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burton > Haem/Transfusions > Flashcards

Haem/Transfusions Flashcards

1
Q

Which blood type is the universal donor?

A

O-

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2
Q

Which blood type is the universal receiver?

A

AB

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3
Q

How is major haemorrhage defined?

A
  • Loss of one blood volume in 24 hours
  • 50% total blood volume lost in less than 3 hours
  • More than 150ml/minute
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4
Q

What bloods should you order in a bleed before transfusing blood?

A

FBC
Group and save
Clotting screen
U&E

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5
Q

When should you think about transfusing blood?

A

< 30% loss (1500ml) fluids
30-40% red cell transfusion
> 40% (2L) major haemorrhage protocol

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6
Q

What is group and save?

A

Identifies patients ABO and rhesus blood group and screens blood for antibodies.

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7
Q

What is cross-match?

A

Mixing the patients blood with the blood they are going to receive to check for a reaction.

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8
Q

How long does group and save and cross-match take?

A

40 mins each

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9
Q

How long should one unit of blood be given over?

A

2 hours

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10
Q

How can you safely give blood to a patient who is at risk of overload?

A

Prescribe diuretic at same time

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11
Q

When might you need to give platelets?

A

Haemorrhagic shock
Severe thrombocytopenia <20
Low pre-op platelets < 50

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12
Q

What does fresh frozen plasma (FFP) contain?

A

Clotting factors and plasma proteins.

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13
Q

When is FFP given?

A

Major haemorrhage (every 2 packs of red cells)
DIC
Liver disease haemorrhage
TTP

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14
Q

What does cryoprecipitate contain?

A

Fibrinogen, vWF, factor VIII, fibronectin.

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15
Q

When is cryoprecipitate given?

A

LOW FIBRINOGEN:
Massive haemorrhage
VW disease
DIC with low fibrinogen

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16
Q

List 6 complications of blood transfusion.

A

Infection transmission
Overload
Transfusion related acute lung injury (TRALI)
Haemolytic reaction
Allergic reaction
Febrile non-haemolytic transfusion reactions

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17
Q

What blood tests can confirm haemolytic reaction to blood products?

A

Coombs test positive

Hyperbilirubinaemia

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18
Q

What are signs of haemolytic transfusion reaction?

A 
Pyrexia
Dyspnoea and wheezing
Loin pain
Hypotension
DIC with bruising
Acute oliguric renal failure
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19
Q

What are causes of macrocytic anaemia?

A 
Vitamin B12 deficiency
Folate deficiency 
Myelodysplasia
Liver disease
Hypothyroidism
Alcohol
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20
Q

What are causes of normocytic anaemia?

A 
Primary bone marrow failure - rare: aplastic anaemia
Secondary bone marrow failure:
• Anaemia of chronic disease
• Combined haematinic deficiencies 
• Uraemia
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21
Q

What blood tests can you do if you suspect haemolysis?

A 
FBC (reticulocytes)
Blood film - spherocytes, schistocytes
Bilirubin
LDH
Haptoglobin
Direct coombs test
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22
Q

What might you suspect if you see macrocytosis with hyperhsegmented neutrophils?

A

B12 or folate deficiency

Myelodysplasia

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23
Q

Where is B12 absorbed?

A

Terminal ileum

24
Q

What tests would you do to investigate anaemia?

A 
FBC, U&amp;E, LFTs
B12, folate, ferritin
Blood film
TFTs
Serum immunoglobulins
Urine bence jones protein
25
Q

Would you expect to see a raised reticulocyte count in acute bleeding?

A

Yes

26
Q

What would you expect reticulocyte count to be in ACD?

A

Low - suppressed

27
Q

What patients are likely to have secondary polycythaemia and how should they be treated?

A

Cyanotic heart disease
Cor pulmonale
COPD
Treat with venesection

28
Q

What pathway does APPT measure?

A

Intrinsic

29
Q

What pathway does PT measure?

A

Extrinsic

30
Q

How can you measure fibrinogen?

A

Thrombin clotting time

31
Q

What does INR measure?

A

PT - extrinsic pathway

32
Q

What can cause prolonged PT?

A

Vit K deficiency
Warfarin anticoagulation
Factor deficiency

33
Q

What can cause prolonged APPT?

A 
Factor deficiency
UF heparin (NOT LMWH)
An inhibitor
34
Q

What are causes of low platelets?

A 
Medication 
- HIT (heparin induced thrombocytopenia)
Alcohol
DIC/HUS/TTP
ITP
Hepatosplenomegaly
35
Q

What should you do if blood results show low platelets?

A

Repeat
Full clotting screen - check for DIC
Blood film

36
Q

What blood results are characteristic of DIC?

A 
Low platelet
Prolonged PT and APPT
Low fibrinogen
High D-dimers
Schistocytes on film
37
Q

Which patient should have a coagulation screen before surgery?

A

Only if past history of bleeding or family history of bleeding disorder, or in emergency with patient on anticoagulants

38
Q

What does a low INR mean?

A

Blood clots more quickly (thicker)

39
Q

What might you see in FBC a patient with any inflammation e.g. RA?

A

‘Reactive’
Thrombocytosis
Neutropenia

40
Q

If a patients INR is too low before surgery, what should you do?

A

Stop warfarin

Vitamin K - IV takes a few hours to work, PO takes 24 hours.

41
Q

What are signs and symptoms of thrombocytopenia?

A

petechieae, epistaxis, purpura

42
Q

If the lab reports platelet clumping in a sample, what can you do?

A

Send a citrate sample

43
Q

What lab test can you do to assess the level to DOAC activity?

A

anti-Xa activity

44
Q

What is the mechanism of LMWH?

A

Inhibits factor Xa (common to both extrinsic and intrinsic)

45
Q

What are the pharmacokinetics of LMWH?

A

Longer half life than UFH

Predictable response so no monitoring

46
Q

Why is a patients creatinine level important if they are taking LMWH?

A

LMWH accumulates in renal failure

47
Q

What coagulation test is used to monitor unfractionated heparin?

A

APPT

48
Q

What is the MOA of unfractionated heparin?

A

Binds to anti-thrombin, increasing its ability to inhibit thrombin and factor Xa.

49
Q

What are side effects of both types of heparin?

A

Bleeding

HIT (thrombocytopenia) - less common in LMWH

50
Q

What must you warn patients about when starting heparin?

A

Do not eat too much Vit K (leafy greens)
Must not become pregnant
Avoid grapefruit juice
Seek advice if bleeding

51
Q

What is the MOA of warfarin?

A

Inhibits reductase enzyme that activates vitamin K

52
Q

What is the antidote for unfractionated heparin?

A

Protamine sulfate

53
Q

Which DOAC has an antidote?

A

Dabigatran - monoclonal antibody antidote

54
Q

What is the MOA of apixaban and rivoroxaban?

A

Factor Xa inhibtiors

55
Q

What is the MOA of dabigatran?

A

Inhibits thrombin

56
Q

What can you give a patients INR is > 5 and there is a minor bleed?

A

IV Vitamin K

57
Q

What can you do to reverse warfarin in a major bleed?

A

Give prothrombin complex

burton (10 decks)

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