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Heme/Onc > Hemostasis and Transfusion Therapy > Flashcards

Hemostasis and Transfusion Therapy Flashcards

1
Q

What is a typing?

A

Ensures ABO/Rh compatibility by determining the recipients blood ype. Ex) A-

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2
Q

What is an antibody screen?

A

Tests for unexpected antibodies in the recipient plasma

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3
Q

What is a cross match?

A

Tests the patient’s serum against the prospective unit of blood for reactivity

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4
Q

Why do we transfuse (3)?

A
  1. Replace acute blood loss
  2. Oxygen delivery
  3. Morbidity and mortality
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5
Q

Who do we transfuse?

A

Hgb <6 always
Hgb 6-7 Likely
Hgb 7-8 Yes in post-op patients
Hgb 8-10 No except symptomatic anemia, ongoing bleeding, ACS with ischemia
Hgb >10 Almost never

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6
Q

When do we assess post transfusion Hgb?

A

15 minutes after transfusion as long as the patient is not actively bleeding

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7
Q

How much does 1 unit increase the Hgb?

A

1 g/dL

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8
Q

What are the risks of transfusion (11)?

A
  1. Transfusion reactions (1/14,000)
  2. Febrile non-hemolytic reactions
  3. Allergic reactions (urticaria to anaphylaxis)
  4. Infectious complications (septic reactions, viral transmission. Hep B/C and HIV are 1/1,000,000)
  5. Transfusion Related Acute Lung Injury (1/10,000)
  6. Circulatory overload
  7. Transfusion associated graft versus host disease
  8. Post transfusion purpura
  9. Iron overload
  10. Hyperkalemia or other electrolyte toxicity
  11. Hypothermia
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9
Q

When do transfusion reactions occur?

A

During or within 24 hours of transfusion

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10
Q

What are the types of blood product transfusions (5)?

A
  1. whole blood
  2. packed red blood cells
  3. fresh frozen plasma
  4. cryoprecipitate
  5. platelets
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11
Q

What is the purpose of whole blood?

A

O2 carrying capacity and volume expansion
Used in massive hemorrhage, otherwise rare because storage issues where platelets become dysfunctional and clotting factors degrade, Hgb gains oxygen affinity

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12
Q

What is the purpose of packed red blood cells?

A

Most common use
Increases oxygen carrying capacity

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13
Q

What is the volume of a unit of PRBCs?

A

200 mL

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14
Q

What are leukocyte reduced PRBCs used for?

A

used to reduce risk of immunologically-mediated effects, infectious disease transmission, and reperfusion injury

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15
Q

What are irradiated PRBCs used for?

A

Avoid graft-versus host disease in immunodeficient patients

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16
Q

What are washed PRBCs used for?

A

Prevent/eliminate complications associated with infusion of proteins present in the small amount of residual plasma

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17
Q

What is contained in the plasma?

A

Platelets and proteins including procoagulant and anticoagulant factors

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18
Q

What is in FFP?

A

Coagulation factors, fibrinogen, antithrombin, albumin, protein C, and protein S

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19
Q

What is cryoprecipitate?

A

Von Willebrand factor, factor VIII, factor XIII, and fibrinogen
Advantageous because smaller volume

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20
Q

What are factor concentrates?

A

A large amount of a specific clotting factor either produced by recombinant technology or pooled from thousands of donors.

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21
Q

What are the criteria for platelet transfusion?

A

<10,000 everyone gets due to risk of hemorrhage
<50,000 transfuse if bleeding, procedure planned, or have qualitative intrinsic platelet disorder
<100,000 transfuse if there is a CNS injury, multisystem trauma, or undergoing neurosurgery
Transfuse anyone with a normal platelet count but active bleeding and a known platelet dysfunction

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22
Q

How much does one unit raise the platelet count?

A

5-10,000

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23
Q

What is the indication for protamine sulfate?

A

Heparin reversal agent

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24
Q

What is the dose of protamine sulfate determined by?

A

The dose of heparin given

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25
Q

What is the BBW for protamine sulfate?

A

Can cause severe hypotensive or anaphylactoid reactions

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26
Q

What is vitamin K used for?

A

Reversal of warfarin

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27
Q

What is the dosage of vitamin K dependent on?

A

The severity of bleeding and INR level

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28
Q

What is desmopressin (DDAVP) MOA?

A

Increases vWF, VIII, t-PA leading to a shortened aPTTT and bleeding time

Think von Willebrand disease and hemophilia A

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29
Q

What must you do alongside giving desmopressin?

A

Restrict fluids and monitor sodium due to possible hyponatremia

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30
Q

What is Topical Thrombin used for?

A

Aid in hemostasis of oozing blood during surgery

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31
Q

What is the MOA of topical thrombin?

A

Converts fibrinogen to fibrin at the site of bleeding

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32
Q

What are the three types of antithrombotic agents?

A
  1. antiplatelet drugs
  2. anticoagulants
  3. fibrinolytic agents
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33
Q

What is the MOA of heparin?

A

Binds to anti-thrombin (III) and enhances the inactivation of factor Xa and thrombin

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34
Q

Do you need to adjust heparin for renal patients?

A

No, it is hepatically metabolized

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35
Q

What determines the anticoagulant activity of heparin?

A

The levels of heparin binding proteins in the plasma, weight and fixed doses are not predictors

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36
Q

What test do we use to monitor heparin levels?

A

aPTT or anti-factor Xa level

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37
Q

How do we monitor patients on heparin for bleeding?

A

Daily CBCs, ask about stool

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38
Q

What are the adverse effects of heparin?

A

Bleeding
Thrombocytopenia
Osteoporosis
Elevated LFTs

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39
Q

What are the CI for heparin?

A

HIT, allergy, active bleeding, hemophilia, thrombocytopenia, purpura, HTN

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40
Q

What is HIT?

A

Heparin induced thrombocytopenia

Kills platelets but also creates hypercoaguable state

More common in females

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41
Q

What is HIT caused by?

A

neoantigen is formed on platelet surface causing IgG antibody immune response

42
Q

When does HIT occur?

A

5-10 days after heparin
any dose, any amount

43
Q

How to treat HIT?

A

Stop heparin and mark as allergy in chart
Do not give platelets
Start non-heparin anticoagulant
After recovery continue on warfarin for 2-3 months if no thrombosis and 3-6 months if thrombosis occured

44
Q

What is the brand name for low molecular weight heparin?

A

Lovenox

45
Q

What is the MOA of Lovenox?

A

Enhances the inhibition of factor Xa by AT III
Does NOT inhibit thrombin

46
Q

Can you use Lovenox in renal patients?

A

Dose adjust needed, do not use in ESRD

47
Q

What monitoring should you do for Lovenox?

A

None really but can do factor Xa levels, aPTT should be normal

48
Q

What are the adverse effects of Lovenox?

A

Bleeding, HIT, osteoporosis (all less so than heparin)

49
Q

If you have a pregnant patient, would Lovenox or heparin be better?

A

Lovenox

50
Q

What is the MOA of argatroban (Acova)?

A

selectively and reversibly binds to the active thrombin site of free and clot associated thrombin, thus inhibiting fibrin formation, activation of V, VIII, XIII, protein C and platelet aggregation

51
Q

What are the indications for argatroba?

A

HIT
percutaneous coronary intervention

52
Q

What is the MOA for bivaliruidin (Angiomax)?

A

reversibly binds to active thrombin site of free and clot associated thrombin

53
Q

What are the indications for bivalirudin (Angiomax)?

A

percutaneous coronary intervention with a h/o HIT

54
Q

What is the MOA for warfarin?

A

inhibits vitamin K oxide reductase complex subunit I, thus inhibiting factors II, VII, IX, and X

55
Q

How long does it take warfarin to take effect?

A

5-7 days

56
Q

When will a patient’s PT/INR change on warfarin?

A

36-72 hours

57
Q

What pregnancy category is warfarin?

A

X DONT USE. But can be used while breastfeeding

58
Q

What are the indications for warfarin?

A

prophylaxis and txt of thromboembolitic disorders/complications

59
Q

What are the adverse effects of warfarin?

A

Bleeding
Necrosis/gangrene (seen without bridge)

60
Q

Ethanol causes what effect on INR?

A

Acute increases but chronic decreases

61
Q

Vitamin E causes what effect on INR?

A

increases

62
Q

Cranberry juice causes what effect on INR?

A

increases

63
Q

What is the MOA of Pradaxa?

A

direct thrombin inhibitor

64
Q

What are the indications for Pradaxa?

A

stroke prevention in A-fib, DVT/PE (txt and prophylaxis)

65
Q

Is there renal adjustment?

A

Yes

66
Q

What medication reverses Pradaxa?

A

Praxbind

67
Q

What is the MOA of Xarelto?

A

Oral Factor Xa inhibitor

68
Q

What are the indications for Xarelto?

A

Stroke prevention in A-fib, PE/DVT txt and prophylaxis

69
Q

Is there renal adjustment?

A

yes

70
Q

What are the patient education points on Xarelto?

A

avoid in hepatic impairment
avoid grapefruit juice
avoid CYP3A4 inhibitors including fluroquinolones

71
Q

What reverses Xarelto?

A

AndexXa

72
Q

What is the MOA of Eliquis?

A

Reversible Oral Factor Xa inhibitor

73
Q

What are the indications for Eliquis?

A

A-fib and DVT/PE

74
Q

Is there a renal dose adjustment?

A

yes

75
Q

What reverses Eliquis?

A

AndexXa

76
Q

What is the MOA of edoxaban (Savaysa)?

A

Factor Xa inhibitor, selectively and reversibly blocks site of FXa without requiring a cofactor (antithrombin III) for activity

77
Q

What are the indications for edoxaban (Savaysa)?

A

A-fib, PE/DVT

78
Q

What condition needs a dose adjustment?

A

Reduce the dose for renal impairment and DO NOT USE with really good CrCl >95 mL/min

79
Q

What is the antidote for edoxaban (Savaysa)?

A

No antidote

80
Q

What is the MOA of Aspirin?

A

Irreversibly inhibits COX-1 and thus thromboxane A2

81
Q

What are the indications for Aspirin?

A

Prevention of MI, vascular events, vascular disease

82
Q

When should you take ASA in relation to NSAIDS?

A

60 minutes before or 8 hours after

83
Q

What are common adverse events from ASA?

A

GI bleeding
Dyspepsia
Allergies

84
Q

What is the MOA for Plavix?

A

Irreversibly binds and blocks ADP receptor (P2y12) inhibiting the ADP pathway of platelets. Requires metabolic activation (works 3-5 days)

85
Q

Do you need a dose adjustment for Plavix?

A

Not renal or hepatic no, does require a loading dose

86
Q

What drugs reduce plavix’s efficacy?

A

Omeprazole and esomeprazole

87
Q

What is the MOA for prasugrel (Effient)

A

Irreversibly binds and blocks ADP receptor (P2y12) inhibiting the ADP pathway of platelets. Requires metabolic activation (works in 2-4 hours)

88
Q

How long do the effects of prasugrel (Effient) last?

A

5-9 days

89
Q

What are contraindications for prasugrel (Effient)?

A

h/o TIA and CVA

90
Q

What is the MOA for ticlopidine (Ticlid)?

A

Irreversibly binds and blocks ADP receptor (P2y12) inhibiting the ADP pathway of platelets. Requires metabolic activation (works 3-5 days)

91
Q

What monitoring must be done for ticlopidine (Ticlid)?

A

CBC with diff every 2 weeks for 3 months

92
Q

What are the SE of ticlopidine (Ticlid)?

A

neutropenia, agranulocytosis, thrombotic thrombocytopenia purpura (TTP), and aplastic anemia

93
Q

What is the MOA of Ticagrelor (Brilinta)?

A

Reversibly binds and blocks ADP receptor (P2y12) inhibiting the ADP pathway of platelets. Does NOT require metabolic activation (works in 1-3 hours)

94
Q

How long do the effects of Ticagrelor (Brilinta) last?

A

3 days

95
Q

What is the BBW for ticagrelor (Brilinta)?

A

Do not use with >100 mg ASA daily 2/2 decreased effectiveness

96
Q

What is the MOA for cangrelor (Kengreal)?

A

Reversibly and non-competitively binds ADP receptor (P2y12) inhibiting the ADP pathway of platelets. Immediate onset of action within 3-5 minutes

97
Q

What are the indications for cangrelor (Kengreal)?

A

percutaneous coronary intervention (cath lab only)

98
Q

What is the MOA for TPA?

A

preferentially activates plasminogen that is bound to fibrin, which in theory confines fibrinolysis to the formed thrombus

99
Q

What are the indications for TPA?

A

Ischemic stroke within 3 hours, PE with hemodynamic instability, STEMI, DVT, ascending thrombophlebitis

100
Q

What is the MOA for steptokinase?

A

a protein produced by streptococci that combines with the proactivator plasminogen. The enzyme complex catalyzes the conversion of inactive plasminogen to active plasmin.

101
Q

What are the indications for streptokinase?

A

PE, STEMI, DVT, ascending thrombophlebitis.
Do not use for ischemic stroke.

Heme/Onc (10 decks)

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