Blood and Blood Products, Chapter19 P124-128

Question 1

Define the following terms:
PT
P124

Answer 1

Prothrombin Time: Tests extrinsic coagulation pathway

Question 2

Define the following terms:
PTT
P124

Answer 2

Partial Thromboplastin Time: Tests intrinsic coagulation pathway

Question 3

Define the following terms:
INR
P124

Answer 3

International Normalized Ratio (reports PT results)

Question 4

Define the following terms:
Packed red blood cells (PRBCs)
P124

Answer 4

One unit equals 300 ml (50 ml); no platelets or clotting factors; can be mixed with NS to infuse faster

Question 5

Define the following terms:
Platelets
P124

Answer 5

Replace platelets with units of platelets

6–10 units from single donor or random donors

Question 6

Define the following terms:
Fresh frozen plasma (FFP)
P124

Answer 6

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

Question 7

Define the following terms:
Cryoprecipitate (cryo)
P124

Answer 7

Replaces fibrinogen, von Willebrand factor, and some clotting factors

Question 8

Which electrolyte is most likely to fall with the infusion of stored blood? Why?
P124

Answer 8

Ionized calcium; the citrate preservative used for the storage of blood binds serum calcium

Question 9

What changes occur in the storage of PRBCs?

P124

Answer 9

↓Ca, ↑ K, ↓2,3-DPG, ↑ H (↓ pH),

↓PMNs

Question 10

What are general guidelines for blood transfusion?

P124

Answer 10

Acute blood loss, Hgb < 7

Question 11

What is the rough formula for converting Hgb to Hct?

P124

Answer 11

Hgb x 3 = Hct

Question 12

One unit of PRBC increases Hct by how much?

P124

Answer 12

≈3% to 4%

Question 13

Which blood type is the “universal” donor for PRBCs?

P125

Answer 13

O negative

Question 14

Which blood type is the “universal” donor for FFP?

P125

Answer 14

AB

Question 15

What is a type and screen?

P125

Answer 15

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

Question 16

What is a type and cross?

P125

Answer 16

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

Question 17

Define thrombocytopenia.

P125

Answer 17

Low platelet count (<100,000)

Question 18

What are the common causes of thrombocytopenia
in the surgical patient?
P125

Answer 18

Sepsis, H(2) blockers, heparin, massive transfusion, DIC, antibiotics, spurious lab value, Swann-Ganz catheter

Question 19

What can be given to help correct platelet dysfunction
from uremia, aspirin, or bypass?
P125

Answer 19

DDAVP (desmopressin)

Question 20

What common medication causes platelets to
irreversibly malfunction?
P125

Answer 20

Aspirin (inhibits cyclooxygenase)

Question 21

What is Plavix®?

P125

Answer 21

Clopidogrel—irreversibly inhibits platelet
P2Y(12) ADP receptor (blocks fibrin
crosslinking of platelets)

Question 22

What platelet count is associated with spontaneous bleeding?

P125

Answer 22

20,000

Question 23

What should the platelet count be before surgery?

P125

Answer 23

> 50,000

Question 24

When should “prophylactic” platelet transfusions be given?

P125

Answer 24

With platelets 10,000

old recommendation was 20,000

Question 25

What is microcytic anemia “until proven otherwise” in a man or postmenopausal woman? P126

Answer 25

Colon cancer

Question 26

Why not infuse PRBCs with lactated Ringer’s? | P126

Answer 26

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

Question 27

For how long can packed RBCs be stored? | P126

Answer 27

About 6 weeks (42 days)

Question 28

What is the most common cause of transfusion hemolysis? | P126

Answer 28

ABO incompatibility as a result of clerical error

Question 29

What is the risk of receiving a unit of blood infected with HIV? P126

Answer 29

≈1 in 1,000,000

Question 30

What are the symptoms of a transfusion reaction? | P126

Answer 30

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

Question 31

What is the treatment for transfusion hemolysis? | P126

Answer 31

Stop transfusion; provide fluids; perform diuresis (Lasix) to protect kidneys; alkalinize urine (bicarbonate); give pressors as needed

Question 32

What component of the blood transfusion can cause a fever? P126

Answer 32

WBCs

Question 33

What is the transfusion “trigger” Hct in young healthy patients? P126

Answer 33

21%

Question 34

What is the widely considered “optimal” Hct in a patient with a history of heart disease or stroke? P126

Answer 34

≈30%

Question 35

When should aspirin administration be discontinued preoperatively? P126

Answer 35

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

Question 36

What can move the oxyhemoglobin dissociation curve to the right? P127

Answer 36

Acidosis, 2,3-DPG, fever, elevated PCO(2) (to the right means greater ability to release the O(2) to the tissues)

Question 37

What is the normal life of RBCs? | P127

Answer 37

120 days

Question 38

What is the normal life of platelets? | P127

Answer 38

7 to 10 days

Question 39

What factor is deficient in hemophilia A? | P127

Answer 39

Factor VIII

Question 40

How can the clotting factor for hemophilia A be remembered? | P127

Answer 40

Think: “Eight” sounds like “A”

Question 41

What is the preoperative treatment of hemophilia A? | P127

Answer 41

Factor VIII infusion to 100% normal preoperative levels

Question 42

What coagulation study is elevated with hemophilia A? | P127

Answer 42

PTT

Question 43

How do you remember which coagulation study is affected by the hemophilias? P127

Answer 43

There are two major hemophilias and two t’s in PTT

Question 44

What factor is deficient in hemophilia B? | P127

Answer 44

Factor IX

Question 45

How do you remember which factors are deficient with hemophilia A and hemophilia B? P127

Answer 45

Think alphabetically and chronologically: A before B—8 before 9 Hemophilia A = factor VIII Hemophilia B = factor IX

Question 46

How are hemophilias A and B inherited? | P127

Answer 46

Sex-linked recessive

Question 47

What is von Willebrand’s disease? | P127

Answer 47

Deficiency of von Willebrand factor (vWF) and factor VIII:C

Question 48

How is von Willebrand’s disease inherited? | P127

Answer 48

Autosomal dominant

Question 49

What is used to correct von Willebrand’s disease? | P127

Answer 49

DDAVP or cryoprecipitate

Question 50

What coagulation is abnormal with the following disorders: Hemophilia A P128

Answer 50

PTT (elevated)

Question 51

What coagulation is abnormal with the following disorders: Hemophilia B P128

Answer 51

PTT (elevated)

Question 52

What coagulation is abnormal with the following disorders: von Willebrand’s disease P128

Answer 52

Bleeding time

Question 53

What is the effect on the coagulation system if the patient has a deficiency in protein C, protein S, or antithrombin III? P128

Answer 53

A hypercoagulable state

Question 54

What is a “left shift” on a CBC? | P128

Answer 54

Juvenile polymorphonuclear leukocytes (bands); legend has it that the old counters for all the blood cells had the lever for bands on the LEFT of the counter

Question 55

What is the usual “therapeutic” PT? | P128

Answer 55

With coumadin, usually shoot for an INR of 2.0–3.0

Question 56

What is the acronym basis for the word WARFARIN? | P128

Answer 56

Wisconsin Alumni Research Foundation-ARIN

Question 57

What is the most common inherited hypercoagulable state? P128

Answer 57

Factor V Leiden | Think: LEiden = LEader

Question 58

What is Xigris®? | P128

Answer 58

Activated protein C, which is used in severe sepsis