How to interpret PT/ aPTT? When do you give FFP or cryo??!!

What does PT measure? What about aPTT? Does Hemophilia make both numbers go up? What about vitamin K deficiency? When do we give cryoprecipitate? Why do we give FFP? Learn all about the extrinsic and intrinsic coagulation pathways- and TRULY understand how to interpret the lab tests and how to react to them!
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Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
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***TIMESTAMPS***
01:53 Extrinsic and Intrinsic pathways
03:49 PT and PTT
05:21 Vitamin K
06:07 DIC
08:54 Fibrinogen
09:41 Replacement with blood products (FFP / cryoprecipitate)
12:07 Cryoprecipitate
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

[@felipeguinancio7456]

Another excellent vídeo Dra Tala. Thank you so much. One question is what about platelets transfusion on active bleeding..., what range and dose do you use on your unit? Thank you so much again. Follower of your work.

[@TalaTalksNICU]

Hello Felipe- we touched on this in one of the earlier platelet videos. I'd say our thresholds fell considerably after this paper was published: www.nejm.org/doi/full/10.1056/NEJMoa1807320 In a baby not bleeding, we'll go down to 25-40K. If the baby is bleeding actively, my numbers are still higher- probably < 100K. Hope this helps?!

[@felipeguinancio7456]

Sure it does. Good to know we think the same (:

[@Spicytots5]

Brilliant!!!! Thank you for making this confusing topic crystal clear :)

[@TalaTalksNICU]

Oh yay!!! So happy it helped! Thanks for taking the time to comment!

[@msandar5767]

Amazing and you explained it very clearly and it stick to my memory. Thank you Dr.Tala😊

[@TalaTalksNICU]

Glad it was helpful! Thank you for commenting!

[@iboprincess1]

Thank you so much! All this information is making me a better NICU nurse.

[@TalaTalksNICU]

Oh yay! So happy you feel these are helping in any way- and that you are striving to be better- as we all should all the time!! Love the handle too :)

[@abeyoutifuljourneyahead]

Thank you for all of your videos. They always help me so much.

[@TalaTalksNICU]

We really appreciate you being here and watching these. So happy they help :)

[@drazam325]

It's great for students and us as quick revision and understanding ,keep it up ,Weldon

[@TalaTalksNICU]

Thank you so much! Really appreciate you watching and always commenting- it's keeping us going :)

[@naitramsingh6942]

Awesome video as always, you and your team always makes these topics so easy to understand, thanks

[@TalaTalksNICU]

Awesome comment as always! ha! Thanks so much to you :)

[@sadybol5703]

I wonder the place that you are working must be a great learning NICU environment. All the NICU staff should be blessed to have a mentor like you Dr. Tala - I wish you were my preceptor during my clinical rotations 😉😉😊

[@TalaTalksNICU]

Thank you so much Sady! What a lovely compliment. The truth is we have absolutely fantastic staff in our hospitals- so I think we're probably all really lucky :)

[@gelilawitasefa6247]

Yet another excellent talk by Dr Tala! Thank you

[@TalaTalksNICU]

THANK YOU!!! So glad you're still here and watching!!

[@Vishvin69]

A topic, that I can't get enough of. Would luv to hv more n more of this anytime. Well rendered 💞👌🏻

[@TalaTalksNICU]

Thanks so much for watching and for letting us know :)

[@selsabildraou6943]

Thanks Tala for this brief nice summary

[@TalaTalksNICU]

Thanks so much for your continued positive comments! We really appreciate them :)

[@lvillarreal8865]

Thank you for the mnemonics Dr Tala! 🥰

[@TalaTalksNICU]

Ha! Love them! Let us know if you have others for anything else?!

[@CaitlinConner]

These videos are so helpful for graduate school! Could you make some on metabolic disorders?

[@TalaTalksNICU]

Hello Caitlin! yes thank you for the great suggestion- we are getting around to it!! Thanks for being here :)

[@nadalmarwan7298]

Thanks ..very important topic

[@TalaTalksNICU]

Yes! Clinically very important!Thanks so much fort watching and for subscribing Nadal :)

[@nagashreenagaraj2079]

This is very good thanks a lot 👍🏽

[@TalaTalksNICU]

Thank you so much for watching and for being here :)

[@shameemmahmood-aberasturi9985]

Great video as always! Thankyou Tala and team! Quick question, when in DIC, is there a preferred order when giving products and reasoning behind it. Thankyou again!❤

[@TalaTalksNICU]

Hello Shameem! Thanks for your lovely words. Generally- I try to treat the most abnormal number first (e.g. your Hct is 22 and your PT is 21, I'd give PRBCs first). In reality- we give what the blood bank gives us first! When babies are on ECMO we'd worry more about giving clotting products at the same time- but usually we can give products rapidly following each other.

[@through_Ameera_]

Thanks Dr Tala #nainann keep explaining difficult points into such an easy way

[@TalaTalksNICU]

Thank you so much for continuing to watch!

[@goecmj]

Great video again! You have such a gift! Do you mind sharing what your thresholds are for when you would give FFP (i.e. at or above what PT/PTT level?) Would it depend on whether they are bleeding or how sick they are? Thank you!

[@TalaTalksNICU]

Hi JH! So glad you like video- sorry took me a couple of days! Honestly I don’t really have thresholds for PT/PTT. Often I don’t even check it- because takes so much blood. So if an infant is bleeding weirdly then I’ll check it- and if at all elevated (eg INR > 1.5) then I’d transfuse. If there is a reason for the infant having bleeding eg liver failure- and baby is bleeding then we’ll give it. If a baby has hypotension and is not bleeding then may give FFP to help with volume if PT/PTT out of whack. And I have cryo if fibrinogen

[@Chris-di6nl]

Thanks for excellent video! Do you know when you’ll have more nursing specific videos??

[@TalaTalksNICU]

Hi Chris! Let us know specifically what videos you'd be interested in? We'd love to run more nursing videos! Thanks!

[@Chris-di6nl]

@@TalaTalksNICU calculating fluid rates, changes in fluid rates i.e. if I w feed increases how tpn comes down; commonly forgotten nursing actions/ assessments in nicu, handling of super small premies, what to say and not to say to parents, things docs expect from nicu nurses stuff like that!

[@TalaTalksNICU]

These are amazing suggestions Chris!!! Thanks so much! Will get to a very specific nursing video addressing these things. Thank you!!!

[@thegoalvoyage5485]

THaNKS MAM!

[@TalaTalksNICU]

Thank you so much for watching and for being here :)

[@britneywebster2669]

Great video as usual!! Why is it that we care more about anti- xa levels when a baby is on a heparin drip or lovenox as opposed to PT/PTT?

[@TalaTalksNICU]

Great question! PT is often unaffected with heparin therapy, and PTT is not a sensitive test. So infant may be anti-coagulated with a normal PT and PTT. Still a complete pain to follow the anti-Xa levels though :(

[@mamoonbilal5983]

Awesome explain as usual🥰 But I have a question what about giving plasma to improve the general conditions of preterm is this evidence-based?

[@TalaTalksNICU]

Honestly- not really! Which is why- we won't just treat numbers. If the PT and PTT is elevated and the baby is bleeding out- or hypotensive, then maybe we'd give. Otherwise we would ignore it. (Back to one of first principles of medicine : only get a lab test if you're going to do something with it).

[@mamoonbilal5983]

@@TalaTalksNICU Thank you to explain this point🙏

[@rasoulhoma8007]

Cryo.is rich in all factors. Can we START with it instead of FFP.....tank you

[@TalaTalksNICU]

Cryo takes more processing than FFP, and is not as factor rich many of the other factors (i.e. not the ones listed)- so generally we'd start with FFP, unless it really is for VWF, factor 8, fibrinogen and factor 13.