well we haven't gotten into colloids, which is
our next discussion.
Colloids is interesting and the reason I
say that it is because it is so specific as
far as being a type of fluid in which it strictly
remains within the plasma compartment and
we have mentioned this earlier and why is it
that you don't want to give? No, it is not
that you don't want to give, but what precludes
or prevents you from giving this readily is
because once again being cost effective. This
colloid, some of these, tend to be quite expensive
especially when you are dealing with albumin.
So these are large proteins, colloids are, versus
crystals, crystalloids would be your electrolytes,
which was a previous discussion. Well colloids,
these tend to be large proteins. Now in the
ECF, that membrane means the capillary membrane
is not permeable to large protein, is it?
Not at all. So the large protein remains within
the vasculature thus if need be and you see
any scenario in which the patient is receiving
colloids, please understand it is only the
plasma compartment that you are in fact filling.
Now in terms of it being effective, obviously
a lot more effective. Theoretically, it remains
within the intravascular space. What does
that mean to you? The plasma compartment, for
longer periods of time. Example here,
now I do want to give you a clinical correlation
for fresh frozen plasma and we are going to
call this cryoprecipitate as well, but now
there is actually a fine difference between
cryoprecipitate and fresh frozen plasma that
I need to delineate. Because if you just read
through this line here, the statement, you
may or may not understand the significance
of it. Albumin, straightforward. You want to
replenish the vascular compartment, then you
give albumin. Okay fine. That is straight
forward. Now the fresh frozen plasma is interesting.
What are you doing with fresh frozen plasma
and what are the indications of giving FFP?
Fresh frozen plasma or FFP, the indication,
who is this patient? The patient comes in
and my goodness gracious pretty much looks
as close to death as a patient can get, and
by that I don't mean where the EKG has a v.fib
of course. I'm just saying, just straight up
gross examination of your patient. Gross appearance,
just bleeding from every orifice of what I
am getting at. Bleeding from the nose, bleeding
from the mucous membrane, looks really just
sickly and well the labs have hardly been
done and on the labs, you will find the following.
You end up finding where the PT is prolonged,
PTT is prolonged. You find that the bleeding
time is prolonged and you find the platelet
count to be decreased and that patient there
looks as though they are bleeding from every
orifice and guaranteed with those type of
labs your patient has what, please? Good.
DIC, disseminated intravascular coagulopathy.
With DIC, what is that you might want to do
to stop that bleeding? Fresh frozen plasma,
because it contains what? Your coag factors
or coagulation factors. Now versus cryoprecipitate.
The cryoprecipitates are a little bit more
specific. Yes, it does contain some of your
coagulation factors, but not all of them.
Your cryoprecipitates there include some of
the ones that begin with the letter F and
these include fibrinogen, fibronectin and
it would actually be something like von Willebrand
factor. So what does this means to you is
well what if you did have a patient who is
a female and whenever she is having her menstrual
cycle, she was having pretty large amounts
of bleeding taking place, menorrhagia and
along with this the labs then show the following
where you find that all the bleeding
time has increased and then you also find
that the PTT is increased. With that type
of history and those types of labs, where its
PTT and bleeding time elevated, would you
tell me as to what the diagnosis of your female
is here? Good. Von Willebrand disease. So
what is von Willebrand disease? You might
be thinking about giving something like cryoprecipitates.
Are you seeing now as to, fine, you find the
categories, you're looking at the definition of what
a colloid is but then truly I am giving you
perfect, I said perfect because I
don't like saying that for the patient. The
patient obviously is in great demise, great
distress, but these are really excellent diagnoses
in which the indication would be the particular
colloid that I have highlighted here.