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231 Cards in this Set

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What white blood cells are partially formed in the bone marrow?
Grandulocytes, monocytes, and a few lymphocytes
What white blood cells are partially formed in the lymph tissue?
Lymphocytes and plama cells
What are the granulocytes?
Neutrophils, eosinophils, and basophils
Platelets are formed from fragmentation of _______.
Megakaryocyte (similar to WBC)
Which types of cells ingest organisms through phagocytosis?
Granulocytes and monocytes
What are the concentrations of neutrophils, lymphocytes, monocytes, eosinophils, and basophils?
neutrophils: 62%
ymphocytes 30%
monocytes 5.3%
eosinophils 2.3%
basophils 0.4%
What is the lifespan of a platelet?
8-12 days
Which types of cells ingest organisms through phagocytosis?
Granulocytes and monocytes
Monocytes are immature in blood and must mature into ______ in tissue and live for ________.
Monocytes become macrophages and can live for months in tissue
What are the concentrations of neutrophils, lymphocytes, monocytes, eosinophils, and basophils?
neutrophils: 62%
ymphocytes 30%
monocytes 5.3%
eosinophils 2.3%
basophils 0.4%
What are the three modes of movement for neutrophils and macrophages?
Diapedesis (small portions at a time slide through pore in capillaries)
Ameboid motion
Chemotaxis (move toward source of chemical d/t concentration gradient)
What is the lifespan of a platelet?
8-12 days
Monocytes are immature in blood and must mature into ______ in tissue and live for ________.
Monocytes become macrophages and can live for months in tissue
What are the three modes of movement for neutrophils and macrophages?
Diapedesis (small portions at a time slide through pore in capillaries)
Ameboid motion
Chemotaxis (move toward source of chemical d/t concentration gradient)
What is the most important function of neutrophils and macrophages?
Phagocytosis
What 3 "invader" factors lead to phagocytosis?
Rough surface
No protective coat
Opsonization (attachment of complement to invader, marking it for phagocytosis)
Macrophages are _______ powerful phagocytes than neutrophils, and survive ______
More powerful, last longer
Macrophages can be mobile or fixed. Name 5 types or locations of fixed macrophages.
Histiocytes of skin
Lymph nodes
Alveolar macrophages
Hepatic Kupfer Cells
Macrophages of spleen and bone marrow
What are the (simplified) steps of inflammation?
Vasodilation of local blood vessels (excess flow)
Increased permeability of capillaries (leads to interstitial edema)
Fibrinogen causes clotting (walls of area)
Neutrophils and macrophages migrate to tissue
Name 6 mediators of inflammation
Histamine
Serotinin
Bradykinin
Prostaglandins
Reaction products of complement system
Lymphokines
In what order do WBCs respond to inflammation?
Fixed or tissue macrophages (respond first)
Neutrophils (2nd)
Mobile macrophages enter inflamed tissue (3rd)
Bone marrow causes increased production of granulocytes and monocytes (4th)
Eosoiniphils are produced in response to______ and _____.
Parasites and allergens
Basophils play an important role in _________ and cause release of ________.
Play important role in allergic reactions; cause release of heparin, histamine, bradykinin, and serotonin
(similar to mast cells)
The first time a person encounters an allergen, large amounts of _____ antibodies are produced, which attach themselves to ________. The next time a person encounters the allergen, the primed ______ cells cause release of chemical mediators and an allergic reaction takes place.
IgE antibodies are produced and attach to mast cells; on the next encounter with the allergen, the primed mast cells release granules of mediators (histamine, cytokines, etc) resulting in allergic symptoms.
What is leukopenia? What are 3 causes?
Decreased bone marrow production of WBCs; causes include radiation, drugs and chemicals (chloramphenicol, thiouricil, BARBITURATES)
Which type of leukemia is more severe in children?
AML is more severe in children than adults; ALL is more severe in adults than children
What are 6 S/S of leukemia?
1. Bone pain, easy fracture
2. Infections
3. Severe anemia
4. Bleeding
5. Thrombocytopenia
6. Excess use of metabolic substrate (weight loss, wasting)
What is acquired immunuty?
Ability to resist disease, bacteria, or toxins after exposure
Humoral (antibody) mediated immunity is due to _____ lymphocytes.
B lymphocytes
75% of normal antibodies are what type? What type of antibody is responsible for allergy? What antibodies are formed during the primary response to infection?
Most antibodies are IgG (this is IVIG)
Allergies are modulated by IgEantibodies
IgM antibodes are formed during primary response
What are gamma globulins or immunoglobulins?
Antibodies
T-cells are responsible for _______ mediated immunity
T cells are responsible for cell-mediated immunity
Where are B and T lymphocytes formed?
Spleen
Lymph nodes
GI system
Bone Marrow
What happens when antibodies directly attack an invader?
1. Agglutination
2. Precipitation
3. Neutralization (antibodies cover the toxic site of the antigen)
4. Lysis (antigen cell rupture)
Antibodies can activate the ______ system by way of the classic pathway (antigen-antibody reaction)
Complement
What are the steps of the classic pathway?
1. Opsonation and phagocytosis
2. Lysis
3. Agglutination
4. Neutralization
5. Chemotaxis
6. Mast cell and basophil activation
7. Inflammation
Define antibody; what are they secreted from?
A protein produced as the result of introduction of an antigen; secreted from plasma cells
What determines the specificity of an antigen?
Antigenic determinants- specific areas on the cell membrane of the antigen
Define antigen
What substance are they typically comprised of?
Foreign substances capable of stimulating an immune response; typically proteins
Define autoimmunity
Loss of self-tolerance; antibody production towards "self" antigens
What is complement?
A series of enzymes circulating in the bloodstream that are activated by an antigen-antibody reaction and then participate in the inflammatory response
What are immunocompetent cells?
B and T lymphocytes; cells that can recognize and react with an antigen
Tolerance
A state of unresponsiveness developed towards a specific, known antigen
What is the definition of AIDS?
T-cell count less than 200, or first specific opportunistic infection (typically pneumocystis carinii)
What are some specific anesthetic implications of HIV or AIDS infection?
1. Universal precautions
2. Patients may exhibit anemia from chronic infection, upper airway obstruction from supraglottic Kaposi's Sarcoma, oxygenation may be impaired by pneumocystis carinii infection
Plasma is _____% H20, and ______% dissolved organic acids, salts, and proteins
Plasma 90% H20, 10% "stuff"
What is the average blood volume of an adult?
5L
What are the important components of plasma?
Albumin, globulins, clotting factors
What are the functions of red blood cells (erythrocytes)?
1. Transport Hgb (carry O2)
2. Contains carbonic anhydrase (acid-base buffer)
How much O2 can 1 gm of Hgb carry?
1.34 ml O2 per 1 gm Hgb
What is the typical Hct?
40-45
Where are RBCs produced in children under age 5? Where are RBCs produced from 5-20?
Where are most RBCs produced after age 20?
until 5: marrow in almost all bones produces RBCs
5-20: marrow of long bones
After 20: marrow in proximal humeri and tibiae , but most RBCs produced in marrow of membranous bones (vertebrae, sternum. ribs, and ilia)
What is erythropoietin? Where is it produced?
EPO: circulating hormone that is the stimulus for RBC production;
90% EPO is made in kidneys, 10% in liver
What is the timeline of RBC production after EPO release?
Tissue hypoxia causes increased erythropoetin in minutes to hours; release of EPO peaks at 24 hours; new RBCs appear 5 days later
What is the stimulus for increased EPO release?
Tissue hypoxia-
1. Low blood volume
2. Anemia
3. Low Hgb
4. Poor blood flow
5. Pulmonary disease
What does B12 deficiency cause?
macrocitic anemia; cells are poorly formed, can carry O2 normally but are fragile and have a 1/2 to 1/3 normal life
What is pernicious anemia?
Anemia caused by failure to absorb B-12 from the gut due to a lack of intrinsic factor ; B12 is stored in the liver, so symptoms may not appear for 3-4 years; causes a failure of maturation of RBCs
What is the most common form of hgb in the adult?
Hgb A
Hgb A is comprised of 2 _____ chains and 2 _____ chains
2 alpha, 2 beta
Each Hgb molecule has _____ iron atoms which can each bind O2 molecules. Hw many atoms of Oxygen can each Hgb molecule carry?
4 iron atoms in each Hgb molecule; can carry 8 oxygen atoms, or 4 O2 molecules
Valine is substitued for glutamic acid on the ______ chain of Hgb in what disease?
Substitution on beta chain causes sickle cell
Hgb sickles at _______
low O2 tension
Iron is important for formation of ______ and _____. Where does excess dietary iron go?
Hgb (65%) and Myoglobin (4%)
15-30% of iron is stored in liver as ferritin for later us
What is the average lifespan of an RBC?
120 days; many self- destruct in the spleen
What happens to Hgb when RBCs burst?
Hgb is phagocytized by macrophages (especially Kupffer cells of liver and macrophages of spleen and bone marrow); iron is then transferred to bone marrow or to storage; the polyphrin portion is converted to bilirubin
What is microcytic anemia and what causes it?
Small RBCs with deficient Hgb caused by chronic blood loss- the body does not have enough iron to produce normal cells
After rapid hemorrhage, how long does it take for the fluid portion of blood to be replaced? How long for RBC concentration?
Fluid portion returns to normal in 1-3 days: RBC concentration is not restored for 3-6 weeks
What causes Aplastic anemia?
Lack of functioning bone marrow (radiation, chemo, industrial chemicals, nuclear irradiation)
What is hereditarty spherocytosis?
A disease in which RBCs are very small and spherical rather than biconcanve, the rupture easily at slight compression and cause a hemolytic anemia
Sickle cell can lead to _____ anemia
Hemolytic anemia; low O2 tension causes crystals on the Beta chains to elongate and leads to rupture, which further decreases O2 tension and can lead to rapid deterioration
What is microcytic anemia and what causes it?
Small RBCs with deficient Hgb caused by chronic blood loss- the body does not have enough iron to produce normal cells
After rapid hemorrhage, how long does it take for the fluid portion of blood to be replaced? How long for RBC concentration?
Fluid portion returns to normal in 1-3 days: RBC concentration is not restored for 3-6 weeks
What causes Aplastic anemia?
Lack of functioning bone marrow (radiation, chemo, industrial chemicals, nuclear irradiation)
What is hereditarty spherocytosis?
A disease in which RBCs are very small and spherical rather than biconcanve, the rupture easily at slight compression and cause a hemolytic anemia
Sickle cell can lead to _____ anemia
Hemolytic anemia; low O2 tension causes crystals on the Beta chains to elongate and leads to rupture, which further decreases O2 tension and can lead to rapid deterioration
Anemia causes _____ viscosity and ______ resistance to flow
Decreased blood viscosity, decreased resistance to flow
A patient with anemia may be ______ at rest, but experience _____ with exercise
May be compensated at rest, but cardiac failure may result with exercise
What are 2 causes of a secondary polycythemia?
High altitude
Failure of oxygen delivery to tissues (Cardiac failure, cyanotic congenital heart disease)
Polycythemia Vera may result in a Hct of ______, leading to:
Hct 60-70%; increased blood viscosity. engorgement of the vascular system, plugging of capillaries- may have ruddy complexion with bluish tint to skin
Polycythemia leads to ______ viscosity and _____ resistance to flow
Increased viscosity, increased resistance to flow
Methemoglobinemia shifts the oxyhemoglobin dissociation curve to the ___________. What are two common culprits?
Local anesthetics (PRILOCAINE, benzocaine)
Nitrates (Nitric Oxide, SNP)
Methemoglobinemia causes iron in Hgb to exist in the ______ versous the normal ferrous state, The ______ form cannot bind O2.
Hgb becomes ferric rather than ferrous, and cannot bind O2
What is the classic presentation of methemoglobinemia?
Cyanosis with a normal PaO2 and low SaO2
What is the treatment for methemoglobinemia?
Methylene Blue 1 mg/kg IV over 5 minutes; may cause SpO2 reading to decrease because the pulse ox detects the blue color
What is glucose-6-phosphade dehydrogenase deficiency (G6PD)?
Most common inherited RBC enzyme disorder; certain triggering foods, medications, and infections provoke the sudden destruction or RBCs and cause a hemolytic anemia
What drugs should be avoided with G6PD deficiency?
Tylenol, Nitroprusside, many antibiotics (penicillin), methylene blue, many others
What are the most common triggers for G6PD deficiency?
Infection, Fava beans (with a nice chianti)
What are the symptoms of hemolytic anemia (or G6PD deficiency crisis)?
Paleness
Lethargy
Tachycardia
Rapid breathing, SOB
Jaundice
Enlarged spleen
Dark, tea colored urine
What is polyphyria?
Genetric overproduction of polyphyrins and their precursors (which normally help transport and store O2 along with other functions)
Only _____ forms of polyphyria are affected by drug induced enzyme induction. What drugs should be aboided in these patients?
Thiopental (no problem there)
Methohexital
Etimomidate
(and thiamylal and pentazocine, but I've never heard of those)
What are the signs and symptoms of polyphria crisis?
Abdominal pain
ANS instability
Electrolyte disturbance
Neuropsychiatric problems
Skeletal muscle weakness (respiratory distress or failure)
Vomiting and diarrhea
What is the treatment for polyphyria crisis?
Hematin 3-4mg/kg
What antigens are most likely to cause blood transfusion reactions?
ABO>Rh
Blood type is determined by the _________
Antigens present on the RBC surface
A person with type O blood has what antibodies?
Anti-A, Anti-B
A person with type AB blood has what antibodies?
None
List the blood types in order of frequency
O
A
B
AB
It takes ______ to Rh antigen before another antibodies are produced to cause a transfusion reaction
Massive exposure
How does a delayed Rh transfusion reaction occur
When a Rh- person gets Rh+ blood, it is unlikely that a reaction will take place immediately; over the next 2-4 weeks, anti Rh antibodies can develp and cause agglutination of transfused cells still circulating in the blood, causing hemolysis by macrophages
Who is at greatest risk for Rh transfusion reaction?
Rh- women in their child bearing years
Rh- mothers should receive______ during the 28th week of pregnancy and after delivery. Why?
Rhogam; prevents sensitization to Rh+ fetal blood that could result in erythroblastosis fetalis in this or (more likely) subsequent pregnancies
What is primary hemostasis?
Constriction of blood vessels and formation of the platelet plug
The extrinsic, intrinsic, and final common pathways are means of _______ hemostasis
Secondary
What are the 5 platelet reactions in clot formation?
Adhesion, aggregation, plug formation, fibrin formation, clot retraction
What is a normal PT?
What pathway does it measure? What factors?
12-14 seconds
Extrinsic and final common pathway; 7, 10, 5, 2, 1
What is a normal aPTT?
What does it meausure?
25-35 seconds
Measures intrinsic and final common pathway
what is a normal platelent count?
150-400k/mm3
What is a normal bleeding time?
What does this measure?
What drugs affect this?
5-10 minutes;
Measures platelet count and function; useful for measuring platelet aggregation inhibitors like aspirin and NSAIDs
What is a normal fibrinogen?
What factor is this?
200-400 mg/dl
Factor 1
What is a normal thrombin time?
What factors does this measure?
12-20 seconds; measures Factors 1 and 2
What are 3 causes of decreased platelet count, and how do you treat each of them?
Inadequate production (treat by giving platelets); ITP (Treat with steroids and IVIG); DIC (treat underlying cause, give platelets)
What are 5 causes of increased bleeding time?
1. Aspirin and NSAIDs
2. Low platelets
3. Von Willebrands disease
4. Uremia
5. IV Nitroglycerin
How do you treat bleeding with Von Willebrands Disease? What lab tests would show this?
DDAVP, Cryoprecipitate; increased bleeding time with normal platelet count
How do you treat Factor 7 deficiency? What lab test would show this?
FFP; elevated PT
Hemophilia A is Factor _____ deficiency. What lab test would show this and how would you treat bleeding?
Factor 8 deficiency; give factor 8 concentrate or cryo
Hemophilia B (Christmas Disease) is Factor _____ deficiency. How do you treat it and what lab test would be elevated?
Give Factor 9 concentrate or FFP; elevated PTT
What are 3 causes of asymptomatic elevated PTT (no bleeding)?
Factor 12 deficiency, deficient prekalikrein, deficient HMWK
Liver disease causes an increased ______. How do you treat bleeding?
PT and PTT; treat with FFP and consider Vit K
Citrate chelates _____ and prevents coagulation in banked blood
Calcium
What is the Hct of CPDA PRBCs?
70-75%
How much plasma is in a bag of PRBCs?
50-70ml
What are the benefits of blood with additive solution versus CPDA PRBCs?
Less plasma so less TRALI
Less citrate
Fewer microaggregates
Regenerates 2,3DPG more quickly
Most fatal hemolytic transfusion reactions result from ______ incompatible blood
ABO
What is the indirect Coombs test?
Antibody screen- indentifies dangerous antibodies, positive test requires blood bank to find an antigen negative donor unit
How long does a full crossmatch take?
What is a crossmatch?
45 minutes; donor RBCs are mixed with recipient serum to test for agglutination (detects ABO incompatibilites as well as MN, P, and Lewis incompatibilities)
What types of blood can you give in an emergency when you cannot wait for a full cross match?
Type specific, partially crossmatched
Type specific uncrossmatched
Type O- uncrossmatched
If you give one blood volume (10-12 units) of type O blood to a non type O patient, what should you do?
Stick with giving Type O blood and call blood bank
What is TRALI?
What are the symptoms?
What is believed to cause it?
Transfusion Related Acute Lung Injury
Non-cardiogenic pulmonary edema within 1-2 hours after transfusion; fever, hypotension
Caused by antibodies against WBCs (anti-HLA) in blood, platelets, and plasma
What is the only reason to give PRBCs?
To improve the oxygen carrying capacity of blood
PRBC infusion guidelines support transfusion of ______ followed by_____.
Give one unit and recheck Hgb/Hct
How much does 1 unit of blood increase Hgb and Hgb in an adult?
How much blood is required per kg in a child to acheive these same increases?
1 unit raises Hgb 1gm/dl and Hct 3% in an adult;
5 ml/kg results in the same increases in a child
PRBC transfusion indications at baptist:
Hgb<7 asymptomatic
<8 asymptomatic with CV disease
<10 if symptomatic or significant CV, respiratory, or bone marrow disease
How much does a unit of platelets increase the platelet count of an adult?
30-60; give one unit and recheck count
What is the operative indication for platelet transfusion?
<50,000 with bleeding or impending surgery/invasive procedure
Do not give FFP to reverse and INR of <_______. The INR of plasma is _____.
1.5
What are the indications for FFP administration?
1. INR >1.5 with bleeding or impending surgery
2. Factor deficiency and specific concentrates unavailable
3. Massive transfusion (>1 blood volume)
4. TTP
5. Urgent Coumadin reversal
Cryo indications:
How much does 1 unit of cryo increase the fibrinogen level?
5-10 units of cryo to increase fibrinogen to greater than 100;
1 unit increases the fibrinogen 10 mg/dl
What happens to thawed cryoprecipitate if not used and returned to blood bank?
Discarded
What is the result of vascular spasm following injury?
Occurs immediately after vessel is cut, causing the wall of the vessel to contract and instantly reduces flow of blood from ruptured vessel
Platelet aggregation is caused by release of _____ and ______ and results in formation of the _____ ______.
ADP and Thromboxane A2 cause the formation of the platelet plug
Platelets adhere to the _______ on injured vessel walls due to the activity of _______
Adhere to exposed collagen due to activity of Von Willebrands factor
When damage to tissue occurs, factor ____ (an intrinsic membrane glycoprotein that is not normally exposed on intact vessel surfaces) activates the extrinsic clotting cascade
Factor 3 becomes exposed due to tissue injury and activates factor 7
The action of Factor 7 is dependent on ______ and _______. It has the shortest half-life of all procoagulants and is impeded almost immediately after ________
Activated Factor 7 is calcium and Vitamin K dependent; inhibited almost immediately after initiating the extrinsic clotting cascade
Where is Factor 7 manfucatured? What is the significance of this?
Liver; decreased synthesis occurs in liver failure, coumadin administration
Activated clotting factors are removed by_______
The liver
What does t-PA do?
Converts plasminogen to plasmin, which degrades fibrin
What procoagulant is not manufactured in the liver?
vWF
What coagulation factors are dependent on Vitamin K
7, 9, 10, 2 are Vitamin K dependent
How does Factor 8 circulate?
As part of an 8-VWF complex
What effect do anticoagulants have on a thrombus after it is formed?
No effect
High concentrations of heparin are naturally found in:
the liver and granules of mast cells and basophils
Heparin is used as primary prophylaxis agains post-op _____ and ______.
DVT and PE
Onset of IV Heparin
Onset SQ Heparin
Immediate
20 minutes
How does Heparin work?
Combines with ATIII and increases its effectiveness 100-1000x in removing thrombin (Factor 2)
Heparin duration is dependent on ______ and ______
Body temperature and dose of drug; duration is prolonged in hepatic and renal disfuction
Bleeding time is or is not affected by heparin?
Is NOT
Heparin is monitored by ____ and _____
PTT and ACT
What is a therapeutic anticoagulation PTT following Heparin administration?
60-70 seconds
What is a normal ACT? What should ACT be to go on CPB?
Normal ACT 90-120, should be >400 for bypass
What are 6 potential side effects from Heparin?
1. Hemorrhage
2. Allergic reaction
3. Thrombocytopenia
4. Altered prodein binding
6. CV changes (decreased SVR, MAP, PAP with large doses)
6. Decreased ATIII concentrations
What is Heparin rebound? What causes it and how is it treated?
The heparin-protamine complex may dissociate due to the shorter half life of protamine leaving unbound heparin in the body; treat with subsequent small doses of protamine
What type of reaction does protamine have with heparin?
Form and electrostatic bond; neutralization reaction
Protamine has significant side effects, including
allergic reaction and Histamine release, hypotension, pulmonary hypertension
What are the symptoms of histamine release following protamine administration that you might observe in an anesthetized patient?
Facial flushing. tachycardia, hypotension (especially in patients with poor LV function)
Protamine may cause what respiratory problems?
Can cause complement activation and thromboxane release, leading to pulmonary vasoconstriction, pulmonary HTN, and bronchoconstriction
Protamine allergic reactions occur most often in patients who have received _____, and may also be present in patients with a ______ allergy
protamine containing insulin preparations (NPH); fish allergy
What are your options if you think your patient might have an allergic reaction to protamine?
1. Avoid it (duh!) and administer hexadimethrine instead
2. Pretreat with histamine receptor antagonist (benadryl) and administer slowly
How does Coumadin work?
Competitive inhibition of Vitamin K
Coumadin theraphy should be monitored by _______
PT and INR; PT should be twice baseline (24-30)
Surgery can safely be performed with and INR < __________
1.5
Coumadin should be discontinued ______
1-3 days pre-op
How does aspirin work? How long does this effect last?
Inhibits thromboxane synthesis and release of ADP by platelets, thereby inhibiting platelet aggregation for the life of the platelet (7-12 days)
Dabigatran works by______.
When should it be discontinued?
direct thrombin inhibitor; inhibits conversion of fibrinogen into fibrin; DC 1-2 days pre-op with normal creatinine; may want to consider more time before major surgery or spinal/epidural
The is ______ for dabigatran.
NO ANTIDOTE
Dextran causes ______
prolonged bleeding time; perhaps by polymerizing fibrin and imparining platelet function
Thrombolytic drugs are used to ______,
promote dissolution of thrombi
How does Plavix work? When should it be discontinued?
Inhibits ADP induced platelet aggregation; stop 5-7 days pre-op?
What factor can be used in case of uncontrolled hemorrhage or in bleeding hemophiliacs who have developed antibodies against coagulation factors?
Factor 7
What factor is responsible for basal levels of Factor 7?
Factor 9
What vitamin is a platelet inhibitor?
Vitamin E
What herbal supplements might inhibit platelet function?
Ginko Biloba, ginger, garlic and ginseng
Petechiae is typically a sign or _____, whereas ecchymosis is usually a sign of _______.
Petecheiae is a sign of thrombocytopenia or platelet dysfunction wherease ecchymosis is a sign of procoagulant deficiency
What is the best measure of platelet function?
Bleeding time
Elevated PTT indicates deficiency of all factors except _____ and _______
7 and 13
Hemophilia A is a deficiency of factor _____ with a normal ______.
Factor 8-C deficiency with normal vWF
Patients with severe hemophilia my have intra-articular or intramuscular bleeding into
Knee and elbow joints as evidenced by pain, warmth, and decreased ROM
Patients with Hemophilia A should have a Factor VIII level of at least _____% normal to assure hemostasis for surgery
30% normal
Patients with Hemophilia A shoul be treated with
Concentrated Factor 8, DDAVP, cryo
DDAVP causes _______ but stores can become depleted
release of Factor 8C from endothelium
Hemophilia B is a result of Factor ____ in the presence of normal factor ______. How is it treated?
Factor 9, normal factor 8; treat with factor 9 concentrate
Von Willebrands Disease is autosomal ______ and affects _______. How is it treated?
Autosomal dominant, effects both sexes equally. Treat withDDAVP and cryo
What is necessary for adherance of platelets to endothelium
vWF
Congenital afibrinogenemia often presents as ______ and is treated with
Uncontrolled bleeding from umbilical cord stump; treat with Cryo or fibrinogen
What happens in protein C deficiency?
Protein C nomally breaks down activated factors 5 and 8 in the liver and initiates fibrinoysis; patients are hypercoagulable and may have thromboembolic events at a young age
What are some non-genetic causes of protein c deficiency?
DIC
Liver failure
ARDS
Postop]
Postpartum
Hemoialysis
Antithrombin III (ATIII) degrades what factors?
Activated factor 2 (thrombin) and V
Resistance to anticoagulant effects of heparin may be a sign of _____
AtIII deficiency
Acute correction of ATIII deficiency is with
concentrated ATIII or FFP
Prolonged PT with a normal PTT is indicitive of ?
Vitamin K deficiency
How long does it take for IV Vitamin K to work? How might defiiency be treated emergently?
6-24 hours; treat bleeding with FFP
Heparin is reversed with _______; Coumadin is reversed with _______
Proamine; coumadin overdose treated with FFP and Vitamin K
Epidural hematoma may be caused by ________. Wat are S/S?
Regional anesthesia in an anticoagulated patient; bloody tap, pain, parasthesias, numbness, weakness; may require surgical evacuation
What is a good prognostic indicator in liver failure?
PT
Massive blood transfusion is defined as _______ and can result in coagulopathy characterized by__________.
10 units banked blood = 1 blood volume; can cause diffuse microvascular bleeding d/t thrombocytopenia
What factors are not stable in banked blood, and can therefore become deficient in massive blood transfusion?
V and VIII
CPB can result in coagulopathy because ______
Platelets are damaged by contact with oxygenator; hypothermia may also play role
What test is useful for diagnosing DIC?
D-Dimer; elevated fibrin degradation products can result from surgery, hematomas, or renal o liver failure so not specific to DIC
ITP is caused by _____ and patients may present with ______.
Antibody activation and response platelets resulting in their destruction; patients may resent with petechiae
How is ITP treated?
Steroids; if unresponsive to steroids, then splenectomy
What is TTP and how is it treated
Thrombotic thrombocytopenic purpura; Disseminated microvascular aggragation of platelets resulting in hemolytic anemia and thrombocytopenia; treated with anti-platelet drugs and exchange plasmapheresis
What material of catheters is particularly thrombogenic?
Polyvinylchloride (PVC)
Tissue oxygen delivery =
CO x arterial O2 content
How long can PRBCs be stored?
35 days
What size filter should be used for a standard blood transfusion. When should a smaller filter be used?
170 micrometers; use smaller filter with history of febrile reaction
What two things can you do to speed blood transfusion?
Warm the blood and add saline to derease viscosity
What risks are associated with platelet transfusion?
Bacterial transmission (stored at room temp), sensitization reactions, viral transmission (especially with pooled donor)
What is present in FFP?
All procoagulants except platelets, also ATIII
What risks are associated with FFP transfusion?
Viral transmission, allergic reaction, fluid overload
FFP will raise the level of all procoagulants ______%
2-3%
Are coagulation factors present in Albumin?
No
Does Albumin transfusion carry a risk of hepatitis transmission?
No; heated to 60 degrees C for 10 hours to eliminate risk
Why is dextran used?
Intravascular volume expansion and decrease risk of thromboembolism by preventing platelet aggregation and decreasing blood viscosity
Dextran may interfere with ____
crossmatching blood
Rank transmission risk ofthe following in banked blood: HIV, Hep B, Hep C
Hep B (1/350,000)
HIV=Hep C (1/2 million)
What are the symptoms of an allergic transfusion reaction? What is the presumed mechanism?
Erythema (along pathway of vein), pruritis, uticaria (especially on face, chest, and neck), increased temperature (d/t histamine release)
Mechanism presumed to be incompatibility of plasma proteins
How do you treat allergic reactions to blood transfusion?
Benadryl, slow transfusion rate, wash subsequent transfusions to remove plasma proteins
What causes febrile transfusion reactions? How is it treated?
Reaction against donor leukocytes; treat by slowing infusion, giving antipyretics, and subsequently giving leukoreduced, HLA matched platelets
Temperature rarely goes above _____ in febrile transfusion reactions
38 C
To appropriately use cell saver, how much blood loss should there be?
at least 1000-1500
What are contraindications to cell saver?
Septic wound, malignancy
What should the Hct be for theraputic hemodilution?
21-25%