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331 Quiz 2 > hematology/coagulation (week 7) > Flashcards

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)
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2
Q

what do platelets do?

A
  • they form plugs and activate coagulation
  • help stop bleeding
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3
Q

what are the risks with thrombocytopenia

A
  • bleeding from an injury of spontaneous
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4
Q

what are the three pathways that create low platelet counts

A
  • decreased production
  • increased breakdown
  • abnormal distribution
  • or severe hemorrhage
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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
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6
Q

what needs to be assessed if all levels in the CBC lab results are abnormally low?

A

check bone marrow

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7
Q

if all CBCs are normal excpet for platelets then what would you expect?

A
  • HIT
  • ITP
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8
Q

laboratory results for ITP will show:

A
  • very low platelets
  • normal hemoglobin, PT, aPTT, and D-dimer
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9
Q

laboratory results for HIT will show:

A
  • decreased platelets
  • increased D-dimer (blood clotting problems)
  • normal hemoglobin, PT, and aPTT
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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
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11
Q

what is the order of treatment for ITP

A
  • steriod therapy (prednisone)
  • splenectomy
  • IV immune anti-D antibody
  • platelet transfusion
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12
Q

how does steroid therapy help ITP?

A
  • suppress phagocytic response (response to breakdown) of macrophages in the spleen
  • and suppresses antibody formation
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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
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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
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15
Q

how does platelet transfusion help with ITP

A
  • the last resort
  • life threatening situations
  • can lead to antibody formation
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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
Q

treatment if bleeding in DIC

A
  • provide blood products
  • and treat underlying cause
  • anticoagulation (if clotting lots - outweighs the risk of bleeding)
26
Q

if bleeding what type of fluid would you give?

A
  • isotonic NS but need to check electrolyte levels first
27
Q

how to treat underlyign cause for DIC

A
  • sepsis - antibiotics
  • shock syndromes
  • massive traumas
  • neoplams
  • liver disease
28
Q

what to consider when working with a patient who has ITP, HIT ir DIC

A
  • 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
Q

indication for use of whole blood

A
  • large volume loss (hemorrhages)
  • increase O2 carrying capacity, restores blood volume, and homeostasis
30
Q

what to watch for when giving whole blood

A
  • blood types,
  • Rh factor
  • transfusion reaction/ allergies
  • fluid overload
31
Q

what is the use for packed WBC

A
  • low hemoglobin
  • severe of symptomatic anemia
  • increase O2 carrying capacity
  • replace 500CC of blood loss
  • low chance of fluid overload, and allergies
32
Q

what is the use for platelet transfusions

A
  • platelet function abnormalities
  • low P count
  • corrects low P counts
  • aids in clotting
  • watch for reaction/allergy
33
Q

what is the use for fresh frozen plasma?

A
  • deficiency of plasma coagulation factors (TTP)
  • risk: respiratory distress, fluid overload, reactions
34
Q

why give albumin trasnfusions?

A
  • volume expansion
  • third spacing (moves fluid from interstitial to vascular)
  • septic patients
  • liver failure
35
Q

what to watch for when giving albumin

A
  • hypotension, flushing
  • nausea, fever
36
Q

what could an allergic reaction look like and how to intervene?

A
  • flushing/itching -> bronchospasm, hypotension, shock, arrest
  • intervention -> stop transfusion, give antihistamine or epinephrine
37
Q

signs and symptoms of circulatory overload

A
  • respiratory distress
  • tachycardia
  • high BP
  • pulmonary edema/peripheral edema
38
Q

interventions for circulatory overload

A
  • upright positioning
  • diuretics/lasix
  • O2 therapy
  • spironolactone (if hypokalemia)
  • vasodilator and nitro to reduce venous return (preload)

331 Quiz 2 (8 decks)

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