Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Hemostasis, Surgical Bleeding, & Transfusions > Flashcards

Hemostasis, Surgical Bleeding, & Transfusions Flashcards

1
Q

Define Hemostatic Process

A

Process involves interaction between blood vessel walls, platelets, & coagulation proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Initial Hemostasis Activity After Injury

A

Vasoconstriction
Platelets adhere to site of vascular injury
After adhesion, platelets release ADP causing platelet aggregation
Formation of white thrombus
Formation of permanent thrombus with fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Coagulation Pathway

A

Extrinsic: thromboplastin interacts with VII to covert X to Xa
Intrinsic: factors XII, XI, IX, & VIII to convert X to Xa
Common: X, V, II, & I; factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Deficiency of what factors causes bleeding?

A

Any EXCEPT XII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can reduce the effectiveness of clotting?

A

Hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Evaluation of a Bleeding Patient

A

Hx: OTC, ASA, clopidogrel (Plavix), warfarin (Coumadin)
Look for signs of bleeding disorder
Labs: platelets, PT, PTT, bleeding time, thrombin time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Signs of a Bleeding Disorder

A 
Splenomegaly
Hepatomegaly
Bleeding after dental procedures
Menses
Minor cuts
Family history of bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does a platelet count verify?

A

An adequate number of platelets are available in the circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a normal platelet value?

A

150,000-400,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some reasons for low platelets?

A

Cancer treatment
Meds: lasix, penicillins, sulfonamids, NSAIDs
Autoimmune disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does prothrombin time measure?

A

Ability of the blood to form stable thrombi

Extrinsic & common pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is a PT normally ordered?

A

Monitor warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define INR

A

Ratio of a patient’s PT to a normal (control) sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does a partial thromboplastin time (PTT) measure?

A

Adequacy of intrinsic & common pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is PTT most commonly used?

A

Unfractionated heparin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define Bleeding Time

A

Time from injury to cessation of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What may a prolonged bleeding time indicate?

A

Thrombocytopenia
Medication (ASA)
Von Willebrand disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does thrombin time evaluate?

A

Fibrinogen to fibrin conversion with an external source of thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What may a prolonged thrombin time indicate?

A 
Low fibrinogen levels
Abnormal fibrinogen
Fibrin & fibrinogen split products
Heparin
Blood or coagulation disorders
DIC Chronic liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Von Willebrand’s Disease Pathophysiology

A

Reduced factor VII activity & von Willebrand activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Main Site of Bleeding for Von Willebrand’s Disease

A

Mucocutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lab Results for Von Willebrand Disease

A

Prolonged PTT
Normal PT
Abnormal platelet function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of Von Willebrand Disease

A

Cryoprecipitate infusions

Desmopressin (DDAVP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pathophysiology of Hemophilia A

A

Reduced or absent factor VII activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Main Sites of Bleeding for Hemophilia A

A

Joints

Intramuscular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Lab Results of Hemophilia A

A

Prolonged PTT
Normal PT
Normal platelet function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of Hemophilia A

A

Purified factor VII products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Common People who get Hemophilia A

A

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Causes of Acquired Bleeding Disorders

A 
Advanced liver disease
Anticoagulation therapy
Acquired thrombocytopenia
Platelet-inhibiting drugs
Uremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Liver Disease as an Acquired Bleeding Disorder

A

Inability to synthesize proteins leads to decreased levels of prothrombin & factors V, VII, & X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What liver disorders may lead to clotting factor deficiencies?

A

Obstructive jaundice

Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Anticoagulation Therapy

A

Warfarin (Coumadin)

Heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

MOA of Warfarin (Coumadin)

A

Depression of clotting factors II, VII, IX, X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How can warfarin (Coumadin) be reversed in an emergency?

A

FFP

Vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MOA of Heparin

A

Increases speed of antithrombin III binds to & neutralizes factors IXa, Xa, XIa, XIIa, & thrombin

36
Q

Lab Results on Heparin

A

Prolonged PTT

Prolonged thrombin time

37
Q

How is heparin reversed?

A

Protamine sulfate

38
Q

3 Mechanisms of Acquired Thrombocytopenia

A

Decreased platelet production in bone marrow
Increased destruction of platelets in peripheral blood
Splenic pooling in enlarged spleen

39
Q

Examples of Acquired Thrombocytopenia

A 
ITP
DIC
Aplastic anemia
Cirrhosis
Platelets destroyed during surgery
Cell saver
40
Q

Platelet-Inhibiting Drugs

A

ASA
Clopidogrel (Plavix)
NSAIDs

41
Q

Medication-Associated Bleeding

A

Anticoagulants: warfarin, heparin
Platelet-inhibiting drugs: clopidogrel, ASA, NSAIDs
OTC meds: dong quai (angelica), garlic, giner, gingko biloba, ginseng, St. Johns wort

42
Q

How is intra-operative bleeding controlled?

A

Gelfoam
Surgicel
Floseal
Tisseel

43
Q

Reasons for Post-Op Bleeding During Surgery

A 
Poor hemostasis
Residual heparin
Shock
Altered liver function
Malnutrition
44
Q

Classification of Post-Op Bleeding

A

Primary
Reactive
Secondary

45
Q

Post-Op Bleeding: Primary

A

Occurs during operation

Monitor with drains post-op

46
Q

Post-Op Bleeding: Reactive

A

Occurs within 24 hours of operation

Hemorrhage-like reaction

47
Q

Post-Op Bleeding: Secondary

A

7-10 days post procedure

Erosion of the blood vessels: usually due to infection

48
Q

Define DIC

A

Intravascular coagulation & thrombosis that is diffuse instead of localized at the site of injury

49
Q

What does DIC result in?

A

Systemic deposition of platelet-fibrin micro thrombi that causes diffuse tissue injury

50
Q

Etiology of DIC

A 
Release of tissue debris into bloodstream after trauma or obstetric catastrophe
Endothelial damage to vascular wall
Hypotension
Operations with large blood loss
Burns
Sepsis
Transfusion reactions
51
Q

How is DIC diagnosed?

A

Diminished levels of coagulation factors & platelets

52
Q

Labs for DIC

A

Prolonged PTT & PT
Hypofibrinogenemia
Thrombocytopenia
Presence of fibrin & fibrinogen products

53
Q

Treatment of DIC

A

Remove precipitating factors
Cryoprecipitate
Platelet transfusion
FFP

54
Q

5 Types of Blood Transfusions

A 
Whole blood
Packed RBCs
Washed RBCs
Leukoreduced RBCs
Divided or pediatric unit RBCs
55
Q

Factors in Deciding When to Infuse

A 
Reason for anemia
Degree & acuity/chronicity of anemia
Underlying medical condition
Anticipated future transfusions
Hemodynamic instability
56
Q

How much does 1 unit of PRBCs raise the hematocrit & hemoglobin?

A

Hct: 3%
Hg: 1 g/dL

57
Q

What does FFP not contain?

A

RBC
Leukocytes
Platelets

58
Q

Indications for FFP

A

Coagulation factor deficiency with clinical bleeding

Need for invasive procedure

59
Q

Indications for Platelets

A

Patients with thrombocytopenia due to platelet dysfunction

60
Q

Complications with Blood Transfusions

A 
Metabolic derangements
Immunologic reactions
Infection complications
Volume overload
Pulmonary complications
61
Q

Most Common Metabolic Derangements with Blood Transfusions

A

Hypocalcemia
Hyper/hypokalemia
Hypothermia

62
Q

When are metabolic derangements usually seen with blood transfusions?

A

Large volume transfused

Older blood products

63
Q

How does hypocalcemia occur in blood transfusions?

A

Rapid rate of transfusion

64
Q

Presentation of Hypocalcemia

A 
Muscle tremors
ST prolongation
Delayed T waves
V-fib
Tachycardia
65
Q

When does hyperkalemia occur in blood transfusions?

A

Units of blood frozen longer than 35 days

66
Q

How does hypokalemia occur in blood transfusions?

A

After transfusion, potassium is taken up by the red cell

67
Q

How to prevent hypothermia in blood transfusions?

A

Multiple transfusions

Need to be placed in a warmer

68
Q

Types of Immunologic Reactions with Blood Transfusions

A 
Febrile reaction
Acute & delayed hemolytic reactions
Thrombocytopenia
Anaphylactic shock
Urticaria
Graft vs. host disease
Immune suppression
69
Q

Presentation of Febrile Reaction to Blood Products

A

Fever/chills

Tachycardia

70
Q

What can you pretreat a blood transfusion with to prevent a febrile reaction?

A

ASA
Antipyretics
Antihistamines
Leukocyte reduced RBCs

71
Q

What are hemolytic reactions generally caused by?

A

ABO incompatibility

72
Q

Presentation of Hemolytic Reactions

A 
Hot/cold flushing
Chest pain
Low back pain
Fever
Hypotension
Tachycardia
Hematuria
Acute renal failure
73
Q

Treatment of Hemolytic Reactions

A

Stop transfusion

Recheck blood

74
Q

When does a graft vs. host disease occur?

A

Immunosuppressed patients receive donor leukocytes

75
Q

Presentation of Graft vs. Host Disease

A 
Delayed reaction
Fever
Rash
Liver dysfunction
Diarrhea
76
Q

Prevention of Graft vs. Host Disease

A

Leukocyte-reduced RBCs

Irradiated RBCs

77
Q

Infectious Agents in Transfusion of Blood Products

A

Bacteria: usually platelets
Viruses: Hep B, Hep C, HIV
Parasites

78
Q

Presentation of Bacteria Infection with Blood Transfusion

A

Fever/chills
Tachycardia
Hypotension

79
Q

When do transfusion-related lung injuries usually occur?

A

Units transferred that contain plasma

80
Q

What is transfusion-related lung injury characterized by?

A

Pulmonary edema

81
Q

Treatment of Transfusion-Related Lung Injury

A

Supportive

Possibly intubation

82
Q

Define Massive Transfusions

A

10+ PRBCs in 24 hours
Patient’s total blood volume in 24 hours
1/2 patients blood volume in 1 hour

83
Q

Complications of Massive Transfusions

A 
Dilutional coagulopathy
Oxygen transport abnormalities
Electrolyte/acid-base derangements
Hypothermia
Disease transmission
ARDS
84
Q

Define Autologous Blood

A

Collection & re-infusion of a patient’s own blood

85
Q

Collection of Autologous Blood

A

Pre-surgical donation

Intra-operative cell saver

86
Q

Reasons for Autologous Blood

A

Fully compatible
No risk of transmission
Less dependent on blood bank
Patients with rare blood types

Surgery (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions