Special populations

Question 1

Surgical complications

Answer 1

Infection
stress ulcer
multidrug resistance
sepsis
respiratory/cardiac complications

Question 2

Hyper acute rejection

Question 3

acute organ rejection

Question 4

chronic rejection

Answer 4

is a slowly progressive. It can take place over many years. The body’s constant immune response against the new organ slowly damages the transplanted tissues or organ.

Question 5

Rejection is confirmed by________ of suspected organ tissue

Answer 5

biopsy

Question 6

he goal of immunosuppression is to prevent graft rejection while minimizing infection and other side effects. The current initial (ie, for induction) immunosuppression regimens used in solid organ transplants usually consists of a

Answer 6

corticosteroid, a calcineurin inhibitor, and an antiproliferative agent.

Question 7

Corticosteroids (methylprednisone and prednisone)
Side effects:

Answer 7

mood changes, encephalopathy, hypertension, gastritis, hyperglycemia, hypokalemia, metabolic alkalosis, myopathy, and increased risk of infection.

Question 8

Calcineurin inhibitors
side effects

Answer 8

(cyclosporine & Tacrolimus (progaf))

Nephrotoxicity and neurotoxicity (tremors, headaches, dysarthria, neuropathies, delirium, cognitive impairment, somnolence, seizures, posterior reversible encephalopathy syndrome, and coma) remain the most important adverse side effects.

Question 9

________________increases neurotoxicity and magnesium replacement with the avoidance of hypomagnesemia is important in patients receiving calcineurin inhibitors.

Answer 9

Hypomagnesemia

Question 10

Anti-proliferative agent

Answer 10

Mycophenolate mofetil (Cellcept) and azathioprine (Imuran) are antimetabolite purine synthesis inhibitors.

Side effects include myelosuppression with leukopenia and thrombocytopenia and gastrointestinal symptoms including vomiting, ileus, and oral ulcers.

Question 11

Monoclonal antibodies (eg, basiliximab) side effects

Answer 11

block IL-2 receptors on activated T-lymphocytes thwarting their multiplication and expansion

Side effects: fever, headache, nausea, and noncardiogenic pulmonary edema.

Question 12

This medication is avoided in the early post transplant period due to delayed wound healing and should be avoided in patients with non healing wound infections.

Answer 12

Sirolimus (Rapamune)

Question 13

Define DIC

Answer 13

Disseminated intravascular coagulation is an acquired syndrome characterized by dispersed and uncontrolled activation of blood coagulation leading to intravascular fibrin formation

Question 14

DIC etiology

Answer 14

trauma, sepsis, malignancy, obstetric complications, intravascular complications

Question 15

DIC presentation

Answer 15

Presentation: Bleeding, petichiae, blood oozing from wound sites, IV lines. Organ dysfunction (kidney failure, liver disfunction, acute lung injury). Purpura fulminans (rare, life threatening)

Question 16

abnormal labs in DIC

Answer 16

prolonged PT/aPTT, low plasma fibrinogen, elevated d-dimer, reduced level of procoagulant factors (VII, X, V and II). Thrombocytopenia (acute DIC)

Question 17

treatment of DIC

Answer 17

Treat the underlying cause first in order to eliminate stimulus for ongoing coagulation and thrombosis

RBCs in severe bleeding

Platelet transfusion if < 50,000

FFP or Cryo- Patients with severe bleeding and prolonged PT or aPTT or fibrinogen level <50