HEME Flashcards
Factor common pathway and one drug acts here
factor 10
heparin anti-factor Xa
trigger of the extrinsic pathway
tissue thromboplastin outside of the vessel
trigger of the intrinsic pathway
collagen exposure
diseases of the intrinsic pathway
hemophilia A. and B.
how is factor XIII related to clot
measured by area clot stability
primary factor that pro time measures
factor VII
how dose deficiency in protein C and S. present
blood clots at young age
Minor risk factors create DVT
thrombus more commonly than factor V Leiden deficiency
workup for patient with multiple abortions
anticardiolipin antibody
findings with anticardiolipin antibody
only procoagulants screening test
multiple portions
Increase in PTT and procoagulant screening test positive the
major test positive with hemophilia A. and B.
PTT
percentage of hemophilia factor and needed for major Versus minor surgery
Cardiovascular, prostate, neurosurgery:
Greater than 100% x3 days
80%-100% x4-7 days
Greater than 50% for 8-14 days
Marjor:
80-100%
for 3 days then greater than 50% for next 7-11 days
minor:
greater than 50% for 3-7 days
description and interpretation of mixing study correction studies her lupus
normal serum added to patient
does not correct: Negative
does not correct is good
Corrects with normal plasma: Positive
most common hypocoagulable condition
von Willebrand’s disease
bleeding time up
( possible increase in PTT)
mechanism of von Willebrand disease
prevent factor VIII from activation
von Willebrand’s disease the does not correct with DDAVP
von Willebrand 3
missing factor endothelium
treatment of von Willebrand disease
cryoprecipitate
DDAVP
preop treatment of uremia
dialysis
DDAVP during surgery
treatment to reverse Coumadin right away and efficacy
FFP
six-hour efficacy
major mechanism of heparin
acts on thrombin
factor 10
heparin is toanti-factor Xa
what lab values his warfarin effect
PT elevated
possible effect also on PTT
Ribaroxaban
Xarelto
irreversible heparin-like mechanism
Dabigatran
Pradaxa
warfarin-like mechanism
Hyper homocystinemia Defined, severity, treatment
20 times more blood clots and any other hypercoagulable disease
Most dangerous
Treatment:
folic acid
B12
differential diagnosis with arterial thrombus and findings
hyper homocystinemia
HIT - have been induced thrombocytopenia
white clot-represent clumped platelets
prothrombin factor
II
thrombin factor
IIa
potential coagulopathy from prostate surgery
DIC
treatment DIC
Amicar
Aminocaproics acid
HIT time course
5-7 days from first exposure
mins - hrs from second exposure
Argatrobam mech
Leach
Shorter half-life
Liver cleared
blood product with highest infection rate
platelets
highest infection contaminant
How much does 6 pack race platelet count
sixpack 50,000
storage time of packed cells
the 42 days
increase hematocrit with one unit
3%
hematocrit with a hemoglobin of 7
21
factor 7a for trauma
no
Antithrombotic-intracranial bleed
Xigris indications
none
pulled for market
prevent clot from activated protein C
most common infection from transfusion
CMV
hepatitis C. risk transfusion
one-2 million
can test for antigen
hepatitis B risk transfusion
one-200,000
test for antiBODY
coagulation complications from antibiotics
protein C deficiency
Pro time
Extrinsic pathway
Liver disease coagulopathy
vitamin K
Viable
Prothrombin time
Complications with rapid protamine administration and use
heparin reversal
Can get anaphylaxis from sensitivity with prior use of NPH insulin
first blood consistent deficit with massive transfusion
decreased platelets
causes for symptoms of hypo-coagulation
current recommendations for massive transfusion ratio
1:1:1
1 unit PRBC (not 2)
1 (SIXpack) of platelets
1 FFP
cause of hypocalcemia with massive transfusion
citrate is bound with calcium
acid-base pathology with massive transfusion
ALKOalotic
citrate down to bicarbonate
result is similar to contraction alkalosis
separate issue from acidosis with massive blood loss
findings of contraction alkalosis
dehydration- hypovolemia- increased sodium retention- decreased potassium- responsive loss of hydrogen for exchange
needle stick protocol
test patient
2 agent antiretroviral if high viral load
use is alternative drugs from patient
coagulation finding with Bernard Soulier syndrome
congenital platelet dysfunction
GPIIb/IIIa
Storage pool disease
congenital platelet dysfunction
defect in granules storage
coagulation defect with mucosal bleeding epistaxis petechiae
platelet
preoperative platelet count goal for most surgeries and exception
most surgeries 50,000
Spinal surgery 100,000
hemophilia A. and B. laboratory abnormality
PTT
von Willebrand disease lab abnormality
increased (or norm) bleeding time
Possible increased PTT
factor VII deficiency Laboratory findings
PT elevated
heparin laboratory findings
PTT elevated
ow molecular weight heparin laboratory findings
PTT elevated
DIC laboratory findings
elevated:
PTT, PT, bleeding time
decreased:
Platelets
Fibrinogen
positive split products
liver disease coagulation laboratory findings
elevated:
PTT, PT bleeding time
Decrease: Platelets
Fibrinogen
lupus anticoagulant laboratory findings
elevated:
PTT*
PT +/-
bleeding time
decrease:
Platelets
Bernard-Soulier syndrome cause and laboratory findings, treatment
drugs:
Aspirin / NSAIDS
Ticlopidine
Clopidogrel
Mechanism:
GP IIB/IIIA Platelet dysfunction with
treatment: DDAVP aprotinin e-aminocaproic acid Platelet transfusion
vitamin deficiencies that can cause platelet decrease
B12
Folate
B12 also cause macrocytic anemia
treatment of cardiopulmonary bypass coagulation defect
platelets are chewed up
Treatment: DDAVP aprotinin e-aminocaproic acid Platelet transfusion
First choice of treatment for von Willebrand’s disease with elective scheduled surgery for optimization
DDAVP
Or
Von Willebrand factor concentrating factor VIII (Humate P)
or
Cryo
major:
50-100% 7-14 days
Minor:
greater than 50% one-3 days
Factor V deficiency preoperative optimization
FFP
OR
prothrombin complex concentrates
major colon
Greater than 50%
Didn’t greater than 30%
Minor:
Greater than 15%
prothrombin deficiency preoperative optimization
FFP
OR
prothrombin complex concentrates
treatment of hypofibrinogenemia
cryoprecipitate
constituents of cryoprecipitate and disadvantages
higher infectious risk than von Willebrand factor factor VIII concentrate
contained: Factor VIII Von Willebrand factor Fibrinogen Factor XIII
what is in fibrin sealant
fibrinogen
Thrombin
Factor 13
Huge for hemostasis
mechanism of e-Aminocaproic acid and Aprotinin
antibiotic fibriolytic agents
inhibit fibrinolysis by inhibiting plasmin activity or generation
mechanism desmopressin
releases of von Willebrand factor and factor VIII
Used for mild von Willebrand and factor VIII deficiency
Lepirudin
recombinant direct thrombin inhibitor
Used for heparin-induced thrombocytopenia
Monitor with PTT
Extremities by kidneys
Half lipoma 0.3 hours
NO REVERSAL AGENT
Bivalrudin
synthetic direct thrombin inhibitor
alternatives to heparin for cardiac procedures
no reversal agent
renal clearance
Argatroban
based on L-arginine
asked on thrombin
Usual kit
Half-life 40-50 minutes
Liver metabolized-sacrum Q4 50
NO REVERSAL AGENT TO THE
% blood volume is usually the trigger for transfusion and trauma
30%
advantage with local reduced PRBCs
prevent CMV infection and transplant patient
Review febrile reaction
Cardiac surgery patient
Hello immunization
Advantage of the washed PRBCs
prevention of allergic reactions
define massive transfusion requirement
greater than 10 units of PRBCs in 24 hours
how many units of PRBCs typically begins significant coagulopathy
10 units
BUT massive transfusion protocol is 111
other than CMV what is the most common virus transmitted in transfusion
hepatitis B
Workup for acute come office transfusion reaction
Stop transfusion
Fluids
Diuresis
Return units of blood bank with paperwork
Tests: Direct Coombs test Repeat crossmatch Hemoglobin anemia Hemoglobinuria BUN/creatinine Coagulation parameters LDH hepatic Hepatoblobin blood cultures
Most common nonhemolytic transfusion reaction
Febrile
Reaction to donor leukocyte or septic signs
protective and decremental effects of transfusion
renal transplant-improved allograft
Colon cancer increased recurrence only cancer this is not found in his the cervix
Increase multiorgan failure
Leukocyte reduction improved for cardiac surgery only
Though-
Decreased febrile, and decreased hemolytic anemia decreased see him the risk
FDA approved blood substitute available
no
whichever greater risk of diffuse endothelial damage and consumptive coagulopathy theblunt or penetrating trauma
blunt when compared to more localized penetrating trauma
effect of old blood and trauma patient’s
increased mortality greater than 14 days a storage
storage time of FFP
one year
FDA approved use for recombinant activated human factor VII a
hemophilia
