmatch sample.
50108
c
Stop his apixaban and continue to monitor
QuestionChoice
This patient has suffered an acute bleed. They are haemodynamically unstable due to the hypotension and tachycardia. They also have a low Hb of 68 with the transfusion threshold being a Hb of 70 (80 in patients with a significant cardiac history). He should therefore have all blood thinners suspended and a unit of O negative blood given STAT. You should also get a group and save and crossmatch sample.
50106
a
Stop his apixaban, take a group and save blood sample and prescribe a unit of O negative blood STAT
QuestionComment
does anyone know if there is a tx summary or page on transfusion thresholds or bleeding?
61629
User
subscriber
Vitals 'R' Us
QuestionComment
Not sure but it is HB<80 in ACS and Hb<70 otherwise
61898
User
subscriber
Mj
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3601
The transfusion threshold and importance of stopping blood thinners in patients with acute episodes of bleeding
Topic
13
Neurosurgery
10069
Case Presentation: A 76 year old man is brought to the emergency department due to a PR bleed. He is unsure how much blood he has lost. 




 **PH** Diverticular disease, atrial fibrillation, hypercholesterolaemia


 **DH** Bisoprolol 5mg PO OD, apixaban 5mg PO BD, atorvastatin 20mg PO OD. NKDA


 **On examination**


Temperature 37.4°C, HR 108, RR 18, BP 94/68, O2 95% RA.


 **Investigations**


||||
|--------------|:-------:|---------------|
|Haemoglobin|68 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|7.3x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|333x10<sup>9</sup>/L|150 - 400|
|C Reactive Protein|48 mg/L|< 5|


Question: Select the most appropriate management at this stage.
a