Chapter 5: Blood Disorders

Question 1

Cold Agglutinins (cytoprotiens)

Answer 1

• serum antibodies that work on the antigens found on surfaces of RBC at low temperatures cause complement activation and clumping, this doesn’t happen if patient is kept warm
• IgM class of antibodies, primarily in patients above 50 yo
• keep patients above the temperature the causes their clotting, if absolutely necessary to cool= use plasmapheresis
• give warm PRBC, and if cold CPG- no blood with!

Question 2

Sickle Cell Disease

Answer 2

-caused by hemoglobin S (Hgb-S) (instead of Hgb A in normal adults)= abnormal type of Hgb
-RBC are crescent shaped, move slow, clump, break down
= blood clots and anemia
=sickling begins at less than 85% hgb O2 saturations

Question 3

Sickle Cell Disease and Perfusion

Answer 3

• keep oxygen saturations high
• do not cool the patient
• no acidosis
• use vasodilators to keep vessels open to prevent blockages
• helpful to remove patient blood and give blood products (to help keep the O2 saturation above 85%)

Question 4

Polycythemia

Answer 4

=high number of RBC

-may be caused with pulmonary and heart disease, living at high altitude

Question 5

Thalassemia (aka: Colley’s anemia)

Answer 5

=insufficient hemoglobin synthesis, RBC are microcytic, hypo chromic and short lived
-“thalassemia minor” = mild anemia, patients do well on bypass

Question 6

Elliptocytosis

Answer 6

= high number of elliptocytes (RBC that are elliptical in shape, not biconcave)

Question 7

Spherocytosis

Answer 7

= due to premature removal from spleen= RBC are spherical

-stopmach pain, spleen enlargement, RBC have short life

Question 8

Hemosiderosis

Answer 8

= high iron deposits in some tissue

Question 9

Hemochromatosis

Answer 9

= iron deposits but up in whole body, iron > 15 grams

-bronze color skin, liver, DM2, cardiomyopathy

Question 10

Erythroblastosis fetalis

Answer 10

= anemia in newborns, Rh positive baby & Rh negative mother
-mom has developed antibodies form first baby= in second baby, destroyed RBC

Question 11

Three Types of Platelet Disorders

Answer 11

1) thrombocytopenia
2) hereditary disease
3) acquired disease

Question 12

Thrombocytopenia

Answer 12

= low platelet counts

• caused by low bone marrow production, increased sequestration in spleen, or accelerated destruction (by drugs, sepsis, CPB)
• Thrombocytopenic purpura= immune response that decreases platelets

Question 13

Hereditary Coagulation Disorders

Answer 13

1) von Willebrand’s disease= no platelet adhesion
- -on bypass= infuse 10 bags of cryoprecipitate after coming off bypass (plasma enriched with vWF) and give DDAVP
2) Hemophilias= hereditary bleeding disorders that lack on of the clotting factors
- -Hemophilia A= no VIII
- -Hemophilia B= no IX

Question 14

Acquired Coagulation/Platelet Disorders

Answer 14

1) disseminated intravascular coagulation (DIC)= clotting substances produced too rapidly in response to various conditions. treat with blood components
2) Vitamin K dependent deficiency= low factors that dependent on Vit. K= II, VII, IX, X
3) primary fibrinolysis= high activation of breaking down fibrin, treat with TXA/amicar

Question 15

Re-explore if Post Op Bleeding is:

Answer 15

• greater than 200 ml/hr for 4 hr
• greater than 300 ml for 3 hours
• greater than 400 ml for 2 hours
• greater than 500 for 1 hour