Transfusions and haemostasis Flashcards
RED CELL TRANSFUSION
i) what is given in major haemmorhage? what Hb level should be aimed for?
ii) name three acute risks of transfusion
iii) name three chronic risks of transfusion
i) major haemm - give group O Rh -ve
aim for Hb 7-9g/dL according to symptoms
ii) acute risk - fluid overload/pulm oedema, haemolytic incompatible blood reaction (fatal), non haem febrile or allergic reactions
iii) chronic risk - viral transmission, allosensitisation (formation of antibodies), iron overload causing haemosiderosis (tx with chelation therapy)
OTHER TRANSFUSION PRODUCTS
i) when is a plat transfusion given? (3)
ii) when is FFP + cryoppt given? (3) what is cryoppt risk in?
iii) what is the major haemmorhage protocol?
iv) when is octaplex given? what is it aka? what does it contain?
i) plats if on chemo and plat count is <10, if bleeding or to cover sx
ii) give in DIC and hepatic coagulopathy, used in major haemm protocol
CP is rich in fibrinogen
iii) MHP = 4 o-ve RC, 4 FFP, 2 cyro, 1 plts
iv) give octaplex to urgently reverse warfarin
aka prothrombin complex concentrate
contains vitamin K dep clotting factors II, VII, IX, X
INHERITED BLEEDING PROBLEMS - HAEMOPHILIA
i) which factor is deficient in haem A? which is deficient in haem B? which aka christmas disease
ii) what is the inheritance pattern for both types? what does this mean for who it mostly affects?
iii) what is the main symptom? when do most cases present? name three ways it can present?
iv) what classic feature of severe haemophilia is often seen? what happens if this is untreated?
v) name three things that are done to diagnose?
i) haem A = defic factor VIII
haem B = defic factor IX (xmas disease)
ii) X linked recessive - most are men (only need one abnormal X) but women need both X to be affected (both mum and dad)
iii) bleeding excessively in response to minor trauma or spontaneous haemmorage with no trauma
usually px in neonates or early childhood with intracranial haemm, haematomas or cord bleeding
iv) severe - spont bleeding into joints (haemoarthrosis) and muscles > can lead to joint damage and deformity
v) dx with bleeding scores, coagualation factor assays and genetic testing
HAEMOPHILLIA TX
i) how can affected clotting factors be replaced? which two situations may this be done? what complication can occur?
ii) name three things that can be done for acute episods or prevention of excess bleeding suring surgery? what does desmopressin stimulate?
i) replace deficient factor 8 or 9 with intravenous infusions - either prophylactically or in response to bleeding
complication - formation of antibodies against the clotting factor > tx is ineffective
ii) infusion of affected factor, desmopressin to stim VWF, antifibrinolytic such as tranexamic acid
VON WILLEBRAND DISEASE
i) what does it cause? what is the most common inheritance pattern? which clotting factor is low?
ii) what protein is deficient/malfunc? how many types are there? which is most severe?
iii) name three ways a patient may present? what else is very relevant?
iv) what is diagnosis based on? (3)
v) when is mx required? name three things that can be given?
vi) name four things that may be given to women that suffer from heavy periods due to iit? what can be done in severe cases?
i) causes abnormal bleeding - auto dominant
low facor VIII
ii) defic in von willebrand factor (glycoprotein)
three types - type 3 is most severe
iii) px with bleeding gums, nose bleeds, heavy periods, heavy bleeding during surgery
FH is very relevant
iv) dx based on hx of abnormal bleeding, FH and bleeding assess tools
v) doesnt require day to day tx but tx in response to major bleed or trauma
give desmopressin (stim VWF), VWF or factor VIII (infused with VWF)
give women tranexamic acid, mefanmic acid, norethisterone, COCP or mirena coil
may do hysterectomy if severe
ACQUIRED BLEEDING DISORDERS
i) name three iatrogenic causes? how is heparin reversed
ii) how can the liver be implicated?
iii) name three things that can cause a DIC
i) anticoagulats - warfarin and heparin (reverse with protamine)
anti plat agents
ii) hepatic coagulopathy - liver failure cant make clotting factors
iii) sepsis (meningococcal), cancer (met breast/prostate), obstetric eg pre eclampsia
ANTICOAGULANTS
i) how does warfarin work? how is it monitored? how is it reversed? is it safe in pregnancy? is it safe in renal failure?
ii) what must eGFR be to give LMWH sc? how is it dosed? is monitoring requred? is it safe in pregnancy? is it safe in renal failure?
iii) which type of heparin is used in renal failure? what is it reversed by?
iv) name a direct thrombin inhibitor? name an anti factor Xa? what umbrella do these fall under?
v) name two anti plats
i) prevents gamma carbox of factors II, VII, IV, X
monitor using INR (based on PT), reversed by vitamin K or octaplex if urgent
teratogenic in pregnancy but safe in renal fail
ii) LMWH requred eGFR >30
dosed by weight with no monitoring required
tinzaparin, enoxaparin
safe in pregnancy but not safe in renal fail
iii) use unfractionated heparin in low eGFR
monitor with APTT
safe in renal failure and reversed by protamine sulphate
iv) direct thrombin inhibitor = dabigatran
Xa inhibitors = rivarox, apix
v) aspirin, clopidogrel
THROMBOTIC DISORDERS
i) what two types of VTE should all patients be assesed for?
ii) name four risk factors for VTE
iii) which group of patients should be considered for thrombophilia screening?
iv) name three inherited thrombophilias? name one acquired
i) DVT and PE
ii) RF are surgery, cancer, pregnancy, hospitalisation, long haul flights
iii) consider screening in young patients who have unprovoked DVT/PEs
iv) inherited - factor V leiden, deficienes in anti thrombin/proteinC/protein S (anti coagulants)
acquired - anti phospholipid syndrome
ANTI PHOSPHOLIPID SYNDROME
i) what is it? name three clinical features
ii) name two antibodies that are implicated
iii) how is it treated? which two drugs are given in pregnancy?
i) autoimmune condition that increases risk of blood clots
ii) lupus anticoagulant and anti cardiolipin antibodies
iii) treat with warfarin to anti coagulate
LMW heparin and aspirin in pregnancy
ANTI PHOSPHOLIPID SYNDROME
i) what is it? name three clinical features
ii) name two antibodies that are implicated
iii) how is it treated? which two drugs are given in pregnancy?
i) autoimmune condition that increases risk of blood clots
ii) lupus anticoagulant and anti cardiolipin antibodies
iii) treat with warfarin to anti coagulate
LMW heparin and aspirin in pregnancy
