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Surgical Recall > SR 19 - Blood and Blood Products > Flashcards

SR 19 - Blood and Blood Products Flashcards

1
Q

Define - PT

A

Prothrombin time

Tests extrinsic coagulation pathway (Warfarin)

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2
Q

Define - PTT

A

Partial Thromboplastin Time

Tests intrinsic coagulation pathway (Heparin)

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3
Q

Define - INR

A

International normalized ratio (reports PT results)

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4
Q

Define - PRBC

A

Packed red blood cells
One unit - 300mL
No platelets or clotting factors
Can be mixed with NS to infuse faster
Remember - RBCs have the antigens - so O is the universal RBC donor (they have no antigens for plasma antibodies to react against)
-/+ only really matters for girls who still may get pregnant at some point

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5
Q

Define - FFP

A

Fresh frozen plasma
Replaces clotting factors
No RBCs, WBCs, platelets
Remember - plasma has the antibodies - so AB is the universal plasma donor (Since they both antigents, they cannot have AB antibodies swimming around in their blood)

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6
Q

Define - Cryoprecipitate

A

Replaces fibrinogen, von Willebrand factors, some clotting factors

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7
Q

Which electrolyte is most likel to fall with the infusion of stored blood? Why?

A

Ionized calcium

The citrate preservative used for the storage of blood binds serum calcium

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8
Q

What changes occur in the storage of PRBCs?

A 
Decreased Calcium
Decreased 2,3-DPG
Decreased pH
Decreased PMNs
Increased potassium
Increased hydrogen
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9
Q

What are generaly guidlines for blood transfusions?

A

Acute blood loss, history of CAD/COPD - Hb

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10
Q

Which blood type is the universal donor for PRBCs?

A

O negative

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11
Q

Which blood type is the universal donor for FFP?

A

AB

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12
Q

What is type and screen?

A

Determine blood type and screen for antibodies

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13
Q

What is type and cross?

A

Cross-matched with specific donor units for possible transfusion

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14
Q

Define thombocytopenia

A

Low platelet count

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15
Q

Common causes of thrombocytopenia in the surigcal patient?

A 
Sepsis
H2 blockers
Heparin
Massive transfusion
DIC
Antibiotics
Spurious lab value
Swan-Ganz catheter
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16
Q

What can be given to correct platelet dysfunction from uremia, ASA or bypass?

A

DDAVP (desmopressin)

Leads to increased levels of coagulation factor (F) VIII, von Willebrand factor (vWF), and tissue plasminogen activator

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17
Q

What common medication causes platelets to irreversibly malfunction?

A

ASA

Inhibits cyclooxygenase

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18
Q

What is Plavix?

A

Clopidogrel
Irreversibly inhibits platelet P2Y12 ADP receptor
Blocks fibrin crosslinking of platelets

19
Q

What platelet cout is associated with sponatneous bleeding?

A
20
Q

How high should the platelet count be before surgery?

A

> 50,000

21
Q

When should ‘prophylaxtic’ platelet transfusion be given?

A
22
Q

What is microcytic anemia ‘until proven otherwise’ in a man or postmenopausal woman?

A

Colon cancer

23
Q

Why not infuse PRBCs with LR?

A

Calcium in LR may result in coagulation within the IV line

Use NS

24
Q

How long can PRBCs be stored?

A

6 weeks (42 days)

25
Q

What is the most common cause of transfusion hemolysis?

A

ABO incompatibility as a result of clerical error

26
Q

What are the symptoms of a transfusion reaction?

A 
Fever
Chills
Nausea
Hypotension
Lumbar pain
Chest pain
Abnormal beleding
27
Q

What is the treatment for transfusion hemolysis?

A 
Stop transfusion
Profide fluids
Perform diuresis (with lasix) to protect kidneys
Alkalinize urine with bicarb
Pressors as needed
28
Q

What component of the blood transfusion can cause a fever?

A

WBCs

29
Q

What is the transfusion ‘trigger’ Hct in young healthy patients?

A

21%

30
Q

What is the ‘optimal’ Hct in a patient with a history of heart disease and stroke?

A

30%

31
Q

When should ASA administration be discontinued preoperatively?

A

1 week
Platelets live for 7-10 days
(Use clinical judgement if patient is at risk for MI or stoke, may be better to continue the ASA and use excelelent surgical hemostasis instead)

32
Q

What can move the oxyhemoglobin dissociation curve to the right?

A

Acidosis
2,3-DPG
Fever
Elvated Pco2

To the right means better unloading of O2 (Right = release)

33
Q

What is the normal life of RBCs?

A

120 days

34
Q

What is the normal life of platelets?

A

7-10 days

35
Q

What factor is deficient in hemophilia A? What coagulation study is elevated?

A

Factor VIII

PTT

36
Q

What is the preoperative treatment of hemophilia A?

A

Factor VIII infusion to 100%+ normal preoperative levels

37
Q

What factor is deficient in hemophilia B? Elevated coagulation study?

A

Factor IX

PTT

38
Q

What is von Willebrand’s disease? Elevated coagulation study?

A

Deficiency of vWF and factor VIII-C
Autosominal dominant
Bleeding time

39
Q

What is used to correct vWF deficiency?

A

DDAVP or cryoprecipitate

40
Q

What is the effect on the coagulation system if the patient has a deficiency in protein C, protein S, or antithrombin III?

A

A hypercoagulable state

41
Q

What is a ‘left shift’ on a CBC?

A

Juvenile polymorphonuclear leukocytes (bands)

42
Q

What is the most common inherited hypercoagulable state?

A

Factor V leiden

43
Q

What is Xigris?

A

Actived protein C

Which is used in severe sepsis

Surgical Recall (32 decks)

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