Hematology, Immunology & DIC Flashcards
What is TACO?
Transfusion Associated Circulatory Overload
What is TRALI?
Transfusion related acute lung injury
What are coagulation side effects of massive transfusions? Plt, Fibrinogen, PT&PTT levels
Coagulation disorder: decreased platelet and fibrinogen count.
Increased bleeding time and PT * PTT
What are metabolic derangement from massive blood transfusions? pH, temp, Ca, 2,3dpg shift
Metabolic Acidosis
Hypothermia
Calcium, ionized Ca decrease
Drop in 2,3 DPG left Shift
Citrate Intoxication
What’s the normal range of platelets?
150k-400k/mm^3
What is the life span of Platelets?
9-12 days, removed by liver & spleen if not consumed by clotting reactions.
When may you transfuse platelets?
ct<50k
DIC is a common physiologic response when what 3 damages occur? Remember possible etiologies of DIC doesn’t always lead to DIC.
- Tissue damage
- Platelet damage
- Endothelial Damage
What are the following like in DIC? Hgb, HCT, Platelet, PT&PTT, Fibrinogen, FDP/FSP, D Dimer
Decreased Hgb, HCT, Platelet, Fibrinogen (low at end process of DIC)
Increased FDP/FSP, D Dimer, Pt& PTT,
Treatment for DIC?
No definitive oen since DIC is typically secondary. Goal is to treat primary disorder. Stop the pain, decrease bleeding risk and transfusion therapy. Possibly vitamin K and heparin
What is HIT and what happens to the platelets?
Heparin induced thrombocytopenia. When antibodies are produced and attacks heparin and antigens on platelets. Platelet count drops 50% from baseline.
What is the treatment of HIT?
Stop heparin, and admin non heparin AC. Admin platelets ONLY if needed
What is Tumor Lysis Syndrome?
Acute metabolic imbalance that occurs 2nd to cancer cell death occuring 1-5 days after chemo/radiation.
What metabolic imbalance is caused in Tumor Lysis Syndrome? K, P, Ca, uremia, pH
Hyperkalemia, Hyperphosphatemia, hyperuricemia, hypocalcemia and acidosis.
hypoCA, think tumor dies and skeleton falls out
What are treatments of tumor lysis syndrome?
Pre treat with fluids.
Phosphate binding agents & allopurinol 48 hours prior to tx.
3L fluids tx/day
Monitor electrolytes
What is erythropoietin and what does it do?
It’s a hormone released from the kidneys and communicates with the bone marrow to make more RBCs
What are negative side effects of massive transfusions?
Metabolic acidosis, myocardial dysfunction, hypothermia, citrate intoxication and electrolyte abnormalities
What is idiopathic thrombocytopenic purpura?
Condition of low platelet count of unknown origin.
What is DIC?
Disseminated Intravascular Coagulation. It’s a secondary disorder from a primary pathophysiology state/disease. Presents as bleeding and thrombosis.
Life threatening condition that has a mortality rate of 50-80%.
Death Is Coming
DIC is over stimulation of clotting, leading to bleeding
What are normal H&H levels?
Hematocrit: >35% for females, >40 for males`
Hemoglobin: >12 g/L
What are S&S RBC transfusions?
Fever, Chills, Hypotension, Shock, Hematuria, Urticaria, SOB, Flank Pain, Rigor
What medications are used to treat a blood transfusion reaction? Think of what kind of reaction it is.
It’s for allergic reaction and to prevent inflammatory response from it. Treat with epinephrine, benadryl, tylenol, diuretics, steroids.
Why does citrate intoxication occur with RBC transfusions?
It’s a preservative in RBC. Too much citrate in the body will decrease the level of functional Ca available.
What’s the normal range of leukocytes?
4.5-11k
Read: Thrombopoietin stimulates the production of platelets and is stimulated by thrombocytopenia. What’s the normal range for platelets?
150-400k
How low would the platelet level have to be, before it’s considered thrombocytopenia?
<150k
What is idiopathic thrombocytopenic purpura?
A condition of low platelet of unknown origin.
What does thrombin do to fibrinogen?
Thrombin breaks fibrinogen to make fibrin for clotting.
What’s the role of the plasmin in the clotting cascade?
To help balance it out by breaking down clots. Plasmin is a major fibrinolytic.
Read pathophysiology of DIC
- Tissue damage occurs
- Healing/Clotting is stimulated
- Fibrinolytic mediators released
- Consumption exceeds synthesis
- Ability to clot is lost
- Fibrinolytics mediators “run a muck” and lyses all clots.
- High bleeding times occurs cuz clotting factors have been used up
*What’s the thought process behind using heparin to treat DIC?
That heparin may possibly break up the clotting, preventing the DIC processes. Unsure if heparin actually works yet. Data size too small.
What is also known as white clot syndrome?
HIT
** Trauma patient comes in. Why is admin of fluid/blood products important?
Even if pt is hemodynamically stable. tissues need to be perfused.
