Hematology Flashcards
what are the 3 layers of blood vessels? (I, M, A)
intima, media, adventitia
Vessels:
- plts adhere to what? (IVW)
- what 2 mediators cause the vessel contract after injury? (T, A)
- what mobilizes during the adhesion phase from endothelial cells? (V)
- what attaches to vWF and attracts plts to bind to endothelial lining? (G)
- what do vWF make plts, which allows them to adhere to the injury site? (S)
- injured vessel wall
- thromboxane, ADP
- vWF
- glycoprotein Ib
- sticky
Coagulation factors:
- what 4 factors are vitamin K dependent?
- what factor is fibrinogen?
- what factor is prothrombin?
- what factor mediates adhesion?
- where are most of these synthesized?
- 2, 7, 9, 10
- 1
- 2
- vWF
what are the factors in order for these coagulation cascades:
- extrinsic (4)
- intrinsic (7)
- 7, 10, 2, 1
2. 12, 11, 9, 8, 10, 2, 1
Meds that influence coagulation:
- what are the 4 anticoagulants? (H, L, CD, TI)
- what med is a procoagulant?
- what 3 meds are antiplatelet? (P, N, T)
- what 2 meds are antifibrinolytic? (T, A)
- heparin, LMWH, coumadin derivatives, thrombin inhibitors
- vitamin K
- persantine, NSAIDs, thienopyridine
- TXA, amicar
coagulation tests:
- bleeding time (minute, range)
- plts (per mm cubed, range)
- thrombin T (seconds, range)
- PT average (seconds, range)
- aPTT average (seconds, range)
- ACT (seconds, range)
- FDP < what mcg/mL?
- D-dimer less than what mg/mL?
- 3-7 min
- 150-350K
- 8-12 sec
- 12-14 sec
- 25-32 sec
- 80-150 sec
- < 10 mcg/mL
- < 500 mg/mL
what are the 3 reasons for blood transfusions? (RV, RCF, IOCC)
- replace volume
- replace coagulation factors
- improve oxygen carrying capacity
does oxygen-carrying capacity of RBCs increase or decrease with length of storage?
decrease
does oxygen carrying capacity improve when 2,3 DPH is regenerated once transfused?
yes
plt infusion guide:
- recommended dose is 1 plateletpheresis pack per how many kg of body weight?
- how is the normal lifespan of donate plts? (range, days)
- 1 pack of plts increases the plt count by what range?
- plt count less than what is associated with increased intraoperative blood loss?
- stored at room temperature for what day range?
- 10 kg
- 4-5 days
- 5,000-10,000
- 50,000
- 4-5 days
what blood product as the greatest risk of bacterial transmission?
plts
FFP guide:
- contains all of what? (CF&NCI)
- average mL
- do they need to be ABO compatible?
- is it used for volume replacement?
- is FFP indicated when PT or INR and aPTT are normal?
- clotting factors and natural clotting inhibitors
- 200 mL
- yes
- no
- no
reasons for FFP infusion:
- urgent reversal of what med?
- correction of what, when specific concentration is not available? (KFD)
- correct excessive what with INR >2 in absence of heparin? (MB)
- correction of microvascular bleeding d/t coag factor deficiency in pts transfused with greater than 1 what? (BV)
- warfarin
- known factor deficient
- microvascular bleeding
- blood volume
Cryo infusion guide:
- contains what 2 things and what 2 factors? (F, F)
- used when fibrinogen is less than what mg/dL range and pt is bleeding?
- used as an adjunct during what when fibrinogen can’t be quickly checked? (MT)
- what are the 2 other reasons to give? (F, CFD)
- fibrinogen, fibronectin, factor 8, factor 13
- 80-100 mg/dL
- massive transfusions
- fibrinolysis, congenital fibrinogen deficiencies
what are 4 blood transfusion strategies? (PAD, ANH, BCS, RF8)
- preop autologous donation
- acute normovolemic hemodilution
- blood cell salvage
- recombinant factor 8
Hgb less than what triggers transfusion for hi risk pts?
< 7
porphyrias:
- inborn metabolic error secondary to what deficiency in the heme synthesis pathway? (E)
- this deficient leads to an overproduction of what? (P)
- porphyrin is needed for what 2 things with O2? (T, S)
- defective enzyme leads to an accumulation of preceding intermediate form of what? (P)
- what porphyria are we most worried about?
- we are only worried about this form of porphyria because its the only form that can result in what type of reactions with certain drugs? (LT)
- enzyme
- porphyrin
- transport, storage
- porphyrin
- acute intermittent porphyria
- life-threatening
Classes of porphyria:
- what are the 2 types? (H, E)
- class depends on the primary site of what or site of what of precursors or porphyrins? (O, A)
- hepatic, erythropoietic
2. overproduction, accumulation
acute porphyria:
- inherited autosomal dominant or recessive?
- attacks are more frequently in men or women in what 2 decades of life?
- acute attacks are precipitated by events that decrease what concentration and increase what enzymes activity? (H, AS)
- the above scenario is a stimulation of the production of what? (P)
- what are the most important trigger for acute porphyria? (EID)
- what are 6 other reasons that can precipitate an acute attack? (HF, M, F, D, S, I)
- this disease is associated with what 3 things in pregnancy? (H, SA, LBW)
- dominant
- women, 3rd and 4th decade
- heme, ALA synthetase
- porphyrinogens
- enzyme inducing drugs
- hormone fluctuation, menstruation, fasting, dehydration, stress, infection
- HTN, spontaneous abortion, low birth weight
acute porphyria:
- can pts with known risk for porphyria but previously asymptomatic experience their first symptoms of porphyria in response to triggering drugs given during the perioperative period?
- what are 5 S/S? (SAP, AI, ED, NS, SMW, S)
- CNS manifestations can be seen with what 3 things? (UMNL, CNP, C/BGA)
- yes
- severe abd pain, ANS instability, electrolyte disturbances, neuropsychiatric symptoms, skeletal muscle weakness, seizures
- upper motor neuron lesions, cranial nerve palsies, cerebellar/basal ganglia abnormalities
acute porphyria triggering drugs:
- they induce what enzyme activity or interfere with what feedback control at final common pathway of heme synthesis? (AS, N)
- allyl groups on what drug type and some structures of what other drug type are known to produce porphyria? (B, S)
- ALA synthetase, negative
2. barbiturates, steroid
acute porphyria:
- avoid what 5 meds? (T, E, M, P, T)
- probably avoid what 1 med? (N)
- thiopental, etomidate, methohexital, pentazocine, thiamylal
- nifedipine
anesthesia and porphyria:
- are pts with active porphyria or acute porphyric crisis at an increased risk?
- is exposure to several enzyme-inducing drugs more dangerous than any one drug?
- yes
2. yes