Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NURS 671 - Intro to Anesthesia > Hematology CH 38 > Flashcards

Hematology CH 38 Flashcards

1
Q

The intima (inner layer- Endothelial) has a role in modulating

A

Procoagulants (Hemostasis)
Anticoagulants
Fribrinolytics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an important function of the endothelial lining of blood vessels

A

They repel blood components away from the vessel was to prevent activation of clotting mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the Media (2nd layer - Subendothelial) contain?

A

It is extremely thrombogenic and very active, contains collagen and fibronectin

Collagen - important in PLT attachment

Fibronectin - Aids with aching fibrin during plug formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is NO and Prostacyclin made and what is their role?

A

Produced by Endothelial (inner layer) cells, and influence Adventitia (Outer layer - Externa)

They work by causing vasodilation and increasing the flow of blood, therefore interfere with PLT formation and aggregation; limit procoagulant mediations “wash them away”

NO –> Muscle relaxation
Prostacyclin –> Lipid molecule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NO specific affects PLT function, by inhibiting?

A

adhesion
aggregation
binding (btw fibrinogen + GPllb/llla)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What role does the adventitia (externa - outer layer) play?

A

Participates in control of blood flow by influencing vessel’s DEGREE OF CONTRACTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where are PLTs formed and stored?

A

Formed in bone marrow
1/3rd stored in Spleen

(megakaryoctes are precursors for PLTs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PLTs contain a nucleus, T/F?

A

False! They do not contain a nucleus, DNA, nor RNA. So they do not reproduce.

THEY DO contain mitochondria in cytoplasm, so they participate in aerobic & anerobic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PLTs store a large amount of
A) Mg
B) Ca
C) K
D) Na

A

B) Calcium

AND… various enzymes like vWF, Fibrinogen, PLT Factor 4, PLT growth Factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PLTs produce
A) ADP
B) Prostacyclin
C) Vit K
D) Thrombin

A

D) Thrombin. Role of thrombin is to activate some coagulation factors and influence recruitment of PLT to injury site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When vessel wall injury occurs, what happens next?

A

Immediately contracts to cause tamponade and decrease blood flow to decrease bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What mediates contraction (vasoconstriction)?

A) ADP & Thromboxane A2
B) Gpllb/llla & Fibrinogen
C) vWF & Gplb
D) None of the above

A

A) ADP & Thromboxane A2

Contraction results from ANS reflexes and expression of f the aforementioned

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 3 steps to form a primary plug?

A

Adhesion
Activation
Aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens during adhesion? (Select all that apply)

A) ADP & Thromboxane A2 vasoconstrict
B) TF influences PLT activation
C) GPlb & Fibrinogen bind to form a plug
D) Gpllb/llla & vWF attach to attract PLTs; make them “sticky”
E) none of the above

A

D) Gpllb/llla & vWF attach to attract PLTs; make them “sticky”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What happens during Activation? (select all that apply)

What happens during adhesion?

A) ADP & Thromboxane A2 vasoconstrict
B) TF influences PLT activation
C) GPlb & Fibrinogen bind to form a plug
D) Gpllb/llla & vWF attach to attract PLTs; make them “sticky”
E) none of the above

A

B & D

TF will influence PLTs to undergo transformation and become activated, GPllb/llla will project off these PLTs and attach to Fibrinogen to help form primary plug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens during aggregation?

A) ADP & Thromboxane A2 vasoconstrict
B) TF influences PLT activation
C) GPlb & Fibrinogen bind to form a plug
D) Gpllb/llla & vWF attach to attract PLTs; make them “sticky”
E) none of the above

A

E.
During this time PLT releases alpha & dense granules, contractile granules, thrombin, and other important procoagulant activators as mediators responsible for PLT aggregation. Here the primary plug is solidified.

Small injuries primary plug is sufficient
Large injuries require secondary plug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What pathway influences the start of extrinsic pathway?
A) contact activation pathway
B) common pathway
C) TF pathway
D) intrinsic pathway

A

C) TF pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what pathway influences the start of intrinsic pathway?
A) contact activation pathway
B) common pathway
C) TF pathway
D) extrinsic pathway

A

A) contact activation pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What factors are in the intrinsic pathway?
A) 3, 7
B) 2, 7, 9, 10
C) 10, 5, 2, 1
D) 11, 12, 9, 8

A

D) 11, 12, 9, 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What factors are in the extrinsic pathway?
A) 3, 7
B) 2, 7, 9, 10
C) 10, 5, 2, 1
D) 11, 12, 9, 8

A

A) 3, 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What factors are dependent on vitamin K?
A) 3, 7
B) 2, 7, 9, 10
C) 10, 5, 2, 1
D) 11, 12, 9, 8

A

B) 2, 7, 9, 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What factors are in the common pathway?
A) 3, 7
B) 2, 7, 9, 10
C) 10, 5, 2, 1
D) 11, 12, 9, 8

A

C) 10, 5, 2, 1

Note: Factor 13 (stabilizing fibrin) is like the “step-sister” is it what helps create that cross-link fibrin mesh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What factor is involved throughout common pathway to help activate?
A) 3
B) 7
C) 10
D) 4

A

Factor 4 which is Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the name of Factor 1? (describe action)
A) Antihempohiliac
B) Christmas
C) Calcium
D) Fibrinogen

A

D

Action - Form a clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the name of Factor 2? (describe action) A) Proaccelerin B) Prothrombin C) Stuart prower D) Fibrinogen
B Action - when IIa, activates I, V, VIII, IX, Xlll, PLTs, & Protein C
26
What is the name of Factor 3? (describe action) A) Prothrombin B) Christmas C) Thromboplastin D) Plasma thromboplastin antecedent
C Action - Cofactor of VII
27
What is the name of Factor 4? (describe action) A) Antihempohiliac B) Christmas C) Calcium D) Fibrinogen
C Action - Promotes clotting reactions
28
What is the name of Factor 5? (describe action) A) Proaccelerin B) Proconvertin C) Christmas D) Fibrin stabilizing
A Action - Cofactor of X, forms prothrombinase complex
29
What is the name of Factor 6? (describe action) A) Antihempohiliac B) Christmas C) Calcium D) Unassigned
D Action - NONE
30
What is the name of Factor 7? (describe action) A) Antihempohiliac B) Proconvertin C) Calcium D) Fibrinogen
B Action - Activates IX & X
31
What is the name of Factor 8? (describe action) A) Antihempohiliac B) TF C) Calcium D) Fibrinogen
A Action - Cofactor to IX
32
What is the name of Factor 9? (describe action) A) Thromboplastin B) Proconvertin C) Christmas D) Stuart Prower
C Action - Activates X
33
What is the name of Factor 10? (describe action) A) Antihempohiliac B) Proconvertin C) Stuart Prower D) Fibrinogen
C Action - Activates II, forms prothrombinase complex with V
34
What is the name of Factor 11? (describe action) A) Prothrombin B) Christmas C) Thromboplastin D) Plasma thromboplastin antecedent
D Action - Activates IX
35
What is the name of Factor 12? (describe action) A) Hageman B) Christmas C) Thromboplastin D) Plasma thromboplastin antecedent
A Action - Activates XI
36
What is the name of Factor 13? (describe action) A) Prothrombin B) Fibrin stabilizing C) Thromboplastin D) Plasma thromboplastin antecedent
B Action - cross-links fibrin
37
What is the name of vWF Factor? (describe action) A) Prothrombin B) Christmas C) Thromboplastin D) Von Willebrand
D Action - Mediates adhesion
38
Which 3 factors are NOT synthesized by liver?
III - synthesized by vascular wall and extravascular cell membranes; released from traumatized cells IV - comes from out diet vWF - Synthesized in Endothelial cells
39
What is the name of Prekallikrein Factor? (describe action) A) Christmas B) Stuart Prower C) Fletcher D) Von Willebrand
C Action - Activates XII, cleaves HMWK
40
What is the name of High MW Kininogen (HMWK) Factor? (describe action) A) Tissue Factor B) Contact activation factor C) Fletcher D) Von Willebrand
B Action - Supports activation of prekallikrein, XII, XI
41
Which mediators vasoconstriction? (select all that apply) A) ADP B) tPA C) Serotonin D) NO E) Protein C & S F) Thromboxane A2 G) Urokinase H) AT III I) Plasminogen J) Prostacyclin
A, C, F
42
Which mediators vasodilate? (select all that apply) A) ADP B) tPA C) Serotonin D) NO E) Protein C & S F) Thromboxane A2 G) Urokinase H) AT III I) Plasminogen J) Prostacyclin
D, J
43
Which mediators have fibrinolytic properties? (select all that apply) A) ADP B) tPA C) Serotonin D) NO E) Protein C & S F) Thromboxane A2 G) Urokinase H) AT III I) Plasminogen J) Prostacyclin
B, G, I
44
Which mediators have anticoagulant properties? (select all that apply) A) TF B) vWF C) Serotonin D) Fibronectin E) Protein C & S F) Collagen G) Urokinase H) AT III I) Plasminogen J) Thrombomodulin
A, E, H
45
Which mediators have procoagulant properties? (select all that apply) A) TF B) vWF C) Serotonin D) Fibronectin E) Protein C & S F) Collagen G) Urokinase H) AT III I) Plasminogen J) Thrombomodulin
B, D, F, J
46
What are 2 antifibrinolytic drugs used to combat clot degradation?
Aminocaproic acid Tranexamic acid
47
Is Vit K a procoagulant or anticoagulant?
Procoagulant
48
Which is the site where the intrinsic and extrinsic converge? A) V B) X C) Va D) II E) Xa F) lla
E) Xa
49
Which factor is first depleted (dt short half life) of all VIT K dependent factors? A) 2 B) 7 C) 9 D) 10
B) 7 Tx: Vit K 10-20mg IM
50
Thrombin (Factor lla) assists in activating which factors? A) 3, 7 B) 2, 7, 9, 10 C) 1, 5, 8, 13 D) 10, 5, 2, 1 E) 11, 12, 9, 8
C) 1, 5, 8, 13 And, it influences recruitment of PLTs to sire of injury. Thrombin can also behave as an anticoagulant
51
In what 3 ways does thrombin behave as an anticoagulant? (select 3) A) Activates l B) Releases tPA C) Binds with vWF D) Simulates Gpllb/llla E) Binds with AT3 F) Stimulates Protein C & S
B) Releases tPA to prevent clot formation E) Binds with AT3 to interfere with coagulation F) Stimulates Protein C & S to inhibit clot formation
52
If you have a low Vit K and low INR, what do you give?
FFP
53
Protein C & S inhibit which coagulation factors? A) 1, 5, 8, 13 B) 2, 7, 9, 10 C) 3, 5, 8 D) 10, 5, 2, 1 E) 11, 12, 9, 8
C) 3, 5, 8
54
AT 3 corrals which clotting factors to influence factor ll? A) 1, 5, 8, 13 B) 11, 12, 9, 8 C) 2, 7, 9, 10 D) 10, 5, 2, 1 E) 12, 11, 10, 9
E) 12, 11, 10, 9
55
Fibrinolysis is highly regulated by?
plasma proteins
56
A clot is primarily composed of?
plasminogen, plasmin, fibrin and fibrin degrading products
57
How many days should aspirin be withheld prior to surgery? A) 3-4 hours B) 1-2 days C) 24-48 hours D) 7-10 days E) 30 days
D) 7-10 days
58
Aspirin inhibits?
Inhibits cyclooxyrgenase (irreversibly), therefore decreasing PLT function
59
NSAIDS inhibit COX irreversibly. T/F
F Inhibit Cox reversibly
60
NSAIDs should be withheld how many days before surgery? A) 3-4 hours B) 1-2 days C) 24-48 hours D) 7-10 days E) 30 days
C) 24-48 hours
61
What is a normal bleeding time?
2-8 minutes
62
Bleeding time evaluates what?
PLT function & count & microvascular contraction
63
What is a normal PLT count?
150-300K/mm3
64
How low can your PLT be and still be sufficient for hemostasis?
100K
65
What PLT level would be mild thrombocytopenia?
50-100K
66
What PLT level would be severe thrombocytopenia?
<50K Spontaneous bleed is rare, but may be prolonged in sx. PLT < 20K will have spontaneous bleeding
67
What is the primary role of PLTs?
maintain vascular integrity aggregate initiate clotting cascade
68
What is a normal PT time
10-15 sec
69
Is PT affecting the intrinsic or extrinsic pathway?
Extrinsic think PET - E for extrinsic Extrinsic factors 3,7
70
What is a normal PTT value?
25-40 sec
71
Is PTT affecting the intrinsic or extrinsic pathway?
Intrinsic think PITT - I for intrinsic Intrinsic Factors 12,11,9,8
72
T/F. Any factor deficiency (intrinsic, extrinsic, or common pathway) will lead to increased risk of bleed.
False For sure only factor 8,9 will cause bleeding if deficient (seen with hemophilia)
73
What is a normal INR?
less than or equal to 1.1 (normal healthy person) 2-3 (therapeutic range) Book says overall (1.5-2.5)
74
What is a normal ACT?
90-150 sec monitors ability to clot
75
What is a normal TT?
9-13 sec it is a measure of fibrinolytic pathway
76
TEG benefits ability to evaluate?
PLT reactions Coagulation Fibrinolysis
77
TEG provides an indication of
Clot strength PLT # & function Intrinsic Pathway defect Thrombin formation Rate of fibinolysis
78
What labs help evaluate fibrinolysis?
DDimer Fibrin degradation products TEG
79
What are the 3 major reasons for transfusing in OR?
Replace volume Replace coagulation factors Improve oxygen carrying capacity
80
What is the recommended dose for PLT infusion?
1 unit/10kg BW This should improve PLT count by 5-10K
81
What is the normal life span of PLT vs if it is donated?
Normal: 7-10 days Donated: 4-5 days
82
PLTs pose a high risk of bacterial transmission. T/F
True. They are stored at room temperature for 4-5 days making it an excellent medium for bacterial growth
83
How do we get FFP and what does it contain?
It is the fluid portion of whole blood, frozen to persevere it contents. Contains: Coag factors and naturally occurring inhibitors Doesn't provide PLTs
84
What are alternatives to replace 1 unit of FFP?
4-5 PLT concentrates 1 unit single donor apheresis PLT 1 unit fresh whole blood
85
Cryo is rich in?
Fibrinogen Factors 8, 13 Fibronectin
86
When would you give cry?
test indicates fibrinolysis concentration of fibrinogen < 80-100mg/dL + bleeding adjunct in MTP congenital fibrinogen deficiencies If desmopressin and vWF/Vlll concentrate are ineffective in try vWD, then cryo can be given
87
When do you use recombinant factor Vll?
Hemophilia A (Vlll) & B (lX) Inhibitor disorders of Vlll & lX Factor Vll deficiency Universal hemostatic agent *will reverse prolonged INR but not replace clotting factors *caution in pts predisposed to thrombosis Tx very expensive suggested dose: 20-45 mcg/kg
88
A pt with an abnormal PT/INR and normal PTT would have what deficiency (ies)? What is the treatment?
Factor Vll Deficient Tx: FFP
89
A pt with an abnormal PTT and normal PT/INR would have what deficiency (ies)? What is the treatment?
Factor Vlll, lX, Xl Deficient or on heparin tx Tx: FFP, Protamine
90
A pt with an abnormal PT/INR and abnormal PTT would have what deficiency (ies)? What is the treatment?
Factor X, V, ll Deficient Dysfrbrinogen Heparin (high level) Warfarin Vit K deficient Liver disease DIC Tx: FFP, Cryo, Protamine
91
Abnormal BT and PLT count, what can you give to treat?
PLT concentrate
92
Abnormal BT, what can you give to treat?
PLT concentrate
93
Abnormal PT/PTT/INR, PLT count, & fibrinogen is low, what can you give to treat?
Pt is in DIC! Tx: FFP, Cryo, PLT concentrate, whole blood
94
Abnormal PT, what can you give to treat?
FFP
95
Abnormal BT and PTT count, what can you give to treat?
vWD! Tx: Desmopressin, vWF/Vlll, and if those don't work then cryo
96
In liver disease, you will see a decrease in which clotting factors?
ll, Vll, lX, X & Fibrinogen you will also see, Vit K deficiency Dysfibrinogenemia enhanced fibrinolysis DIC Thrombocytopenia dt hypersplenism
97
What does this TEG indicate?
normal
98
What does this TEG indicate?
Anticoagulants/hemophilia
99
What does this TEG indicate?
PLT blockers
100
What does this TEG indicate?
Fibrinolysis
101
What does this TEG indicate?
Hypercoagulation
102
What does this TEG indicate?
DIC stage 1
103
What does this TEG indicate?
DIC stage 2
104
What happen to RBCs when they are stored for >7days?
-Decreased 2,3-DPG ---Oxyhemoglobin shift to the left (love = reduced O2 release) -Decreased ATP -Decreased pH (d/t increased lactic acid -Impaired ability to change shape -Hemolysis -Increased Potassium (caution in neonates and renal failure pts) -Increased production of proinflammatory mediators
105
What are the functions of vWF?
1) facilitate platelet adhesion 2) plasma carrier for factor 8 **vWF synthesized by the endothelial cells and magakaryocytes
106
What labs will be abnormal in vWF disease?
1) prolonged BT and PTT (Apex) 2) decreased vWF (Nagelhout) 3) decreased vWF activity (measured by ristocetin (an antibiotic) cofactor essay 4) decreased factor 8
107
What are the treatment options for vWF disease?
1) Desmopressin 2) F8/vWF concentrate 3) IV immunoglobulins 4) cryo can be used only if ristocetin cofactor <50% 5) Tranexamic acid
108
What are the treatment options for hemophiliac patients?
-Factor 8 concentrate -Desmopression 0.3mcg/kg
109
How does Warfarin work?
-Warfarin inhibit the enzyme vitamin K epoxide reductase complex 1, which is responsible for converting inactive Vit K to active (Apex)
110
What lab tests indicate DIC?
Increased PT, PT, D-dimer Decreased Platelet, Fibrinogen
111
Who is at risk for DIC?
Sepsis (highest risk) Postoperative Obstetric Blood transfusion reactions Cancer
112
Treatment options for DIC
Treat the underlying cause For DIC due to sepsis, antithrombin administration
113
what triggers sickle cell crisis?
hypoxemia hypothermia infection dehydration venous stasis acidosis
114
What is the most common surgery among sickle cell patients?
Cholecystectomy due to excess bilirubin from rapid breakdown of sickle erythrocytes
115
What is the most common hemoglobin type in sickle cell disease (SCD)?
Hemoglobin S
116
What are the appropriate anesthesia management for patients with SCD?
provide adequate hydration promote adequate oxygen saturation ensure normothermia maintain acid-base balance provide proper patient positioning Adequate pain management Caution with vaso-oclusive devices such as tourniquets For high risk procedure, decrease hemoglobin S level <30% *preop blood transfusion is a debate
117
What are clinical signs of HIT?
-Decreased of >50% in platelet count from baseline or total platelet count <100,000 on heparin or LMWH -S/Sx: thrombocytopenia, resistance to heparin, thrombosis, positive to assay tests
118
What test gives a definite dx to HIT?
C-serotonin release assay is the gold standard
119
Why does HIT type 2 have worse outcomes?
-Immunoglobulin G response -Thrombocytopenia does not resolve spontaneously--> must d/c heparin -associated with thrombosis
120
Which of the following drugs belong to the ADP receptor inhibitors?
a) ASA b) clopidogrel c) ticlopidine d) ticagrelor e) cangrelor
121
Platelet GP 2b/3a receptor blockers drugs
abciximab tirofiban eptifibatide
122
Direct thrombin inhibitors drugs
bivalirudin dabigatran
123
Direct factor Xa inhibitors drugs
rivaroxaban, apixaban, edoxaban, betrixaban
124
When should the patient stop taking unfractionated heparin or LMWH?
6 hours or 12-24 hours before procedure
125
Pt had BMS (bare metal stent) implanted 15 days ago, pt is scheduled for an elective noncardiac surgery, you are the anesthesia provider, ok for surgery?
box 38.11 Elective non-cardiac surgery should be delayed 30 days after BMS implantation, 6 months after DES implantation
126
Should patient stop taking ASA while on dual antiplatelet therapy?
with dual antiplatelet therapy (DAPT) after coronary stent who must undergo surgical procedure that mandate D/c of P2Y12 inhibitor therapy (clopidogrel or ticagrelor), recommended that ASA should be continued
127
What component of blood product is appropriate for hemophilia A?
Preferred viral inactivated plasma derived or recombinant concentrates > Cryo > FFP other treatments desmopressin (only works for Hemophilia A), tranexamic acid, and epsilon aminocaproic acid
128
What treatment is appropriate for Hemophilia B?
FFP, tranexamic acid, aminocaproic acid
129
What cause sickle cell disease?
autosomal recessive genetic abnormality of the beta-globin gene

NURS 671 - Intro to Anesthesia (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions