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Blood/ Coagulopathy Flashcards

1
Q

What are the 2 functions of RBCs

A
  1. Transport O2 via Hgb

2. Store carbonic anhydrase (H2CO3) to be used in converting HCO3 to CO2 during exhalation

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2
Q

What is the equation for converting CO2 to HCO3 using carbonic anhydrase

A

CO2+H2O—>carbonic anhydrase—> >H2CO3–>carbonic anhydrase—>HCO3+H

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3
Q

Normal value of RBCs for men and women

A

Men: 5 million/mm3
Women: 4.5 million/mm3

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4
Q

Normal value for Hct

A

40-45% nominally

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5
Q

Normal value for Hgb

A

14-15g/100mL

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6
Q

Where does RBC production occur?

A

Bone marrow especially of long bones

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7
Q

Describe the chain reaction of RBC production (5 steps)

A
  1. Decreased O2 from anemia, blood loss, systemic hypoxia, infection or increased altitude
  2. Erythropoietin secretion triggered in kidneys (10% of excretion occurs in the liver)
  3. Erythropoietin secretion peaks within 24 hours
  4. Growth and differentiation inducers (also activated at low oxygen levels) mature and divide RBCs
  5. New RBCs formed within 5 days
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8
Q

What is an example of a growth and differentiation inducer in the formation of RBCs

A

Interleukin-3

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9
Q

What are 3 elements required for RBC formation (brought into the body via digestive tract)?

A
  1. Vitamin B-12 (cyanocobalamin)
  2. Folic acid
  3. Iron
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10
Q

What is the chemical formation of Hgb and why does iron play an important role in its formation?

A

Hgb make-up: 4 heme chains connected by 4 iron molecule

Without iron we cannot make Hgb

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11
Q

What is the main role of Hgb?

A

To carry oxygen

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12
Q

What is the lifespan of a RBC

A

120 days

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13
Q

Where are all the clotting factors contained?

A

Plasma

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14
Q

What are 3 indications for a HCP to give plasma?

A
  1. To increase the circulating volume
  2. For the treatment of angioedema
  3. To improve the function of clotting in pts with poor coagulation (low circulating clotting factor, on warfarin, ineffective heparin function)
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15
Q

What is a key component of cryoprecipitate?

A

Fibrinogen

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16
Q

What is the most influential factor in surgical coagulopathy?

A

Platelets

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17
Q

What is the lifespan of a platelet?

A

10 days

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18
Q

How many platelets are formed a day?

A

30,000 per day per mL of blood

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19
Q

Normal platelet value

A

150,000-450,000

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20
Q

What are the 3 reasons platelet loss can occur

A
  1. Deficiencies in production (due to nutritional deficiencies, sepsis, or bone marrow pathology)
  2. Antibody formation against plts
  3. Presence of extensive thrombi that is sequestering plts (think DIC)
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21
Q

What are the 2 roles of WBCs

A
  1. Phagocytes ingestion vis granulocytes and monocytes

2. Antibody formation to destroy substances

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22
Q

Where are WBCs formed

A

Bone marrow and lymphatic tissue

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23
Q

What is the life-span of a WBC

A

4-8 hours (NOTE: vast majority of WBCs are kept in storage in the bone marrow and lymph until the are needed

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24
Q

Normal value of WBCs

A

5,000-10,000/ mL

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25
What are the most common type of WBC?
Neutrophils (60% of WBCs)
26
Which 2 types of WBCs are known for their flexible movement and thus are sent out to moved toward inflamed tissue and pathogens first?
Neutrophils and monocytes
27
What is a monocyte called after it envelopes a pathogen
Macrophage
28
What are pathogens attacked by WBCs?
Abnormal shape and no protein protectors—> if these are missing, antibodies will mark them to be destroyed
29
Liposomes
Intracellular organelle that digests and breaks down pathogens
30
What are the methods of pathogen invasion?
Soft tissue, GI tract, lungs, and skin
31
What are 3 systems in place to intercept pathogens?
1. Lymphatic system 2. Lung macrophages 3. Liver via Kupffer cells
32
What is the name of the cells in the liver that assist in intercepting pathogens
Kupffer cells
33
Name the 6 steps in the inflammatory response
1. Injury to tissue 2. Vasodilation at site of injury—>increased blood flow 3. Increased capillary permeability causing movement of fluid to interstitial space (WBCs and clotting factors moved out) 4. Clotting largely due to fibrinogen 5. WBCs encapsulate and eradicate pathogens 6. Tissue edema occurs
34
What is the trauma triad that can occur with substantial volume replacement
1. Hypothermia 2. Acidosis 3. DIC
35
7 components of fluid therapy
1. Fluid movement between spaces 2. Swelling 3. Volume shifts 4. Coagulation 5. Circulation volume and pressure 6. Electrolyte balance 7. PH stasis
36
The extrinsic clotting pathway
Injury—>tissue factor release—>conversion of VII to VIIa—>conversion of X to Xa—> prothrombin activator—>prothrombin to thrombin—> fibrinogen to fibrin
37
What is another name for prothrombin
Factor II
38
Intrinsic clotting pathway
Exposure of activator (usually via collagen)—>XII to XIIa—>XI to XIa—> IX to IXa—> converges with the extrinsic pathway at Xa
39
Where in prothrombin produced and what element must be present for its production?
The liver and vitamin K must be present
40
This part of the clotting cascade is the key to maintaining the clot from anti-clotting factors
Fibrin
41
What is the role of thrombin
Form clots, activate platelets, and catalyze the formation of fibrin
42
What is the most prevalent clotting factor in circulation
Fibrinogen
43
What is the name of the receptor where fibrinogen and platelets bind
GP2b/3a
44
What are 3 types of synthetic clotting factors we might give?
K-Centra Factor VIII VWF
45
What 2 synthetic clotting factors might you give someone with hemophilia A
Factor VIII and VWF
46
What factors are contained in K-Centra
II, VIII, IX, X, and Protein C and S
47
What is found in the endothelium and inhibits the activation of factor VII by binding to tissue factor thus neutralizing factor X
Tissue factor pathway inhibitor
48
Mast cells in the lungs secrete ___
Heparin
49
Heparin doesn’t inhibit clotting but increases the action of anti thrombin III by _____%
1000%
50
How do platelets adhere to the endothelium after an injury
They adhere to VWF via GP1b
51
Platelet aggregation occurs via
Fibrinogen
52
What anti-clotting factor lives in the vessel wall and bind to thrombin to prevent is action in uninjured places
Thrombulin
53
This is created when thrombin and thrombulin bind together
Protein C
54
Protein C can inhibit thrombin receptor and inactivate what 2 factors
V and VIII
55
A C=Reactive Protein lab gives information about _____
Inflammation and clotting: increased C proteins—> increased inflammation and clotting
56
This anti-clotting factor breaks down Xa and thrombin and is naturally circulating in the plasma
Anti-thrombin III
57
This anti-clotting factor transforms plasminogen into plasmin to break down clots (may take a few days)
Tissue plasminogen activator (tPA)
58
A prothrombin time evaluates what aspects of the clotting cascade
Vit K dependent factors: VII, X, V, and prothrombin
59
Normal prothrombin time
12 seconds
60
This evens the PT scale to account for the amount of tissue factor in the medium
International normalized ratio
61
Normal value for INR
0.9-1.3
62
What does a partial thromboplastin time evaluate
The function of heparin
63
Normal value for PTT
30-40 seconds
64
Normal value for an activate clotting time
110-130 seconds
65
What coagulation evaluation lab is not appropriate in patients with multi factorial coagulopathy?
Activated clotting time
66
This coagulation evaluation looks at clotting as a whole
Thromboelastograph
67
What individual aspects of the cascade does a TEG assess
Fibrinogen, plt function, certain clotting factors, and heparin
68
The coagulation evaluation represents fibrinogen that has been broken down
D-dimer
69
This is used to diagnose VTE and DIC
D-dimer
70
What are the clinical manifestations of DIC
Uncontrolled hemorrhage and lack of clotting
71
Patho of DIC
Body’s control mechanism to restrain the action of thrombin to the site of injury stops working—> profound clotting causes all factors to be sequestered usually in distal perfusion sites and lungs and not at the sight of the injury leading to uncontrolled hemorrhaging

Physiology (3 decks)

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