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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
What coagulation factors are in Cryoprecipitate
1 (fibrinogen), 8 (vWF), 13 (Fibrin Stabilizing)
26
Most common INHERITED bleeding disorder?
1st: Von Willebrand's Disease (not enough VIII:vWF) 2nd: Hemophilia-A (not enough VIII:c)
27
Treatment for Von Willebrand's Disease
1st: DDAVP 0.3mcg/kg over 15minutes 2nd: Crypoprecipitate
28
(4) Disorders of Thrombocytopenia
1. Chemotherapy or Cancer 2. Liver disease 3. DIC 4. Pre-eclampsia
29
Best way of evaluating bleeding?
Patient medical history
30
Significant Bleeding Platelet Count
<50,000mm3 (cancel surgery or transfuse)
31
Spontaneous Bleeding Platelet Count
<20,000mm3
32
Lab Test for Aspirin
Bleeding Time (ASA impair platelets for life 8-12 days)
33
D5W can cause?
Cerebral edema and increased ICP
34
Max Dose of Hetastrach (Hespan)
20mL/kg/day; or | 1,500mL
35
Which blood substitute can alter amylase levels?
Hetastarch
36
Indications for Dextran 40
To improve blood flow by decreasing blood viscosity (used in vascular surgery)
37
Most Frequent Infection with Transfusion
``` Viral Hepatitis (either B or C) Pick "C" if both options present ```
38
Which blood product has greatest risk of Hepatitis
Cryprecipitate, because it's pooled from several donors
39
Cryoprecipitate is derived from what?
Skimmed from the thawing of FFP at 4 C
40
Which is better? Homologous or Autologous
Autologous (self-donation)
41
Which blood produce has NO risk of virus?
Albumin, it's heated to 60 C for 10hrs. Also called salt-poor albumin
42
Why not use Lactated Ringers with PRBCs
The calcium in LR can cause clotting
43
CPDA Preservative
Citrate (anticoagulant), Phosphate (buffer), Dextrose (energy), Adenosine (ATP synthesis) 35 day shelf life
44
(8) Changes in stored blood
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
(4) Substances Increase in Stored Blood
1. CO2 2. Lactate 3. Potassium 4. Hemoglobin
46
Minimum Hemoglobin for surgery?
Healthy people >7g/dL | Sick people 7-10g/dL
47
Minimum Hematocrit for surgery?
20% Hct
48
Estimating Blood Volume
``` Premature: 100mL/kg Full-Term: 90mL/kg Infant: 80mL/kg Men: 75mL/kg Women: 65mL/kg ```
49
Unknown blood type gets what blood?
O negative
50
(6) Complications of Massive Transfusion
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
What is a massive transfusion?
>10 units of whole blood or (1) complete blood volume in 24hrs
52
If patient gets large amount of blood and FFP but still bleeding what's the problem?
Dilutional Thyrombocytopenia (tx. Platelet transfusion)
53
(4) Most commonly given blood products
1. PRBCs 2. Platelets 3. FFP 4 Cyroprecipitate
54
Major problem of blood transfusion?
Viral Hepatitis
55
Treatment for prolonged bleeding time?
Platelets (normal 3-10min)
56
What (2) products increase factor-8
FFP (all) and Cryprecipitate (1, 8 ,13)
57
170 Filter removes?
170 allows platelets >170 removes platelets 20-40 removes agregates and firbin strands
58
What is the mandatory filter size for blood?
170
59
Microaggregates of platelets and leukocytes accumulate after how many days of storage?
3-5days
60
(1) unit of platelet increases count by?
5,000-10,000mm3
61
Treatment of Dilutional Coagulopathy
FFP and Platelets
62
What signals a febrile reaction?
Increase in temp by 1 C | Stop transfusion and give Tyelnol
63
Appearance of Hives while getting blood indicates?
Allergic reaction
64
HIT and protamine sulfate?
DO NOT give protamine in patient's with suspected HIT | Can cause allergic reaction
65
Patient is bleeding postoperatively comes back to OR, what do we do?
1. Large bore IV 2. Rehydrate 3. Check coagulation factors
66
Most common adverse reaction to blood transfusion?
Febrile reaction
67
What can happen to plasma calcium with massive transfusion?
Hypocalcemia (Ca binds with citrate) Occurs when transfusion >500mL/min Metabolic Alkalosis, Hypocalcemia, prolonged-QT, hypotension, decrease CO, narrow pulse pressure
68
What might you need to give to patients with massive blood transfusions?
Calcium
69
(5) signs of HEMOLYTIC REACTION in ANESTHETIZED patients
1. Hemoglobinuria (hematuria) - FIRST SIGN 2. Bleeding diathesis 3. Tachycardia (unexplained) 4. Hyperthermia 5. Hypotension (unexplained)
70
Treatment of HEMOLYTIC REACTION
Stop blood, support BP, maintain urine/kidneys with fluids and diuresis
71
Immediate Tests for Hemolytic Reaction
1. Visual check for hemoglo binemia | 2. Direct antiglobulin (Coombs test)
72
What is acute normovolemic hemodiluation?
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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