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Principles & Practice II > P&P II Exam 2 > Flashcards

P&P II Exam 2 Flashcards

1
Q

Adhesion of Platelets Require?

A

von Willebrand’s (Factor 8, vWF:VIII)

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2
Q

Activation of Platelets Require?

A

Thrombin (Factor 2, II)

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3
Q

Aggregation of Platelets Require?

A

ADP and Thromboxane-A2

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4
Q

Platelet Lifespan

A

8-12days

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5
Q

Normal (PT)

Prothrombin Time

A

12-14 seconds

Coumadin / Extrinsic

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6
Q

Crosslinks Fibrin

A

Fibrin Stabilizing (Factor 13)

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7
Q

Normal Bleeding Time

A

3-10 minutes

Platelet Function

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8
Q

Normal (aPTT)

Partial Thromboplastin Time

A

25-35 seconds

Heparin / Intrinsic

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9
Q

Normal (ACT)

Activate Coagulation Time

A

150-180 seconds

Heparin / Intrinsic

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10
Q

Heparin Sites of Action

A

2a, 10a > 9, 11, 12

Antithrombin-III binds and increase 1,000 times

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11
Q

Coumadin Sites of Action

A

2, 7, 10

Vitamin-K: 2, 7, 9, 10

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12
Q

Normal Platelet Count

A

150,000-440,000mm3

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13
Q

Lifespan of Red Blood Cell

A

120 dyas

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14
Q

Determinant of Blood Viscosity

A

Hematocrit
Blood is (3) more viscous than water
Increase from 60-70% Hct causes 10x increase in blood viscosity

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15
Q

How does Aspirin affect clotting?

A

ASA inhibits platelet function for life 7-12days (irreversible)
NSAIDs inhibits platelet function for 24-48hrs (reversible)

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16
Q

What Clotting Factors from the Liver?

A

ALL except - Thromboplastin (3), Calcium (4), von Willebrands (8)

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17
Q

Vitamin-K Clotting Factors

A

2, 7, 9, 10

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18
Q

(2) Components of Factor-8

A

von Willebrand’s (VIII:vWF) and Anti-Hemophilic (VIII:c)

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19
Q

What is the significance of factor VIII:vWF

A

von Willebrand’s is release form endothelial cells, and is needed for platelet ADHESION. Also releases VIII:c

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20
Q

Which clotting factor is not a protein?

A

Calcium (4)

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21
Q

What breaks Fibrin down?

A

Plasmin digest fibrin. Plasmin is formed from tPA

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22
Q

Fresh Frozen Plasma (FFP)

Contains what factors?

A

ALL clotting factors accept platelets

(5) and (8) are the most abundant

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23
Q

Must (FFP) be ABO compatible

A

YES, requires ABO-compatibility

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24
Q

How long does FFP increase PT?

A

12-18hrs - then patient returns to baseline

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25
Q

What coagulation factors are in Cryoprecipitate

A

1 (fibrinogen), 8 (vWF), 13 (Fibrin Stabilizing)

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26
Q

Most common INHERITED bleeding disorder?

A

1st: Von Willebrand’s Disease (not enough VIII:vWF)
2nd: Hemophilia-A (not enough VIII:c)

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27
Q

Treatment for Von Willebrand’s Disease

A

1st: DDAVP 0.3mcg/kg over 15minutes
2nd: Crypoprecipitate

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28
Q

(4) Disorders of Thrombocytopenia

A
  1. Chemotherapy or Cancer
  2. Liver disease
  3. DIC
  4. Pre-eclampsia
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29
Q

Best way of evaluating bleeding?

A

Patient medical history

30
Q

Significant Bleeding Platelet Count

A

<50,000mm3 (cancel surgery or transfuse)

31
Q

Spontaneous Bleeding Platelet Count

A

<20,000mm3

32
Q

Lab Test for Aspirin

A

Bleeding Time (ASA impair platelets for life 8-12 days)

33
Q

D5W can cause?

A

Cerebral edema and increased ICP

34
Q

Max Dose of Hetastrach (Hespan)

A

20mL/kg/day; or

1,500mL

35
Q

Which blood substitute can alter amylase levels?

A

Hetastarch

36
Q

Indications for Dextran 40

A

To improve blood flow by decreasing blood viscosity (used in vascular surgery)

37
Q

Most Frequent Infection with Transfusion

A 
Viral Hepatitis (either B or C) 
Pick "C" if both options present
38
Q

Which blood product has greatest risk of Hepatitis

A

Cryprecipitate, because it’s pooled from several donors

39
Q

Cryoprecipitate is derived from what?

A

Skimmed from the thawing of FFP at 4 C

40
Q

Which is better? Homologous or Autologous

A

Autologous (self-donation)

41
Q

Which blood produce has NO risk of virus?

A

Albumin, it’s heated to 60 C for 10hrs. Also called salt-poor albumin

42
Q

Why not use Lactated Ringers with PRBCs

A

The calcium in LR can cause clotting

43
Q

CPDA Preservative

A

Citrate (anticoagulant), Phosphate (buffer), Dextrose (energy), Adenosine (ATP synthesis)
35 day shelf life

44
Q

(8) Changes in stored blood

A
  1. Cellular debris (microaggregates)
  2. Decrease pH (lactate, CO)
  3. Decreased calcium (chleated by citrate)
  4. Decrease 2, 3-DPG (causes LEFT-SHIFT / HYPOXEMIA)
  5. Increased potassium (lysis)
  6. Increased lactate (anaerobic metabolism)
  7. Increased hemoglobin (PRBCs are concentrated 60-80% Hct)
  8. Increased CO2
45
Q

(4) Substances Increase in Stored Blood

A
  1. CO2
  2. Lactate
  3. Potassium
  4. Hemoglobin
46
Q

Minimum Hemoglobin for surgery?

A

Healthy people >7g/dL

Sick people 7-10g/dL

47
Q

Minimum Hematocrit for surgery?

A

20% Hct

48
Q

Estimating Blood Volume

A 
Premature: 100mL/kg 
Full-Term: 90mL/kg
Infant: 80mL/kg
Men: 75mL/kg
Women: 65mL/kg
49
Q

Unknown blood type gets what blood?

A

O negative

50
Q

(6) Complications of Massive Transfusion

A
  1. Citrate toxicity (tx. Calcium)
  2. Metabolic ALKALOSIS
  3. Coagulation abnormalities (dilutional thyrombocytopenia)
  4. Hypothermia
  5. Transfusion Reactions
  6. Electrolyte Disturbance (Hypo-Ca, Hyper-K, Hyper-NA)
51
Q

What is a massive transfusion?

A

> 10 units of whole blood or (1) complete blood volume in 24hrs

52
Q

If patient gets large amount of blood and FFP but still bleeding what’s the problem?

A

Dilutional Thyrombocytopenia (tx. Platelet transfusion)

53
Q

(4) Most commonly given blood products

A
  1. PRBCs
  2. Platelets
  3. FFP
    4 Cyroprecipitate
54
Q

Major problem of blood transfusion?

A

Viral Hepatitis

55
Q

Treatment for prolonged bleeding time?

A

Platelets (normal 3-10min)

56
Q

What (2) products increase factor-8

A

FFP (all) and Cryprecipitate (1, 8 ,13)

57
Q

170 Filter removes?

A

170 allows platelets
>170 removes platelets
20-40 removes agregates and firbin strands

58
Q

What is the mandatory filter size for blood?

A

170

59
Q

Microaggregates of platelets and leukocytes accumulate after how many days of storage?

A

3-5days

60
Q

(1) unit of platelet increases count by?

A

5,000-10,000mm3

61
Q

Treatment of Dilutional Coagulopathy

A

FFP and Platelets

62
Q

What signals a febrile reaction?

A

Increase in temp by 1 C

Stop transfusion and give Tyelnol

63
Q

Appearance of Hives while getting blood indicates?

A

Allergic reaction

64
Q

HIT and protamine sulfate?

A

DO NOT give protamine in patient’s with suspected HIT

Can cause allergic reaction

65
Q

Patient is bleeding postoperatively comes back to OR, what do we do?

A
  1. Large bore IV
  2. Rehydrate
  3. Check coagulation factors
66
Q

Most common adverse reaction to blood transfusion?

A

Febrile reaction

67
Q

What can happen to plasma calcium with massive transfusion?

A

Hypocalcemia (Ca binds with citrate)
Occurs when transfusion >500mL/min
Metabolic Alkalosis, Hypocalcemia, prolonged-QT, hypotension, decrease CO, narrow pulse pressure

68
Q

What might you need to give to patients with massive blood transfusions?

A

Calcium

69
Q

(5) signs of HEMOLYTIC REACTION in ANESTHETIZED patients

A
  1. Hemoglobinuria (hematuria) - FIRST SIGN
  2. Bleeding diathesis
  3. Tachycardia (unexplained)
  4. Hyperthermia
  5. Hypotension (unexplained)
70
Q

Treatment of HEMOLYTIC REACTION

A

Stop blood, support BP, maintain urine/kidneys with fluids and diuresis

71
Q

Immediate Tests for Hemolytic Reaction

A
  1. Visual check for hemoglo binemia

2. Direct antiglobulin (Coombs test)

72
Q

What is acute normovolemic hemodiluation?

A

removal of blood from surgical patient and replacement with cellular fluid. blood will be returned later as needed

Principles & Practice II (1 decks)

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