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