Hematology Flashcards
What does cryoprecipitate contain?
Factors VIII and XIII
vWF
fibrinogen and fibronectin
hemoglobin A structure vs hemoglobin F structure vs beta thalessemia structure vs alpha thalessemia structure?
HbA = two alpha chains and two beta chains
HbF = two alpha chains and two gamma chains
beta thal = decreased production of beta chains
alpha thal = decreased production of alpha chains
Highest incidence of TRALI with which product?
Plasma, followed by platelets
Pathogenesis of TRALI?
DONOR antibodies activate RECIPIENT leukocytes –> sequestration of granulocytes in the lungs coupled with anti-leukocyte antibodies from the donor blood products –> noncardiogenic pulmonary edema
TRALI presents within what time frame?
within 4 hours
abnormal R value on TEG indicates what problem? treatment?
indicates lack of clotting factors for initial clot formation – give FFP or factors
abnormal K value on TEG indicates what problem? treatment?
INCREASED length of TIME to reach designated clot strength due to decreased fibrinogen – give cryo
abnormal alpha angle on TEG indicates what problem? treatment?
Decreased SPEED of clot formation due to LOW fibrinogen - give cryo
abnormal MA on TEG indicates what problem? treatment?
abnormal maximum amplitude indicates decreased STRENGTH of clot – give platelets
abnormal LY30 on TEG indicates what problem? treatment?
Indicates INCREASED clot breakdown, i.e. fibrinolysis – give TXA or aminocaproic acid
Mechanism of action of Abciximab?
Glycoprotein IIb/IIIa inhibitor of platelets – inhibits platelet aggregation
How to rapidly reverse dabigatran?
Idarucizumab - monoclonal antibody fragment that binds and reverses
Mechanism of action of TXA?
Prevents conversion of plasminogen to plasmin, thereby reducing fibrin degradation
**avoid in patients with preexisting thromboembolic disease
product of choice when active bleeding in setting of Hemophilia?
cryoprecipitate
What to do if active bleeding in setting of hemophilia but resistant to cryo?
give activated factor II and/or activated factor VII so that dysfunctional factor VIII (due to anti-factor VIII antibodies) is bypassed.
Another option is PORCINE factor VIII.
How does liver disease, cystic fibrosis and warfarin change PTT?
prolonged
What does PT measure?
Coagulation initiated by tissue factor until formation of fibrin. Mainly the extrinsic pathway ( I, II, V, VII, and X) and common clotting pathway
think “PET”
What does PTT measure?
VIII, IX, XI, XII
In acute hemorrhage, which coagulation factor will reach a critically low level first?
Fibrinogen! (after loss of about 1.5 blood volumes)
Other coagulation factors typically reach critical levels after about 2-2.5 blood volumes
Acute hemolytic transfusion reaction is in response to what? Coombs test will be _____. Hemolysis will be located ______.
Acute hemolytic transfusion is in response to ABO compatibility.
Coombs test is negative.
Hemolysis will be intravascular mediated by IgM antibodies (as opposed to IgG antibodies in delayed reactions).
Delayed hemolytic transfusion reactions are mediated by which type of antibodies? Hemolysis occurs where?
Delayed reactions are mediated by IgG antibodies to lesser antigens like Lewis, Kidd, Kell and Duffy
Hemolysis occurs in the reticuloendothelial system (versus intravascular for acute reactions to ABO incompatibility)
What causes refractory Hemophilia A? Lifesaving treatment?
Due to antibodies against Factor VIII - give prothrombin complex concentrates or recombinant factor VII
What causes refractory Hemophilia B? Lifesaving treatment?
Due to antibodies against Factor IX - give recombinant factor VIIa
PT, PTT, bleeding time and platelet count in Hemophilia?
PT normal
PTT PROLONGED
Bleeding time normal
Platelet count normal
PT, PTT, bleeding time and platelet count in VWD?
PT normal
PTT PROLONGED
Bleeding time PROLONGED
Platelet count normal
PT, PTT, bleeding time and platelet count in DIC?
PT prolonged
PTT prolonged
Bleeding time prolonged
Platelet count decreased
PT, PTT, bleeding time and platelet count in Vitamin K deficiency?
PT prolonged
PTT prolonged
Bleeding time normal
Platelet count normal
Anesthetic goals in acute intermittent porphyria?
Avoid p450 inducers which will lead to INCR aminolevulinic acid -→ precipitate attacks
So avoid:
- barbs
- benzos
- nifedipine
- glucocorticoids
- alcohol
- dehydration
Keep normothermic!
What does prothrombin complex contain?
II, VII, IX, and X
INR can be normalized within 15-30 minutes without adding substantial volume of fluid to circulation
