Polytrauma + Transfusion (3)

Question 1

What is DIC?

Answer 1

• Pathological consumptive coagulopathy
  
  • activation of the coagulation and fibrinolytic systems
    
    • formation of micro thrombi in many organs, Widespread haemorrhage
    • consumption of the clotting factors and platelets & Thrombocytopenia, decreased fibrinogen, increased FDPs

Question 2

What are the functions of platelets?

Answer 2

• Platelets contribute to the hemostatic process in two ways:
  
  • Adhesive functions→ hemostatic plug.
  • Activating coagulation mechanisms.

Question 3

What is the precursor of platelets? How are platelets formed from bone marrow?

Answer 3

Megakaryocytes.

Question 4

What are the stages of hemostasis?

Answer 4

1. Vasoconstriction: smooth muscle contraction by local reflexes, thromboxane A2, serotonin
2. Platelet activation: adherence, aggregation → plug
3. ## Coagulation: intrinsic and extrinsic pathway → fibrinogen → fibrin
   • Because of liver affection.

Question 5

Why does a patient with liver cirrhosis a bleeding tendency?

Answer 5

Because of liver affection.

Question 6

What are the very late manifestations of HCV?

Answer 6

Cirrhosis and HCC.

Question 7

What activates intrinsic and extrinsic pathways?

Answer 7

• The intrinsic pathway is activated by vessel injury which leads to activation of factor 12.
• The extrinsic pathway is activated by tissue thromboplastin released by the damaged cells.

Question 8

How to test the intrinsic & Extrinsic pathway?

Answer 8

• APTT tests for intrinsic pathway.
• PT tests for extrinsic pathway and the common pathway.

Question 9

What are the different types of Hypersensitivity reactions?

Answer 9

Question 10

What is the percentage of white blood cells in Leukoreduced Packed RBC’s?

Answer 10

<5x10^6 cells/L

Question 11

What is the lifespan of RBC’s?

Answer 11

120 days

Question 12

What tests should be done before blood transfusion?

Answer 12

• ABO
• RH

Question 13

What is GXM?

Answer 13

• Group cross matching
• To test donor red cells against recipient serum to detect any potential incompatibility through which antibodies in recipient cause hemolysis to donor cells

Question 14

What is the antigen in cross matching?

Answer 14

ABO

Question 15

What are the stages of bone healing?

Answer 15

Question 16

What are the effects of prolonged immobility on bone?

Answer 16

Loss of bone density and increased risk of osteoporosis

Question 17

Why should an infected implant be removed?

Answer 17

Septic focus

Question 18

What is the first test to do in case of an infected wound?

Answer 18

Wound swab for culture and sensitivity

Question 19

What is PVL Staph aureus?

Answer 19

• Panton-Valentine leukocidin (PVL) is a cytotoxin produced by Staphylococcus aureus that causes leukocyte destruction and tissue necrosis.
• It is one of the β-pore-forming toxins. The presence of PVL is associated with increased virulence of certain strains (isolates) of Staphylococcus aureus. It is present in the majority of community-associated Methicillin Resistant Staphylococcus aureus.

Question 20

What is the effect of PVL cytotoxin?

Answer 20

PVL creates pores in the membranes of infected cells and is the cause of necrotic lesions involving the skin or mucosa, including necrotic hemorrhagic pneumonia.