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Anesthesiology > Blood and Fluids > Flashcards

Blood and Fluids Flashcards

1
Q

What does PT primarily test? What are some causes of prolongation?

A

Factor VII in the extrinsic pathway

Prolonged by vitamin K deficiency and Coumadin therapy

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1
Q

What does aPTT primarily test for? What are some causes of prolongation?

A

Factors VIII and IX of the intrinsic pathway

Prolonged by Hemophilia A, Hemophilia B, and von Willebrand’s disease

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2
Q

List the vitamin K dependent clotting factors

A

Factors II, VII, IX, and X

Formation of these factors are blocked by Coumadin

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3
Q

What type of matching is required for platelets before transfusing?

A

Rh matching only, although ABO-compatible platelets are preferred

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4
Q

Describe Von Willebrand Disease? What are the types? What is its treatment?

A

vWD is the most common inherited coagulation disorder

Type I - partial quantitative deficiency
Type II - qualitative deficiency
Type III - total deficiency

Treatment:
Type I - trial of DDAVP (stimulates release of von Willebrand factor)
Type II - trial of DDAVP
Type III - vWF concentrate

If needed, FFP and cryo can be given as well

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6
Q

What factor is deficient in hemophilia A? What is the treatment?

A

Factor VIII

Treatment is with Factor VIII concentrate
- half-life of Factor VIII is 12 hours so repeat doses must be given q12H

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6
Q

1 unit of platelets should increase platelet count by how much?

A

5,000 to 10,000

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7
Q

What factor is deficient in hemophilia B? What is the treatment?

A

Factor IX

Treatment with purified and recombinant Factor IX (FFP is a second choice)

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8
Q

For how long can blood be frozen?

A

Up to 10 years

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10
Q

Which clotting factor has the shortest half-life?

A

Factor VII (4 to 6 hours)

It is the first factor to become deficient in pts with severe hepatic failure, Coumadin therapy, and vitamin K deficiency

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10
Q

What disease is blood routinely screened for?

A 
HIV
Hepatitis B
Hepatitis C
HTLV
West Nile
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11
Q

Which blood product is most likely to cause sepsis?

A

Platelets

Because platelets are kept at room temperature and not cooled, bacteria can survive and multiply.

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12
Q

What is a general estimation of blood volume?

A

About 70 mL/kg

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13
Q

What is the most common transfusion related infection?

A

Cytomegalovirus (CMV)

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15
Q

Describe citrate toxicity

A

Stored blood contains citrate, which is an anticoagulant that binds calcium and magnesium

With large transfusion, citrate can dramatically reduce levels of ionized calcium

Results in hypocalcemia, hypomagnesemia, myocardial depression
- seen as hypotension, narrow pulse pressure, increased LVEDP

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16
Q

What is the equation for maximum allowable blood loss?

A

EBV x (HCTs - HCTt)/HCTs

16
Q

How do you calculate the sodium dose needed for serum correction?

A

Kg x 0.6 x (desired change in Na+)

17
Q

How does Hetastarch interfere with clotting?

A

Dilution of clotting factors secondary to increased plasma volume

Decreased Factor VIII and von Willebrand factor

Decreased expression of glycoprotein IIb/IIIa on platelets

Fibrinogen deficiency

19
Q

What are the effects on blood after storage with CDPA-1 as a preservative?

A

CDPA-1 stands for citrate, dextrose, phosphate, and adenine

At 35 days of storage:

  • Glucose levels drop below 100 mg/dL
  • pH falls below 7.0
  • Potassium increases to over 70 mEq/L
  • Concentration of 2,3-DPG fall below 1, causing a leftward shift of the oxyhemoglobin dissociation curve
19
Q

How can you monitor anticoagulation with LMWH?

A

Anti-Xa assay

20
Q

List the shelf life of blood with various preservatives

A

With CDP - 21 days

With CDPA-1 - 35 days

With modern additives - 42 days

22
Q

What is the mechanism of action of Heparin? How is it reversed?

A

Heparin binds to the anticoagulant antithrombin III (AT3) and greatly enhances its effects
- AT3 inactivates multiple coagulation factors including IIa (thrombin), VII, IX, X, XI, and XII

Will result in elevated aPTT

Antagonized by Protamine via acid-base neutralization
- Protamine can cause hypotension, anaphylactoid reaction, and pulmonary HTN

23
Q

What can be done to blood products to prevent GVHD?

A

Irradiation

24
Q

Describe von Willebrand’s disease

A

Lack of a protein important for the function of Factor VIII as well as platelet function

Leads to prolonged bleeding time and PTT

Treatment is with Factor VIII concentrate or DDAVP

25
Q

What is the mechanism of action of Coumadin? How is it reversed?

A

Interferes with the synthesis of vitamin K dependent factors (II, VII, IX, and X)

Prolongs PT

Reversed via vitamin K (takes time) or FFP (more immediately)

26
Q

List some drugs affecting the fibrinolytic system

A

Urokinase - converts plasminogen to plasmin, leading to clot breakdown

Tranexamic acid / Aminocaproic acid - competitive inhibitors of plasminogen activation, stabilizing clot

Aprotinin - trypsin inhibitor, protecting clots

27
Q

What is the normal lifetime of a RBC?

A

120 days

28
Q

How is survival measured in blood banking?

A

Must have at least 70% RBC survival 24 hours after transfusion

29
Q

Anaphylactic reaction to transfusion, in a pt who has previously been transfused, is most likely due to what?

A

IgA deficiency

30
Q

What factors does FFP contain? How much does it increase factors? Are there any concerns with giving it? How long is it good for once thawed?

A

FFP contains all factors necessary for clotting except platelets
- only increases coagulation factors by 3 to 6% with each unit

Associated with TRALI and citrate toxicity (contains 5x the citrate levels found in PRBCs)

Must be used within 5 days after being thawed

31
Q

What factors does Cryoprecipitate contain?

A 
von Willebrand Factor
Fibrinogen
Fibronectin
Factor VIII
Factor XIII
32
Q

Describe the treatment of hyperkalemia

A

Asymptomatic:

  1. Diuretics and IVFs
  2. Kayexalate

Symptomatic:

  1. Glucose (50cc of D50) and insulin
    - cause intracellular movement of K+
  2. Bicarbonate
    - helps reverse acidosis that may contribute to hyperkalemia
  3. Calcium
    - antagonizes the effect of K+ on the cardiac conduction system
  4. Hyperventilation
    - causes alkalosis which drives K+ intracellularly
33
Q

What are some direct thrombin inhibitors? How do they work?

A

Bind directly to and inhibit thrombin

Argatroban
Bivalirudin
Dabigatran
Hirudin
Lepirudin
34
Q

What are the advantages and disadvantage of cell saver? How does it affect platelets and clotting factors?

A

Advantages:

  • reduced transmission of blood-borne disease
  • reduced administration of incompatible blood
  • administration of blood with normal concentration of 2,3-DPG
  • removal of activated clotting factors
  • removal of inflammatory cytokines

Disadvantages:

  • cost
  • delay in availability due to processing and need to recover specific amount I blood
  • increased bacterial contamination
  • lysis of RBCs due to collection procedure
  • risk of embolism

Cell saver does not preserve either platelets or clotting factors (ultimately end up with thrombocytopenia and prolonged PT and PTT)

35
Q

Which virus has the highest risk of transmission after a needle stick injury?

A

Hepatitis B

36
Q

How does anemia effect coagulation?

A

Anemia leads to:

  • delay in initiation of coagulation cascade
  • stronger clot
  • improved clot viscoelastic properties

Anesthesiology (12 decks)

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