Hematology, Immunology & DIC

Question 1

What is TACO?

Answer 1

Transfusion Associated Circulatory Overload

Question 2

What is TRALI?

Answer 2

Transfusion related acute lung injury

Question 3

What are coagulation side effects of massive transfusions? Plt, Fibrinogen, PT&PTT levels

Answer 3

Coagulation disorder: decreased platelet and fibrinogen count.
Increased bleeding time and PT * PTT

Question 4

What are metabolic derangement from massive blood transfusions? pH, temp, Ca, 2,3dpg shift

Answer 4

Metabolic Acidosis
Hypothermia
Calcium, ionized Ca decrease
Drop in 2,3 DPG left Shift
Citrate Intoxication

Question 5

What’s the normal range of platelets?

Answer 5

150k-400k/mm^3

Question 6

What is the life span of Platelets?

Answer 6

9-12 days, removed by liver & spleen if not consumed by clotting reactions.

Question 7

When may you transfuse platelets?

Answer 7

ct<50k

Question 8

DIC is a common physiologic response when what 3 damages occur? Remember possible etiologies of DIC doesn’t always lead to DIC.

Answer 8

1. Tissue damage
2. Platelet damage
3. Endothelial Damage

Question 9

What are the following like in DIC? Hgb, HCT, Platelet, PT&PTT, Fibrinogen, FDP/FSP, D Dimer

Answer 9

Decreased Hgb, HCT, Platelet, Fibrinogen (low at end process of DIC)

Increased FDP/FSP, D Dimer, Pt& PTT,

Question 10

Treatment for DIC?

Answer 10

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

Question 11

What is HIT and what happens to the platelets?

Answer 11

Heparin induced thrombocytopenia. When antibodies are produced and attacks heparin and antigens on platelets. Platelet count drops 50% from baseline.

Question 12

What is the treatment of HIT?

Answer 12

Stop heparin, and admin non heparin AC. Admin platelets ONLY if needed

Question 13

What is Tumor Lysis Syndrome?

Answer 13

Acute metabolic imbalance that occurs 2nd to cancer cell death occuring 1-5 days after chemo/radiation.

Question 14

What metabolic imbalance is caused in Tumor Lysis Syndrome? K, P, Ca, uremia, pH

Answer 14

Hyperkalemia, Hyperphosphatemia, hyperuricemia, hypocalcemia and acidosis.

hypoCA, think tumor dies and skeleton falls out

Question 15

What are treatments of tumor lysis syndrome?

Answer 15

Pre treat with fluids.
Phosphate binding agents & allopurinol 48 hours prior to tx.
3L fluids tx/day
Monitor electrolytes

Question 16

What is erythropoietin and what does it do?

Answer 16

It’s a hormone released from the kidneys and communicates with the bone marrow to make more RBCs

Question 17

What are negative side effects of massive transfusions?

Answer 17

Metabolic acidosis, myocardial dysfunction, hypothermia, citrate intoxication and electrolyte abnormalities

Question 18

What is idiopathic thrombocytopenic purpura?

Answer 18

Condition of low platelet count of unknown origin.

Question 19

What is DIC?

Answer 19

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

Question 20

What are normal H&H levels?

Answer 20

Hematocrit: >35% for females, >40 for males`
Hemoglobin: >12 g/L

Question 21

What are S&S RBC transfusions?

Answer 21

Fever, Chills, Hypotension, Shock, Hematuria, Urticaria, SOB, Flank Pain, Rigor

Question 22

What medications are used to treat a blood transfusion reaction? Think of what kind of reaction it is.

Answer 22

It’s for allergic reaction and to prevent inflammatory response from it. Treat with epinephrine, benadryl, tylenol, diuretics, steroids.

Question 23

Why does citrate intoxication occur with RBC transfusions?

Answer 23

It’s a preservative in RBC. Too much citrate in the body will decrease the level of functional Ca available.

Question 24

What’s the normal range of leukocytes?

Answer 24

4.5-11k

Question 25

Read: Thrombopoietin stimulates the production of platelets and is stimulated by thrombocytopenia. What’s the normal range for platelets?

Answer 25

150-400k

Question 26

How low would the platelet level have to be, before it’s considered thrombocytopenia?

Answer 26

<150k

Question 27

What is idiopathic thrombocytopenic purpura?

Answer 27

A condition of low platelet of unknown origin.

Question 28

What does thrombin do to fibrinogen?

Answer 28

Thrombin breaks fibrinogen to make fibrin for clotting.

Question 29

What’s the role of the plasmin in the clotting cascade?

Answer 29

To help balance it out by breaking down clots. Plasmin is a major fibrinolytic.

Question 30

Read pathophysiology of DIC

Answer 30

1. Tissue damage occurs
2. Healing/Clotting is stimulated
3. Fibrinolytic mediators released
4. Consumption exceeds synthesis
5. Ability to clot is lost
6. Fibrinolytics mediators “run a muck” and lyses all clots.
7. High bleeding times occurs cuz clotting factors have been used up

Question 31

*What’s the thought process behind using heparin to treat DIC?

Answer 31

That heparin may possibly break up the clotting, preventing the DIC processes. Unsure if heparin actually works yet. Data size too small.

Question 32

What is also known as white clot syndrome?

Answer 32

HIT

Question 33

** Trauma patient comes in. Why is admin of fluid/blood products important?

Answer 33

Even if pt is hemodynamically stable. tissues need to be perfused.