hematology/coagulation (week 7) Flashcards
1
Q
what is thrombocytopenia
A
- abnormally low platelet count
- below 150
- mild (100-149)
- moderate (50-99)
- severe (less than 50)
2
Q
what do platelets do?
A
- they form plugs and activate coagulation
- help stop bleeding
3
Q
what are the risks with thrombocytopenia
A
- bleeding from an injury of spontaneous
4
Q
what are the three pathways that create low platelet counts
A
- decreased production
- increased breakdown
- abnormal distribution
- or severe hemorrhage
5
Q
what are acquired thrombocytopenia and what do they lead to?
A
- immune thrombocytopenic purpura (ITP)
- heparin-induced thrombocytopenia (HIT)
- both lead to premature destruction of platelets
6
Q
what needs to be assessed if all levels in the CBC lab results are abnormally low?
A
check bone marrow
7
Q
if all CBCs are normal excpet for platelets then what would you expect?
A
- HIT
- ITP
8
Q
laboratory results for ITP will show:
A
- very low platelets
- normal hemoglobin, PT, aPTT, and D-dimer
9
Q
laboratory results for HIT will show:
A
- decreased platelets
- increased D-dimer (blood clotting problems)
- normal hemoglobin, PT, and aPTT
10
Q
what is the pathophysiology of ITP (what causes ITP)?
A
- autoimmune disorder.
- platelets are coated with antibodies and once they enter the spleen they are broken down by macrophages
11
Q
what is the order of treatment for ITP
A
- steriod therapy (prednisone)
- splenectomy
- IV immune anti-D antibody
- platelet transfusion
12
Q
how does steroid therapy help ITP?
A
- suppress phagocytic response (response to breakdown) of macrophages in the spleen
- and suppresses antibody formation
13
Q
what happens if you do a spenectomy to treat ITP?
A
- decreases the act of macrophages, decrease antibodies, and decrease removal of platelets
14
Q
How does IV immune anti-D antibody help ITP
A
- if steroid therapy and splenectomy does not work
- these compete with antiplatelet antibodies for macrphage receptor on spleen - prevents from breaking down platelets
15
Q
how does platelet transfusion help with ITP
A
- the last resort
- life threatening situations
- can lead to antibody formation
16
Q
what is the pathophysiology of HIT (how does it occur)?
A
a drug induced form of thrombocytopenia
- heparin PF4 bind to antibody making antoibody-heparin PF4
- this causes thrombotic activities (platelets form clots )
17
Q
risk factors for HIT
A
- bleeding
- DVT, and PE
- HIT starts 5 days after start of heparin medication
18
Q
treatment for HIT
A
- immediate discontinuation of heparin and start using warfarin if anti coagulation is needed (takes vitamin K pathway)
19
Q
what is DIC?
A
- it is a bleeding and thrombotic disorder (clotting)
- is always in response to a disease or injury that has gone out of control (septic and cardiogenic shock)
20
Q
bleeding manifestations in DIC
A
- consumption and depletion of platelets and coagulation factors (excessive clotting - depleting platelets)
21
Q
signs and symptoms of bleeding in DIC
A
- skin white,
- purpura
- blood oozing
- hemorrhage
- respiratory: tachypnea, hemoptysis
- cardio: tachycardic, hypotension
- GI: blood in stool
- UT: blood in urine
- neurological: vision changes, dizziness, headache
- MSK: bone and joint pain
22
Q
thrombotic manifestation in DIC
A
- fibrin or platelet deposition in microvasculature
23
Q
signs ans symptoms of thrombotic in DIC
A
- skin: cyanois, ischemic, gangrene (low purfusion)
- resp: tachypnea, dyspnea, PE
- cardio: dysrythmias
- GI: abdominal pain, no bowel sounds
- urinary tract: AKI, no urine output
24
Q
what would be shown on the labs results for DIC?
A
- decreased platelet count
- no change or low hemoglobin (the difference between HIT and ITP)
- increased: PT, aPTT, and D-dimer (coagulation time very fast)
25
treatment if bleeding in DIC
- provide blood products
- and treat underlying cause
- anticoagulation (if clotting lots - outweighs the risk of bleeding)
26
if bleeding what type of fluid would you give?
- isotonic NS but need to check electrolyte levels first
27
how to treat underlyign cause for DIC
- sepsis - antibiotics
- shock syndromes
- massive traumas
- neoplams
- liver disease
28
what to consider when working with a patient who has ITP, HIT ir DIC
- avoid IM injections and SC as much as possible
- SC use smallest needle
- wrap puncture sites
- PPE precautions
- avoid automatic BP cuffs
- take manual BP just above systolic trend
- skin care
29
indication for use of whole blood
- large volume loss (hemorrhages)
- increase O2 carrying capacity, restores blood volume, and homeostasis
30
what to watch for when giving whole blood
- blood types,
- Rh factor
- transfusion reaction/ allergies
- fluid overload
31
what is the use for packed WBC
- low hemoglobin
- severe of symptomatic anemia
- increase O2 carrying capacity
- replace 500CC of blood loss
- low chance of fluid overload, and allergies
32
what is the use for platelet transfusions
- platelet function abnormalities
- low P count
- corrects low P counts
- aids in clotting
- watch for reaction/allergy
33
what is the use for fresh frozen plasma?
- deficiency of plasma coagulation factors (TTP)
- risk: respiratory distress, fluid overload, reactions
34
why give albumin trasnfusions?
- volume expansion
- third spacing (moves fluid from interstitial to vascular)
- septic patients
- liver failure
35
what to watch for when giving albumin
- hypotension, flushing
- nausea, fever
36
what could an allergic reaction look like and how to intervene?
- flushing/itching -> bronchospasm, hypotension, shock, arrest
- intervention -> stop transfusion, give antihistamine or epinephrine
37
signs and symptoms of circulatory overload
- respiratory distress
- tachycardia
- high BP
- pulmonary edema/peripheral edema
38
interventions for circulatory overload
- upright positioning
- diuretics/lasix
- O2 therapy
- spironolactone (if hypokalemia)
- vasodilator and nitro to reduce venous return (preload)
