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Surgical Recall > Blood and Blood Products, Chapter19 P124-128 > Flashcards

Blood and Blood Products, Chapter19 P124-128 Flashcards

1
Q

Define the following terms:
PT
P124

A

Prothrombin Time: Tests extrinsic coagulation pathway

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2
Q

Define the following terms:
PTT
P124

A

Partial Thromboplastin Time: Tests intrinsic coagulation pathway

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3
Q

Define the following terms:
INR
P124

A

International Normalized Ratio (reports PT results)

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4
Q

Define the following terms:
Packed red blood cells (PRBCs)
P124

A

One unit equals 300 ml (50 ml); no platelets or clotting factors; can be mixed with NS to infuse faster

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5
Q

Define the following terms:
Platelets
P124

A

Replace platelets with units of platelets

6–10 units from single donor or random donors

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6
Q

Define the following terms:
Fresh frozen plasma (FFP)
P124

A

Replaces clotting factors; (no RBCs/WBCs/platelets)

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7
Q

Define the following terms:
Cryoprecipitate (cryo)
P124

A

Replaces fibrinogen, von Willebrand factor, and some clotting factors

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8
Q

Which electrolyte is most likely to fall with the infusion of stored blood? Why?
P124

A

Ionized calcium; the citrate preservative used for the storage of blood binds serum calcium

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9
Q

What changes occur in the storage of PRBCs?

P124

A

↓Ca, ↑ K, ↓2,3-DPG, ↑ H (↓ pH),

↓PMNs

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10
Q

What are general guidelines for blood transfusion?

P124

A

Acute blood loss, Hgb < 7

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11
Q

What is the rough formula for converting Hgb to Hct?

P124

A

Hgb x 3 = Hct

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12
Q

One unit of PRBC increases Hct by how much?

P124

A

≈3% to 4%

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13
Q

Which blood type is the “universal” donor for PRBCs?

P125

A

O negative

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14
Q

Which blood type is the “universal” donor for FFP?

P125

A

AB

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15
Q

What is a type and screen?

P125

A

Patient’s blood type is determined and the blood is screened for antibodies; a type and cross from that sample can then be ordered if needed later

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16
Q

What is a type and cross?

P125

A

Patient’s blood is sent to the blood bank and cross-matched for specific donor units for possible blood transfusion

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17
Q

Define thrombocytopenia.

P125

A

Low platelet count (<100,000)

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18
Q

What are the common causes of thrombocytopenia
in the surgical patient?
P125

A

Sepsis, H(2) blockers, heparin, massive transfusion, DIC, antibiotics, spurious lab value, Swann-Ganz catheter

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19
Q

What can be given to help correct platelet dysfunction
from uremia, aspirin, or bypass?
P125

A

DDAVP (desmopressin)

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20
Q

What common medication causes platelets to
irreversibly malfunction?
P125

A

Aspirin (inhibits cyclooxygenase)

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21
Q

What is Plavix®?

P125

A

Clopidogrel—irreversibly inhibits platelet
P2Y(12) ADP receptor (blocks fibrin
crosslinking of platelets)

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22
Q

What platelet count is associated with spontaneous bleeding?

P125

A

20,000

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23
Q

What should the platelet count be before surgery?

P125

A

> 50,000

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24
Q

When should “prophylactic” platelet transfusions be given?

P125

A

With platelets 10,000

old recommendation was 20,000

25
Q

What is microcytic anemia “until proven otherwise” in
a man or postmenopausal woman?
P126

A

Colon cancer

26
Q

Why not infuse PRBCs with lactated Ringer’s?

P126

A

Calcium in LR may result in coagulation within the IV line (use NS)

27
Q

For how long can packed RBCs be stored?

P126

A

About 6 weeks (42 days)

28
Q

What is the most common cause of transfusion hemolysis?

P126

A

ABO incompatibility as a result of clerical error

29
Q

What is the risk of receiving a unit of blood infected with
HIV?
P126

A

≈1 in 1,000,000

30
Q

What are the symptoms of a transfusion reaction?

P126

A

Fever, chills, nausea, hypotension, lumbar pain, chest pain, abnormal bleeding

31
Q

What is the treatment for transfusion hemolysis?

P126

A

Stop transfusion; provide fluids; perform diuresis (Lasix) to protect kidneys; alkalinize urine (bicarbonate); give pressors as needed

32
Q

What component of the blood transfusion can cause
a fever?
P126

A

WBCs

33
Q

What is the transfusion “trigger” Hct in young healthy patients?
P126

A

21%

34
Q

What is the widely considered “optimal” Hct in a patient with a history of heart disease or stroke?
P126

A

≈30%

35
Q

When should aspirin administration be discontinued
preoperatively?
P126

A

At 1 week because platelets live 7 to 10 days (must use judgment if patient is at risk for stroke or MI; it may be better to continue and use excellent surgical hemostasis in these patients)

36
Q

What can move the oxyhemoglobin dissociation curve to the right?
P127

A

Acidosis, 2,3-DPG, fever, elevated PCO(2)
(to the right means greater ability to
release the O(2) to the tissues)

37
Q

What is the normal life of RBCs?

P127

A

120 days

38
Q

What is the normal life of platelets?

P127

A

7 to 10 days

39
Q

What factor is deficient in hemophilia A?

P127

A

Factor VIII

40
Q

How can the clotting factor for hemophilia A be remembered?

P127

A

Think: “Eight” sounds like “A”

41
Q

What is the preoperative treatment of hemophilia A?

P127

A

Factor VIII infusion to 100% normal preoperative levels

42
Q

What coagulation study is elevated with hemophilia A?

P127

A

PTT

43
Q

How do you remember which coagulation study is affected by the hemophilias?
P127

A

There are two major hemophilias and two t’s in PTT

44
Q

What factor is deficient in hemophilia B?

P127

A

Factor IX

45
Q

How do you remember which factors are deficient with hemophilia A and hemophilia B?
P127

A

Think alphabetically and chronologically:
A before B—8 before 9
Hemophilia A = factor VIII
Hemophilia B = factor IX

46
Q

How are hemophilias A and B inherited?

P127

A

Sex-linked recessive

47
Q

What is von Willebrand’s disease?

P127

A

Deficiency of von Willebrand factor (vWF) and factor VIII:C

48
Q

How is von Willebrand’s disease inherited?

P127

A

Autosomal dominant

49
Q

What is used to correct von Willebrand’s disease?

P127

A

DDAVP or cryoprecipitate

50
Q

What coagulation is abnormal with the following disorders:
Hemophilia A
P128

A

PTT (elevated)

51
Q

What coagulation is abnormal with the following disorders:
Hemophilia B
P128

A

PTT (elevated)

52
Q

What coagulation is abnormal with the following disorders:
von Willebrand’s disease
P128

A

Bleeding time

53
Q

What is the effect on the coagulation system if the
patient has a deficiency in protein C, protein S, or
antithrombin III?
P128

A

A hypercoagulable state

54
Q

What is a “left shift” on a CBC?

P128

A

Juvenile polymorphonuclear leukocytes (bands); legend has it that the old counters for all the blood cells had the lever for bands on the LEFT of the counter

55
Q

What is the usual “therapeutic” PT?

P128

A

With coumadin, usually shoot for an INR of 2.0–3.0

56
Q

What is the acronym basis for the word WARFARIN?

P128

A

Wisconsin Alumni Research Foundation-ARIN

57
Q

What is the most common inherited hypercoagulable
state?
P128

A

Factor V Leiden

Think: LEiden = LEader

58
Q

What is Xigris®?

P128

A

Activated protein C, which is used in severe sepsis

Surgical Recall (33 decks)

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