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Pharm 2-EXAM #2 > Hematology 1 > Flashcards

Hematology 1 Flashcards

1
Q

What are the functions of blood?

A

Homeostasis

Defense

Transports O2, nutrients, waste & hormones

Heat exchange

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2
Q

What is the primary source of blood cells?

A

Bone marrow (95%)

Red marrow of sternum, ribs, vertebrae & skull

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3
Q

What is the secondary source of blood cells, but also the primary source in PEDS?

A

Femur & tibia

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4
Q

WBC are ________, which are further categorized as_____ & ____

A

Leukocytes; Granulocytes; Agranulocytes

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5
Q

WBC action

A

Defend against foreign cells & infection

It is non-specific & an acquired immune response & inflammation

Comes from bone marrow

Lymphocytes from lymphatic organs

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6
Q

HGB is equivalent to

A

O2 carrying capacity

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7
Q

What is involved in the destruction of aged RBCs?

A

Destroyed by liver macrophages

Within ~4 months

Heme is broken down into iron & bilirubin

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8
Q

Anemia is the

A

Reduction in RBCs or HGB (hemorrhage or bone marrow failure)

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9
Q

What are the types of Anemia?

A

Dietary deficiency 9folic acid/iron/vitamin B12)

Kidney disease/ Nephrectomy

Sickle cell

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10
Q

Iron is absorbed in __________ & is increased by ____________

A

The diet in the small intestine

Vit C

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11
Q

Iron is bound to

A

Transferrin in the plasma

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12
Q

Iron is an essential component of

A

Enzymes necessary for energy transfer

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13
Q

Iron is incorporated into

A

New erythrocytes & reticuloendothelial cells in the liver & spleen

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14
Q

Plasma concentration of iron

A

50-150 mcg/dL

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15
Q

Causes of iron deficiency

A

Inadequate dietary intake

Increased requirements during pregnancy or blood loss

Interference with GI absorption

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16
Q

Iron supplements increase the rate of

A

Erythrocyte production & HGB concentration

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17
Q

With iron supplementation, levels should rise within

A

3 days to 3 weeks

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18
Q

Agglutinogen is an _________ which stimulates formation of _________

A

Antigen; Agglutinin

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19
Q

Agglutinin is an ________ or other blood substance that causes particle ________

A

Antibody; Aggregation

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20
Q

What happens to RBC as they are stored over time?

A

Depletion of ATP & 2,3 DPG (used to help HGB off-load O2 to tissues)

Shape change

Fragility impairs flow

Promotes inflammation, leading to ALI during transfusion, decreased O2 delivery & INCREASED hemolysis (LEFT SHIFT)

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21
Q

How many days place a patient at an increased risk of adverse events due to RBC storage?

A

> 14-21 days

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22
Q

A lengthy storage of RBCs can also impair

A

NO scavenging

Reduced NOS (dysfunctional endothelial cells)

Na/K ATPase failure–> K+ leak

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23
Q

Acute anemia can result in

A

A compensatory increase in CO & oxygen transport, but this process is limited in those with HF or flow restrictions

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24
Q

What kind of filter should be used with transfusing

A

170-260 micron

Removes clots & aggregates

Leukoreduction

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25
Q

One unit of PRBC will increase HBG by____

HCT by _______

A

HGB 1
HCT 3%

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26
Q

What fluids are compatible with transfusions?

A

NS

Albumin

Plasma often co-administered with RBC transfusion

Isotonic crystalloids (LR, Normosol & Plasmalyte)

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27
Q

Which fluids should be avoided when transfusing blood?

A

D5

Hypotonic

These fluids cause RBC lysis due to RBC taking up glucose & causing lysis

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28
Q

RBC, PLT, & Cryo should be

A

Administered separately

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29
Q

What defines plasma/fresh frozen plasma?

A

Whole blood is removed of RBCs, PLT, coagulation factors, fibrinogen & plasma proteins

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30
Q

FFP is plasma frozen within

A

8-24 hours of collection

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31
Q

What can be obtained from FFP

A

Cryo

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32
Q

FFP can be transfused

A

Interchangeably with thawed plasma

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33
Q

PLasma/FFP should be transfused within

A

24 hours of being thawed

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34
Q

Storage of plasma/FFP reduces factors

A

5 & 8

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35
Q

Plasma transfusions are indicated to

A

Replace volume & coagulation factors

Treat or prevent bleeding

Reverse warfarin anticoagulation

Treat coagulation factor abnormalities

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36
Q

Dose of plasma trasfusion

A

10-15ml/kg

Half of this when treating for warfarin

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37
Q

Plasma will increase the plasma factor concentration by ____

A

30%

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38
Q

What is cryoprecipitate?

A

Formed from show thaw of frozen plasma (residual volume refrozen & stored up to 3 years)

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39
Q

Cryoprecipitate is rish in factors

A

1, 8, & 13

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40
Q

What are the indications of giving cryoprecipitate?

A

Restore fibrinogen depleted from massive hemorrhage or coagulopathy

Treat hemophilia A & factor 13 deficiency

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41
Q

How should cryoprecipitate be administered?

A

Trasfuse with 4 hours

1 unit/10kg

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42
Q

What is the minimum FGN level for homeostasis?

A

~100 mg/dL

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43
Q

Cryoprecipitate will increase FGN by

A

50-100mg/dL

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44
Q

What is the average life span of PLT?

A

8-12 days

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45
Q

PLTs are involved in_________ for hemostasis

A

Thrombus formation

PLT & WBC recruitment

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46
Q

Normal PLT count

A

150,000-400,000/microL

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47
Q

How are PLT prepared?

A

Whole blood pooled & random donor

Single donor apheresis (4-6 pooled units)

Leukoreduced (removal of WBCs)

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48
Q

Leukoreduction will

A

Minimize sensitization & antibody reactions

Reduces risk of HLA alloimmunization, PLT refractoriness & transmission of viruses

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49
Q

PLT will increase plasma level to

A

30,000-50,000

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50
Q

PLT and their storage

A

They are stored at 22 degrees C, which increases the risk of bacterial growth

51
Q

PLT transfusion risk the chance of

A

graft vs host disease, which is when the grafts immune cells recognize the host as foreign & attacks recipient’s cells

52
Q

Which patients have a risk of graft vs host disease?

A

CA patients

Immunocompromised

PEDS

53
Q

Graft vs host disease is common after

A

Bone marrow & stem cell transplant

54
Q

PLTs can be ______ for certain populations & indications

A

Gamma-Irradiated

55
Q

Surgical patients PLT typically

A

> 50,000-100,000microL

56
Q

PLT count does not provide

A

Information on PLT function & quality

57
Q

Adverse effects of transfusions

A

Acute inflammatory response

Immunomodulation

Allogeneic blood w/bioactive substance

Immunosuppressive effects

Fever

Release of inflammatory mediators & neutrophil activation

Risk post-op infection

Transfusion of transmissible infections

58
Q

When should prophylactic administration of PLT be considered?

A

During massive transfusion

Closed surgical procedures with a high risk of hemorrhage

59
Q

What does TACO stand for?

A

Transfusion-Associated Circulatory Overload

60
Q

TACO occurs when

A

There is overload of a poor cardiovascular system (HF) related to transfusion of blood products

61
Q

Symptoms of TACO

A

Acute onset of dyspnea & tachypnea

HTN

Tachycardia

HF exacerbation

Pulmonary edema

62
Q

What lab value will be elevated in TACO?

A

BNP

63
Q

An echocardiography in relation to TACO will show

A

Ventricular & valvular dysfunction

64
Q

What does TRALI stand for?

A

Transfusion-related acute lung injury

65
Q

How is TRALI defined?

A

New & acute lung injury within 6 hours of transfusion

66
Q

On the cellular level int he lungs, what happens during TRALI?

A

Neutrophils &/or endothelial activation in the lungs

Pulmonary vascular injury

Pulmonary edema

67
Q

Symptoms of TRALI

A

Acute onset hypoxia (<90% on RA, PaO2/FiO2<300mmHg)

Bilateral pulmonary infiltrates

NO evidence of HF or volume overload

68
Q

Related factors of TRALI

A

Initiating inflammatory event

Lipids from stored blood

Viral infection

Cardiopulmonary Bypass

Secondary transfusion event triggers further inflammation & injury

Antibody specific

Underlying condition

68
Q

Life threatening 7 uncontrolled bleeding can be caused by

A

Massive transfusion coagulopathy

Trauma induced coagulopathy

69
Q

Thawed plasma will restore

A

Endothelial tight junctions

Proteins to help with osmotic maintenance

Anti-inflammation

70
Q

Coagulopathy is the depletion or decrease in

A

The function of clotting factors & PLTs

71
Q

Coagulopathy will worsen in the presence of

A

Hypothermia & acidosis

72
Q

Coagulopathy will accelerate

A

Clot breakdown

73
Q

Coagulopathy is the lost balance between

A

Physiologic anti- & pro- coaagulant effects

74
Q

What is dilutional coagulopathy?

A

Giving too much volume by administering crystalloids, colloids, RBCs & cell salvage

Blood loss

75
Q

Fibrin is needed for

A

Clot formation

76
Q

Frbrinolysis is the break down of a clot & is excessive in

A

The trauma patient & can lead to increased bleeding

77
Q

Hypofibrinogenemia is NOT corrected by

A

FFP

78
Q

Hypofibrinogenemia is the

A

Excess reduction in fibrinogen (~80-100mg/dL), which will prolong PT/PTT

79
Q

How is Hypofibrinogenemia corrected?

A

Giving Cryo or fibrinogen concentrate

80
Q

Citrate toxicity can cause

A

Hypocalcemia

81
Q

Hyperkalemia associated with transfusions is caused by

A

Potassium leakage during RBC storage, which places the patient at risk for arrhythmias, especially in ECMO, heart lung machines, or using older blood

82
Q

Hypothermia occurs when?

A

Reduces core temperature abruptly

10 units can reduce body temperature by ~3 degrees, risking exacerbation of hemorrhage, arrhythmias & other complications

83
Q

Which laboratory monitoring test is the best to monitor during transfusion

A

TEG/TEM

84
Q

Why is TEG/TEM the better lab value to monitor?

A

Goal directed management

Gives information on clot formation, strength, firmness, fibrin polymerization & coagulopathy

85
Q

What other lab value can be monitor but does not provide as much information as TEG/TEM?

A

PT/aPTT

PT–> loss of factors & hemodilution

85
Q

What defines a massive transfusion?

A

> 10 units RBC in 24 hrs

Higher mortality

Indicative of severity of injury

Protocol to rapidly secure products

Ideal ratio

86
Q

What blood products are given in the 1:1:1 ratio?

A

Frozen plasma/thawed plasma/other plasma product

Apheresis PLT

PRBCs

87
Q

Volume of frozen plasma?

A

~200-300ml

88
Q

Volume of apheresis PLTs

A

Contains ~300 billion PLTs

~25% of normal amount circulation PLTs

Only 50% is circulated

89
Q

Volume of PRBCs

A

~325mL

90
Q

Plasma is given for

A

Clotting factor replacement

91
Q

What are the goals for plasma infusion?

A

PT<18
aPTT<35
ACT>128
Cryo goal fibrinogen >180

92
Q

What is the indication for giving PLTs

A

PLT replacement (.150,000)

93
Q

Goal for RBC transfusion

A

HGB.8-10g/dL

94
Q

RBCs release________, which activates_____

A

ADP; Activated PLTs

95
Q

When are antifibrinolytic agents given?

A

Preserved for clot formation

Indication is based on TEG (LY30 value)

96
Q

Hypocalcemia, due to citrate toxicity is depletion of

A

Serum free Ca+ (ionized) concentration

97
Q

Hypocalcemia risks

A

paresthesia & arrhythmias

98
Q

There is a higher risk of hypocalcemia in

A

Hepatic dysfunctions

99
Q

Chloride does not require

A

Normal liver function

100
Q

10% Ca+ chloride is _____mL per blood unit

A

2-5

101
Q

10% Ca+ gluconate is _______mL per blood unit

A

10-20

102
Q

Large volume resuscitation risks

A

Dilutional coagulopathy

Severe edema

Lung stiffness

ABD compartment syndrome

103
Q

When is the massive transfusion protocol used?

A

Trauma
Cardiac surgery
Obstetrics
Liver patient

104
Q

What is the goal maintenance of fibrinogen in obstetrics?

A

> 200mg/dL

105
Q

Obstetric patients are already in a _________ with________

A

Hypercoagulable state; compensatory increase in fibrinolysis

106
Q

Liver patient have a reduction in

A

Production of normal coagulation factors

Hepatic clearance coagulation factor fragments, which increases the risk for hemorrhage

107
Q

Liver patients have a dysfunction in

A

Vit-K dependent factors & fibrinogen

108
Q

Caution with this in liver patients

A

Consider blood volume and portal circulation

109
Q

Correct acidosis with

A

Bicarb

110
Q

Minimize the use of

A

Crystalloids in massive transfusion

111
Q

With massive transfusion, use these products sooner rather than later

A

Plasma
PLT
RBCs

112
Q

What is postpartum hemorrhage?

A

> 500mL vaginal or >1,000mL section with ongoing bleeding; symptomatic within 24hrs

113
Q

Potential causes of postpartum hemorrhage

A

Uterine atony

Placental retention

Uterine Abnormalities or inversion

Lacerations

Coagulopathies

114
Q

PPH can be treated with

A

Antifibrinolytics

Uterotonics

115
Q

When treating PPH, an antifibrinolytic like tranexamic acid dose is

A

1 gram over 10-20 min & repeat after 30 min if needed

116
Q

Oxytocin MOA

A

Increases intracellular Ca+ for uterine contractions

10-40 units IM/IV diluted

117
Q

Adverse effects of oxytocin

A

Maternal arrhythmias & HOTN

118
Q

MOA of Methylergonovine, an uterotonic

A

Potent vasoconstrictor than increases the strength & frequency of uterine contractions

0.2mg IV every 2-4 hrs

The alternative to oxytocin & TXA

119
Q

When is Methylergonovine, an uterotonic contraindicated?

A

HTN

CVD

Preeclampsia

120
Q

MOA of carboprost, an uterotonic

A

Stimulates uterine smooth muscle contraction

250mcg IM or directly into uterine muscle

121
Q

Adverse effects of carboprost, an uterotonic

A

Nausea

Bronchospasm

Increase in PVR

Pharm 2-EXAM #2 (5 decks)

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