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Surgical Recall > Chapter 18: Blood and Blood Products > Flashcards

Chapter 18: Blood and Blood Products Flashcards

1
Q

PT

A

Prothrombin Time: Tests extrinsic coagulation pathway

PT; Play Tennis→you play tennis OUTSIDE (EXTRINSIC)

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2
Q

PTT

A

Partial Thromboplastin Time: Tests intrinsic coagulation pathway

PTT; Play TABLE Tennis→you play table tennis inside (INTRINSIC)

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3
Q

INR

A

International Normalized Ratio (reports PT results)

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4
Q

Packed red blood cells (PRBCs)

A
  • One unit equals ≈300 mL (±50 mL); no platelets or clotting factors
  • can bemixed with NS to infuse faster
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5
Q

Platelets

A

Replace platelets with units of platelets (6 to 10 units from single donor orrandom donors)

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6
Q

Fresh frozen plasma (FFP)

A

Replaces clotting factors; (no RBCs/WBCs/platelets)

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7
Q

Cryoprecipitate (cryo)

A

Replaces fibrinogen, von Willebrand factor (vWF), and some clotting factors

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8
Q

Which electrolyte is most likely 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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9
Q

What changes occur in the storage of PRBCs?

A

↓Ca+, ↑K+, ↓2,3-DPG, ↑H+ (↓pH), ↓PMNs

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10
Q

What is the rough formula for converting Hgb to Hct?

A

Hgb × 3 = Hct

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11
Q

One unit of PRBC increases Hct by how much?

A

≈3% to 4%

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12
Q

What is a type and screen?

A

Patient’s blood type is determined and the blood is screened for antibodies; a type and cross from that sample can then be ordered if needed later

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13
Q

What is a type and cross?

A

Patient’s BLOOD is sent to the blood bank and cross-matched for specific donor units for possible blood transfusion

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14
Q

What is thrombocytopenia?

A

Low platelet count (<100,000)

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15
Q

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

A

DDAVP (desmopressin)

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16
Q

What common medication causes platelets to irreversibly malfunction?

A

Aspirin (inhibits cyclooxygenase)

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17
Q

What is Plavix®?

A

Clopidogrel—irreversibly inhibits platelet P2Y12 ADP receptor (blocks fibrin crosslinking of platelets)

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18
Q

What platelet count is associated with spontaneous bleeding?

A

<20,000

19
Q

What should the platelet count be before surgery?

A

>50,000

20
Q

When should “prophylactic” platelet transfusions be given?

A

With platelets <10,000 (old recommendation was 20,000)

21
Q

How to reverse the effect of Clopidogrel (Plavix®)?

A

No reversal known. Many treat with platelet transfusion

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 Lactated Ringer’s (LR)?

A

Calcium in LR may result in coagulation within the IV line (use NS)

24
Q

For how long can packed RBCs be stored?

A

≈6 weeks (42 days)

25
Q

What are the symptoms of a transfusion reaction?

A

Fever, chills, nausea, hypotension, lumbar pain, chest pain, abnormal bleeding

26
Q

What is the treatment for transfusion hemolysis?

A
  • Stop transfusion
  • provide fluids
  • perform diuresis (Lasix) to protect kidneys
  • alkalinize urine (bicarbonate)
  • give pressors as needed
27
Q

What component of the blood transfusion can cause a fever?

A

WBCs

28
Q

What is the transfusion “trigger” Hgb?

A

<7.0

29
Q

What is the widely considered “optimal” Hgb in a patient with ahistory of heart disease or stroke?

A

Focus Trial = Liberal (<10 Hgb) vs restrictive (<8 Hgb) Trigger = No difference in mortality or morbidity

30
Q

When should aspirin administration be discontinued preoperatively?

A

At 1 week because platelets live 7 to 10 days (must use judgment if patient is a trisk for stroke or MI; it may be better to continue and use excellent surgicalhemostasis in these patients)

31
Q

What can move the oxyhemoglobin dissociation curve to the right?

A
  • Acidosis
  • 2,3-DPG
  • fever
  • elevated PCO2

(to the right means greater ability torelease the O2 to the tissues)

32
Q

What is von Willebrand’s disease?

A

Deficiency of vWF and factor VIII:C

33
Q

What is used to correct von Willebrand’s disease?

A

DDAVP or cryoprecipitate

34
Q

What is the most common inherited hypercoagulable state?

A

Factor V Leiden (Think: LEiden = LEader)

35
Q

18-year-old woman in high-speed motorcycle collision with subdural hematoma and flail chest; platelets = 189,000; fibrinogen= 400, ionized calcium = 2.8; PT 23 (INR = 3.4); PTT = 35

A

FFP (fresh frozen plasma)

36
Q

44-year-old man involved in a fall from scaffolding going to theoperating room for exploratory laparotomy for significant free air on CT scan; platelets = 25,000; PT = 13.1; PTT = 38; fibrinogen =200

A

Platelets

37
Q

Patient s/p (status post) prostate resection develops diffuseoozing; platelets = 200,000; PT = 13; PTT = 39

A

Amicar® (epsilon-aminocaproic acid) (an antifibrinolytic)

38
Q

56-year-old woman 1 hour s/p CABG × 4 on bypass with continued mediastinal bleeding; surgeons confirm excellent surgical hemostasis; the patient is warm, platelets 178,000; PT =12.9; PTT = 78

A

Protamine

39
Q

67-year-old patient with liver failure and s/p fall in the operatingroom for an exploratory laparotomy; the patient developsprogressive oozing; the PT and PTT are normalized; platelets =300,000; fibrinogen = 49.7

A

Cryoprecipitate—provides fibrinogen

40
Q

Patient with liver failure and poor nutrition with elevated PT that isrefractory to multiple transfusions of FFP

A

Vitamin K, prothrombin complex concentrate (PCC)

41
Q

8-year-old boy with hemophilia A with spontaneous bruising and nose bleed

A

Factor VIII

42
Q

7-year-old boy with hemophilia B with large right knee

A

F9

43
Q

23-year-old woman with von Willebrand’s disease who develops bleeding complications

A

First try DDAVP; then cryoprecipitate prn

Surgical Recall (168 decks)

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