Transfusion and coagulopathies

Question 1

Etiology of spherocytes

Answer 1

Autoimmune or drug-induced hemolysis

Question 2

Etiology of shistocytes

Answer 2

MAHA

Question 3

Etiology of bite cells

Answer 3

G6PD deficiency

Question 4

transfusion threshold for most patients

Answer 4

< 7

Question 5

Should you transfuse multiple units of PRBC’s in the ICU or just a single unit at a time?

Answer 5

Single

Question 6

Transfusion threshold for patients with active ACS

Answer 6

< 8

Question 7

Maximum hours of onset for symptoms of TACO

Answer 7

12 hrs

Question 8

Maximum hours of onset for symptoms of TRALI

Answer 8

6 hrs

Question 9

Main symptom difference between TACO and TRALI

Answer 9

Fever

Question 10

Platelet count required before neurosurgery or major major vascular surgery

Answer 10

100K

Question 11

Platelet count required for regular ICU procedures (thora, para, lines, etc)

Answer 11

20K

Question 12

Platelet transfusion threshold for most patients in the ICU

Answer 12

10K

Question 13

3 reasons to increase threshold for platelet transfusion to > 10K in the ICU

Answer 13

Fever/infection

Combined coagulopathy

Acute promyelocytic leukemia

Question 14

What percentage of coagulation factors must be replaced to allow patient to achieve coagulation ability?

Answer 14

20-30%

Question 15

Amount of FFP that will give 20-30% of factor repletion in the average patient?

Answer 15

10 - 15 ml/kg

Question 16

How many ml in 1 unit of FFP

Answer 16

250 ml

Question 17

Factors found in cryoprecipitate

Answer 17

Factors 13, fibrinogen, and VWf

Question 18

Enzyme deficiency in TTP that results in platelet aggregation

Answer 18

ADAMSTS13

Question 19

Treatment of choice for TTP

Answer 19

Plasma exchange/pheresis

Question 20

4 components measured on TEG

Answer 20

R, alpha angle, maximal amplitude, LY30

Question 21

R on TEG is equivalent to what lab?

Answer 21

PT INR

Question 22

Alpha angle on TEG is equivalent to what lab?

Answer 22

Fibrinogen

Question 23

Maximal amplitude on TEG measures what?

Answer 23

Strength of clot formation

Question 24

LY30 on TEG measures what?

Answer 24

Time to fibrinolysis

Question 25

TEG profile in a hypercoagulable patient

Answer 25

R low, alpha angle high, MA high

Question 26

TEG profile in a hypocoagulable patient

Answer 26

R high, alpha angle low, MA low

Question 27

Blood product to correct high R value on TEG

Answer 27

FFP

Question 28

Blood product to correct low alpha angle on TEG

Answer 28

Cryo

Question 29

Blood product to correct low MA on TEG

Answer 29

Platelets

Question 30

Anticoagulant that is a direct thrombin inhibitor

Answer 30

Dabigatran

Question 31

Half life of Dabigatran

Answer 31

14-17 hrs

Question 32

Half life of Rivaroxaban

Answer 32

5-19 hrs

Question 33

Half life of apixaban

Answer 33

8-15 hrs

Question 34

Half life of edoxaban

Answer 34

10-14 hrs

Question 35

Main mechanism of metabolism for the 4 NOACs

Answer 35

Apixaban - biliary/fecal

Dabigatran/Rivaroxaban/Edoxaban - renal

Question 36

Which of the 4 DOACs is not dialyzable (not bound to protein)

Answer 36

Dabigatran

Question 37

What is the antidote for Dabigatran

Answer 37

Idarucizumab

Question 38

What is the antidote for rivaroxaban on Apixaban

Answer 38

andexanet alfa

Question 39

Antidote to coumadin

Answer 39

4 factor protein complex with vitamin K

Question 40

Diagnosis from common TEG patterns

Answer 40

A - Normal

B - Anticoagulation

C - Platelet problem

D - Hyperfibrinolysis

E - Early DIC: Clotting phase

F - Late DIC: Bleeding phase