Blood products
The evidence for benefit of blood transfusions in GI bleed is poor with some evidence finding harm. In those in shock O-negative packed red blood cells are recommended. If large amounts of pack red blood cells are used additional platelets and fresh frozen plasma (FFP) should be administered to prevent coagulopathies. In alcoholics FFP is suggested before confirmation of a coagulopathy due to presumed blood clotting problems. Evidence supports holding off on blood transfusions in those who have a hemoglobin greater than 7 to 8 g/dL and moderate bleeding, including in those with preexisting coronary artery disease.If the INR is greater than 1.5 to 1.8 correction with fresh frozen plasma or prothrombin complex may decrease mortality. Evidence of a harm or benefit of recombinant activated factor VII in those with liver diseases and gastrointestinal bleeding is not determined. A massive transfusion protocol may be used, but there is a lack of evidence for this indication. Procedures
The benefits versus risks of placing a nasogastric tube in those with upper GI bleeding are not determined. Endoscopy within 24 hours is recommended, in addition to medical management. A number of endoscopic treatments may be used, including: epinephrine injection, band ligation, sclerotherapy, and fibrin glue depending on what is found. Prokinetic agents such as erythromycin before endoscopy can decrease the amount of blood in the stomach and thus improve the operators view. They also decrease the amount of blood transfusions required. Early endoscopy decreases hospital and the amount of blood transfusions needed.
High-functioning autism (HFA) is an autism classification where a person exhibits no intellectual disability, but may exhibit deficits in communication, emotion recognition and expression, and social interaction. HFA is not included in either the American Psychological Associations DSM-5 or the World Health Organizations ICD-10, neither of which subdivides autism based on intellectual capabilities. Characterization
High-functioning autism is characterized by features similar to those of Asperger syndrome. The defining characteristic recognized by psychologists is a significant delay in the development of early speech and language skills, before the age of three years. The diagnostic criteria of Asperger syndrome exclude a general language delay.Further differences in features of people with high-functioning autism from those with Asperger syndrome include the following:
Lower verbal reasoning ability
Better visual/spatial skills (higher performance IQ)
Less deviating locomotion (e.g. clumsiness)
Problems functioning independently
Curiosity and interest for many different things
Not as good at empathizing with other people
Male to female ratio (4:1) much smallerAs of 2013, Asperger Syndrome and High-functioning autism are no longer terms used by the American Psychological Association, and have instead both been merged into autism spectrum disorder (ASD). As of 2021, the World Health Organization also retired the terms and merged them into autism spectrum disorder. Comorbidities
Individuals with autism spectrum disorders, including high-functioning autism, risk developing symptoms of anxiety.