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Fluids, coags, transfusions > Prodigy- Hematology and Blood Products > Flashcards

Prodigy- Hematology and Blood Products Flashcards

1
Q

One gram of fully saturated hemoglobin can carry how man mL of o2?

A

1.34mls

if a person with a hgb of 15g/dL has 20.1ml of o2/dL of blood bound to hemoglobin (15 x 1.34)
If you ad the 0.3ml that is dissolved in blood, the total o2 is 20.4 (20.1 + 0.3)

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1
Q

One gram of fully saturated hemoglobin can carry how man mL of o2?

A

1.34mls

person with a hgb of 15

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2
Q

How is co2 carried in the blood?

A

90% transported in the blood in the form of bicarbonate ions

other 10% is bound + dissolved

CO2 + H20 > H2CO3 (carbonic acid); then dissociates into H+ and HCO3-

*CO2 is 20x more soluble in the blood

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3
Q

When o2 binds with hgb in the lungs, it promotes rlease of CO2 from the bloodstream - what is this effect called?

A

The Haldane effect

O2 + Hgb = release of CO2 from lungs

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4
Q

The first hemostatic response to a damaged blood vessel is what?

A

Vasoconstriction

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5
Q

Factor VII deficiency is an autosomal (dominate/recessive) disorder with a variablity in clinical severity

Pt’s with a (homo/hetero- zygous) genotype will have factor VII levels below 15%, making them more susceptible to sponanteous bleeding

what lab values are most notable in factor VII deficiency?

A

Prolonged PT (12-14)
Normal PTT (25-35)

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6
Q

Pts with severe deficiencys of what 3 factors will exhibit prolongation of both PT and PTT?

what can be used to treat all 3 of these?

A

II, V, X (FCP)

FFP

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7
Q

What factor deficiency affects appoximately 5% of Ashkenazi Jews of Eastern European decent?

lab values with this?

treatment of choice?

A

Factor XI

prolonged PTT, normal PT

FFP (factor XI concentrate not available in US)

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8
Q

How does vitamin K deficiency affect PT/PTT levels?

A

prolonged PT
normal PTT

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9
Q

Concerned with someone taking orlistat

A

coagulopathy due to vitamin K deficiency
prlolonged PT and normal PTT

(weight loss medicine)

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10
Q

How does hemophilia A affect PTT and PT

A

Signficiantly prolonged PTT and normal PT

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11
Q

Pts with hemophilia A- an infusion of DDAVP 30-90 minutes prior to incision will increase the level of factor 8 by what fold?

A

3-5 fold

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12
Q

how many liters of blood transfusion will it take to drop the platelet count to less than 100,000?

A

10-15 units

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13
Q

T/F - HELLP syndrome is generally an indication for immediately delivery of the fetus due to increased maternal morbidity and mortality

A

True

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14
Q

If someone has splenomeagly what are your first thoughts? (2)

A
  1. what are their platelets (platelet sequestration)
  2. Why do they have it? - portal HTN?
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15
Q

Thrombocytopenia is defined as a platelet count less than:

A. 150,000
B. 100,000
C. 75, 000
D. 50, 000

A

A.

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16
Q

PRBCs have a hematocrit of what?

A

55-60%

i think apex said 70% for both banked and salavaged but prodigy says hct 55-60% for PRBCs bc most of the plasma has been removed

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17
Q

Although several studies indicate that LR is acceptable to give with blood, why dont many practitioners use it?

A

bc it could preciptate clotting of the blood (Calcium = factor 4!)

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18
Q

Why shouldnt D5W be used with blood?

A

bc the RBCs would swell and eventually die

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19
Q

T/F- the Rh-type is not always matched for FFP

A

True bc the immune response to the Rh antigen is rarely from FFP transfusion

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20
Q

Rate of cryo transfusion

A

rapid - at least 200ml/hr

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21
Q

Acute Hemolytic Transfusion reaction is what kind of Ig-mediated reaction?

A

IgM

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22
Q

Which type of transfusion reaction will exhibit a positive Coombs test?

A

Acute Hemolytic (IgM)

23
Q

Post-Transfusion Purpura is a syndrome that occurs almost exlusively in what population?

first line tx?

A

pregnant females

IV immunoglobulin

24
Q

How would you differentiate anemia of chronic disease vs anemia from iron deficiency?

A

both have low transferrin levels but the transferrin saturation is normal in anemia of chronic disease

25
Q

What is a autosomal recessive defect that results in anemia that can produce to acute leukemia (2 names)

A

Congenital Aplastic Anemia
Fanconi anemia

26
Q

T/F- iron- deficency anemia is typically caused by poor iron intake

A

false - usually from loss of iron due to chronic blood loss (Gi tract/menstration)

27
Q

What is methemoglobinemia?

3 big players that cause it

treatment

A

an oxidized form of hemoglobin

(the iron is in its ferric state instead of its normal ferrous state)

lidocaine, prilocaine, and benozcaine

Methylene blue 1-2mg (max 7-8mg/kg)
85% pox , left shift in hgb curve

28
Q

When SpO2 levels are greater than 70%, methemoglobinemia produces an (over/underestimation of SaO2).

When SpO2 levels are < 70%, methemoglobinemiap roduces an (over/underestimation) of SaP2

A

> 70% = underestimation of SaO2
< 70% = overestimation of SaO2

opposite

29
Q

In developed countries, what is a key contributor to folate deficiency?

A

alcoholism (poor nutritional status)

30
Q

T/F - preop autologous donation is more effective when combined with erythropoietin

A

true - increases pt’s production of RBCs

31
Q

What is acute normovolemic hemodilution and why would it be done?

A

the removal of multiple units of blood from the patient right before surgery and replacement of the removed blood volume with crystalloid

The net effect is that any blood lost during surgery is diluted and has a lower hematocrit while the removed blood has a high hematocrit and high levels of platelets and clotting factors.

32
Q

Hemophilia B can be treated with
A. factor VIII concentrate
B. desmopressin and cryoprecipitate
C. factor IX concentrate
D. factor VII concentrate

A

C

33
Q

The extrinsic pathway of the hemostatic response is initiated by the release of a group of proteins known as
A. Tissue factor
B. Fibrinogen
C. Collagen
D. Proaccelerins

A

A

34
Q

Which form of thalassemia is most severe?
A. Thalassemia intermedia
B. All forms are roughly equal in severity
C. Thalassemia major
D. Thalassemia minor

A

C

35
Q

The first step in the intrinsic clotting pathway is the
A. release of tissue factor
B. binding of heparin to factor IX
C. formation of thrombin
D. activation of factor XII

A

D

36
Q

Which of the following conditions does not lead to an elevated hematocrit?
A. Chronic hypertension
B. Polycythemia
C. Dehydration
D. Sickle cell crisis

A

Not A - maybe B (bc thats what an elevated hct is called)

so note to self- elevated hematocrit can be from chronic HTN- volume contracted state
*i think its D

37
Q

Patients with von Willebrand disease bleed more readily due to
A. inactivation of platelet cyclooxygenase
B. Factor X deficiency
C. decreased factor VIII activity
D. inhibition of thromboxane A2 production

A

C

38
Q

Which of the following is a cause of polycythemia without an increase in total red cell mass?
A. Chronic lung disease
B. Hypoxia
C. Hypovolemia
D. Living at high altitude

A

Not D

39
Q

In the extrinsic coagulation pathway, disruption of the endothelium leads to exposure of tissue factor which binds to
A. prothrombin
B. factor VII
C. calcium
D. factor X

A

C

40
Q

Which of the following side effects is most likely to occur with the use of intraoperative blood salvage (cell saver)?
A. hyponatremia
B. air embolism
C. hyperkalemia
D. fluid volume overload

A

B

41
Q

Which of the following is false regarding disseminated intravascular coagulation?
A. The most common cause related to septic shock is gram-positive organisms
B. It may occur as a result of prolonged surgery
C. It may occur as a result of placenta previa
D. It may occur in association with tumor lysis syndrome

A

A

42
Q

Which blood disorder is due to bone marrow toxicity?
A. thalassemia
B. sickle cell anemia
C. acquired aplastic anemia
D. iron deficiency anemia

A

not A- C i think

43
Q

Once thawed, fresh frozen plasma may be stored refrigerated at 1-6 degrees Celsius for
A. 2-4 hours
B. 8-24 hours
C. 5 days
D. two weeks

A

C

44
Q

Cell saver blood
A. has a hematocrit of 35-40%
B. must be typed and cross-matched prior to administration
C. has a mild risk of transfusion reaction
D. is devoid of platelets and clotting factors

A

D

45
Q

What is the half-life of factor IX concentrate?
A. 1-2 hours
B. 48-72 hours
C. 18-24 hours
D. 4-6 hours

A

C

46
Q

The hematocrit of a unit of packed red blood cells is approximately
A. 75-80%
B. 55-60%
C. 35-40%
D. 15-20%

A

B

47
Q

A patient with hemophilia B is about to undergo orthopedic surgery. Which agent is most appropriate for decreasing the bleeding tendency of this patient?
A. factor IX-prothrombin complexes
B. packed red blood cells
C. purified factor IX
D. albumin

A

C

48
Q

Patients with factor VII deficiency will typically exhibit a
A. prolonged PT and normal PTT
B. normal PT and prolonged PTT
C. prolonged PT and prolonged PTT
D. normal PT and normal PTT

A

A

49
Q

In the intrinsic pathway, what is the component required to convert factor XII to factor XI?
A. Thrombin
B. Calcium
C. Prekallikrein
D. Prothrombin activator

A

C

50
Q

During preoperative assessment, a patient reveals a prolonged PT due to vitamin K deficiency. How long does it take for intravenous vitamin K to improve the PT?
A. 1-2 hours
B. 24-48 hours
C. 12-16 hours
D. 6-8 hours

A

D

51
Q

A patient with hemophilia A exhibits signs of bleeding tendency. What could you administer prior to surgery to decrease the risk of bleeding?
A. Factor IX concentrate
B. DDAVP
C. fibrinogen concentrate
D. packed red blood cells

A

B

52
Q

Which form of von Willebrand disease is the most severe?
A. Type one
B. Type three
C. Type two
D. Type zero

A

B

1- mild reduction in VwF
2- moderate reduction and/or body does not respond appropriately to it
3- severe/no production of VwF

53
Q

A patient with known factor X deficiency exhibits spontaneous bleeding. How much fresh frozen plasma would you typically need to administer to increase factor X levels by 20-30%?
A. 15-20 mL/kg
B. 5 mL/kg
C. 50-60 mL/kg
D. One unit

A

A

54
Q

Which concomitant condition is most closely associated with thalassemia?
A. acute chest syndrome
B. latex allergy
C. splenomegaly
D. polycythemia

A

C

an inherited blood disorder that causes your body to have less hemoglobin than normal.

55
Q

Which of the following increases in banked blood the longer it is stored?
A. ATP levels
B. potassium level
C. pH
D. 2,3 DPG

A

B

Fluids, coags, transfusions (5 decks)

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