ITE Heme Flashcards
Hypothermia (increases/decreases) risk of bacterial infection compared to normothermic pts
increases
- hypothermia decreases regional blood flow, oxygen tension, and chemotaxis
Trauma triad of death
- Hypothermia
- Coagulopathy
- Acidosis
(Hyper/Hypo)ventilation increases the risk of citrate toxicity
Hyperventilation
_____ is more likely to cause citrate toxicity compared with other blood products bc more citrate is used
FFP
________ contains all clotting factors, fibrinogen, albumin, electrolytes, physiologic anticoagulants (prot C and S), and citrate
FFP
Recipients serum is mixed with commercially supplied RBCs containing selected antigens commonly implicated in hemolytic transfusion reactions
Antibody screen
Recipients serum is mixed with donor RBCs
Crossmatching
Recipients RBCs are mixed with commercially supplied anti-A and anti-B sera
ABO typing
- most important
- ABO incompatibility will cause hemolytic rxns
4 Ts of HIT
- Thrombocytopenia
- Timing of reduced plt count
- Presence of thrombosis
- Exclusion of oTher thrombocytopenia
Having a platelet count of > _____ is a risk factor for heparin resistance
300,000/mm^3
Heparin resistance is defined as an ACT of _____ after 500 U/kg of IV heparin has been administered
< 480
Antithrombin levels ____ of normal is a risk factor for development of heparin resistance
< 60% of normal
Treatment of heparin resistance
- supplemental heparin
- AT3
- FFP
_____ are separated from RRBCs mainly by centrifugation, and from leukocytes by leukocyte reduction filters
Platelets
*but small amounts of RBCs and leukocytes are still present in platelet concentrates and cause RH sensitization
______ is the most common blood product associated with TRALI
Plasma
Platelets lose their activity if ______ and should be stored at ____ deg C
refridgerated
20 deg C
If a pt develops contrast-induced nephropathy and continues to take metformin it can ________
accumulate to toxic levels resulting in lactic acidosis
Can metformin be continued through the perioperative period?
Yes
Anemia causes a (Right/Left) shift of oxygen hgb dissociation curve? This allows for (Higher/lower) hgb affinity to oxygen, which results in greater oxygen release into tissue.
Right shift
lower
*anemia is a disease state of low hgb. The oxygen extraction ratio is increased
The body compensates for anemia by (3)
- increasing CO
- redistributing flow to favor heart and brain
- oxygen extraction ratio is increased (R shift)
_______ is given to pts with Type 1 von willebrand disease (partial decrease in VWF) prior to surgery
desmopressin (DDAVP)
- increases release of von Willebrand factor from endothelial cells
________ is a common genetically inherited quantitative or qualitative dysfunction of von willebrand factor
Von willebrand disease
vWD is divided into 3 major categories:
- Partial quantitative deficiency (type I)
- Qualitative deficiency (type II)
- Total deficiency (type III)
_______ is given to pts with Type III von willebrand disease (total depletion) prior to surgery
vWF concentrate
- DDAVP has no effect
DDAVP trials are contraindicated in pts with type IIB von Willebrand Disease bc of _____ and ____
thrombocytopenia and thrombotic complications
by decreasing plt count
The anticoagulant response to enoxaparin (LMWH) can be monitored by measuring _____ activity
factor Xa activity
(LMWH/UFH) is suitable for outpt use
LMWH
- one or twice daily dosing
- more predictable level of ac
- does not need routine monitoring
Unfractionated heparin exerts its anticoagulation effects by _____
binding to and enhancing effects of AT3 by several thousand folds
*AT3 inactivates multiple coagulant factors, esp factor II (thrombin)
Most preferred way to reverse INR?
Prothrombin complex concentrate
- contains all Vit K dependent coag factors II, VII, IX, X (2790)
*more consistent and rapid than FFP
Warfarin MOA
interferes with hepatic synthesis of Vit K dependent coagulation factors II, VII, IX, X (2790), Protein C and S
Half life of warfarin
2-4 days
________ is the most common inherited bleeding disorder
Von Willebrand disease
Von willebrand factor is a protein that _____
assists platelets to adhere to sites of vascular injury
and stabilizes clotting factor VIII
What are all of the blood products that can be given to pts with von willebrand disease?
- VWF concentrates
- desmopressin (DDAVP)
- Cryoprecipitate
Cryoprecipitate contains what?
- Factor VIII
- VWF
- Factor XIII
- Fibrinogen
PTT measures the speed of clotting of the ______ pathway, which involves factors ______
intrinsic
I, II, V,
VIII, IX, X, XI, XII (89 11 13)
PT measures the speed of clotting of the ______ pathway, which involves factors ______
Extrinsic
I, II, V,
VII, X (710)
