Hematology #2

Question 1

DIC excessive clotting cascade and lysis cascade results in:

Answer 1

• Exhausted factors and co-factors
• partially developed and broken down clots
• micro emboli caught in capillaries

Question 2

Organs with most capillaries

Answer 2

Heart, liver, spleen, brain, lungs,

Question 3

MODS and death result from DIC why?

Answer 3

Entire system losing blood due to mass micro emboli occlusion

Question 4

DIC lab values

Answer 4

1. Positive D-Dimer (fibrin degradation products)
2. Low fibrinogen and platelets (clotting factors)
3. Hg PT, aPTT, INR, FSP

Question 5

PT

Answer 5

Prothrombin Time

-measurement of intrinsic coagulation

Question 6

aPTT

Answer 6

Activated partial thromboplastin time

-measurement of extrinsic coagulation

Question 7

INR

Answer 7

International Normalized Ratio

• universalized rabbit serum to measure PT
• normal 1.0
• high INR suggest it is taking longer to clot

Question 8

FSP or FDP

Answer 8

Fibrin Split / Degradation Product

-clot break down

Question 9

DIC treatment #1 goal

Answer 9

Treat precipitating cause

Question 10

DIC traditional treatment

Answer 10

Give FFP, Cryo, platelets to create clots

-May add to the problem

Question 11

DIC and heparin treatment

Answer 11

Only studies to be beneficial when secondary yo neoplasms and CA

Question 12

Antithrombin III (ATIII) therapy

Answer 12

Interferes with fibrinogen converting to fibrin (normal process in body)

• prevents coagulopathy
• primarily inhibits factors IIa (thrombin) and X (Stuart factor)
• in FFP

Question 13

Chronic heparin therapy can cause what deficiency?

Answer 13

ATIII

• body processes out heparin bound w/ ATIII
• can cause DIC, tx w/ FFP

Question 14

PRBC indication

Answer 14

Increase O2 carry capacity of blood

-volume expander only secondary to this qualification

Question 15

PRBC HgB indications

Answer 15

Indicated for

Question 16

RBC antigen that can cause a reaction

Answer 16

ABO

Question 17

Rh(-) female

Answer 17

Can reach sensitization with Rh (+) blood.

• anaphylaxis possible
• Rh (+) fetus can be aborted (rogan can prevent this)

Question 18

Rh(+) / Rh(-) blood to male or females

Answer 18

Females: Rh(-)
Males: Rh (+)
-can be sensitized, but does not have fetal complication for future.

Question 19

How many ml are in one unit of PRBCs?

Answer 19

330 ccs

Question 20

PRBC pediatric dose

Answer 20

10cc/kg

Question 21

Citrate toxicity considerations

Answer 21

Multiple units: 4 units in less than 20 minutes

-citrate chelates ionized Ca- renders it useless in clotting cascade

Question 22

Administer Ca if giving PRBCs at what rate

Answer 22

One unit in less than 5 minutes or 1 ml/kg/min

General rule: 1 amp of Ca q 4 units PRBCs.

Question 23

Liver considerations with citrate

Answer 23

Liver processes citrate. Liver dysfunction can lead to citrate toxicity despite PRBC admin at slower rates.

Question 24

Universal donor

Answer 24

O(-)

Question 25

Universal recipient

Answer 25

AB(+)

Can take A, B, AB

Question 26

1 unit of PRBCs increases the H&H by what?

Answer 26

1&3

Question 27

Q unit of PRBCs at storage temp will decrease core temp by?

Answer 27

0.25 c

Question 28

PRBC and acidosis considerations

Answer 28

Store blood continued metabolism = lactate = acidotic

• citrate converts to HCO3 = self correcting
• watch ABGs

Question 29

PRBC and hyperkalemia considerations

Answer 29

RBCs die and release K in storage. Stored blood K levels can reach 17-24.
-administration rates greater than 90-120 ml/min can result in hyperkalemia. Watch ECG for changes.

Question 30

DIC cause and mechanism

Answer 30

Causes: sepsis, massive trauma, hypoxia
Mechanism: systemic activation of clotting cascade by overwhelming release of thromboplastin factor. Lysis cascade goes into overdrive as a result to overwhelming clot formation. Clots broken down prematurely.