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Pharm 2-EXAM #2 > Hematology 1 > Flashcards

Hematology 1 Flashcards

(123 cards)

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1
Q

What are the functions of blood?

A

Homeostasis

Defense

Transports O2, nutrients, waste & hormones

Heat exchange

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2
Q

What is the primary source of blood cells?

A

Bone marrow (95%)

Red marrow of sternum, ribs, vertebrae & skull

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3
Q

What is the secondary source of blood cells, but also the primary source in PEDS?

A

Femur & tibia

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4
Q

WBC are ________, which are further categorized as_____ & ____

A

Leukocytes; Granulocytes; Agranulocytes

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5
Q

WBC action

A

Defend against foreign cells & infection

It is non-specific & an acquired immune response & inflammation

Comes from bone marrow

Lymphocytes from lymphatic organs

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6
Q

HGB is equivalent to

A

O2 carrying capacity

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7
Q

What is involved in the destruction of aged RBCs?

A

Destroyed by liver macrophages

Within ~4 months

Heme is broken down into iron & bilirubin

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8
Q

Anemia is the

A

Reduction in RBCs or HGB (hemorrhage or bone marrow failure)

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9
Q

What are the types of Anemia?

A

Dietary deficiency 9folic acid/iron/vitamin B12)

Kidney disease/ Nephrectomy

Sickle cell

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10
Q

Iron is absorbed in __________ & is increased by ____________

A

The diet in the small intestine

Vit C

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11
Q

Iron is bound to

A

Transferrin in the plasma

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12
Q

Iron is an essential component of

A

Enzymes necessary for energy transfer

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13
Q

Iron is incorporated into

A

New erythrocytes & reticuloendothelial cells in the liver & spleen

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14
Q

Plasma concentration of iron

A

50-150 mcg/dL

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15
Q

Causes of iron deficiency

A

Inadequate dietary intake

Increased requirements during pregnancy or blood loss

Interference with GI absorption

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16
Q

Iron supplements increase the rate of

A

Erythrocyte production & HGB concentration

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17
Q

With iron supplementation, levels should rise within

A

3 days to 3 weeks

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18
Q

Agglutinogen is an _________ which stimulates formation of _________

A

Antigen; Agglutinin

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19
Q

Agglutinin is an ________ or other blood substance that causes particle ________

A

Antibody; Aggregation

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20
Q

What happens to RBC as they are stored over time?

A

Depletion of ATP & 2,3 DPG (used to help HGB off-load O2 to tissues)

Shape change

Fragility impairs flow

Promotes inflammation, leading to ALI during transfusion, decreased O2 delivery & INCREASED hemolysis (LEFT SHIFT)

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21
Q

How many days place a patient at an increased risk of adverse events due to RBC storage?

A

> 14-21 days

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22
Q

A lengthy storage of RBCs can also impair

A

NO scavenging

Reduced NOS (dysfunctional endothelial cells)

Na/K ATPase failure–> K+ leak

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23
Q

Acute anemia can result in

A

A compensatory increase in CO & oxygen transport, but this process is limited in those with HF or flow restrictions

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24
Q

What kind of filter should be used with transfusing

A

170-260 micron

Removes clots & aggregates

Leukoreduction

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25
One unit of PRBC will increase HBG by____ HCT by _______
HGB 1 HCT 3%
26
What fluids are compatible with transfusions?
NS Albumin Plasma often co-administered with RBC transfusion Isotonic crystalloids (LR, Normosol & Plasmalyte)
27
Which fluids should be avoided when transfusing blood?
D5 Hypotonic These fluids cause RBC lysis due to RBC taking up glucose & causing lysis
28
RBC, PLT, & Cryo should be
Administered separately
29
What defines plasma/fresh frozen plasma?
Whole blood is removed of RBCs, PLT, coagulation factors, fibrinogen & plasma proteins
30
FFP is plasma frozen within
8-24 hours of collection
31
What can be obtained from FFP
Cryo
32
FFP can be transfused
Interchangeably with thawed plasma
33
PLasma/FFP should be transfused within
24 hours of being thawed
34
Storage of plasma/FFP reduces factors
5 & 8
35
Plasma transfusions are indicated to
Replace volume & coagulation factors Treat or prevent bleeding Reverse warfarin anticoagulation Treat coagulation factor abnormalities
36
Dose of plasma trasfusion
10-15ml/kg Half of this when treating for warfarin
37
Plasma will increase the plasma factor concentration by ____
30%
38
What is cryoprecipitate?
Formed from show thaw of frozen plasma (residual volume refrozen & stored up to 3 years)
39
Cryoprecipitate is rish in factors
1, 8, & 13
40
What are the indications of giving cryoprecipitate?
Restore fibrinogen depleted from massive hemorrhage or coagulopathy Treat hemophilia A & factor 13 deficiency
41
How should cryoprecipitate be administered?
Trasfuse with 4 hours 1 unit/10kg
42
What is the minimum FGN level for homeostasis?
~100 mg/dL
43
Cryoprecipitate will increase FGN by
50-100mg/dL
44
What is the average life span of PLT?
8-12 days
45
PLTs are involved in_________ for hemostasis
Thrombus formation PLT & WBC recruitment
46
Normal PLT count
150,000-400,000/microL
47
How are PLT prepared?
Whole blood pooled & random donor Single donor apheresis (4-6 pooled units) Leukoreduced (removal of WBCs)
48
Leukoreduction will
Minimize sensitization & antibody reactions Reduces risk of HLA alloimmunization, PLT refractoriness & transmission of viruses
49
PLT will increase plasma level to
30,000-50,000
50
PLT and their storage
They are stored at 22 degrees C, which increases the risk of bacterial growth
51
PLT transfusion risk the chance of
graft vs host disease, which is when the grafts immune cells recognize the host as foreign & attacks recipient's cells
52
Which patients have a risk of graft vs host disease?
CA patients Immunocompromised PEDS
53
Graft vs host disease is common after
Bone marrow & stem cell transplant
54
PLTs can be ______ for certain populations & indications
Gamma-Irradiated
55
Surgical patients PLT typically
>50,000-100,000microL
56
PLT count does not provide
Information on PLT function & quality
57
Adverse effects of transfusions
Acute inflammatory response Immunomodulation Allogeneic blood w/bioactive substance Immunosuppressive effects Fever Release of inflammatory mediators & neutrophil activation Risk post-op infection Transfusion of transmissible infections
58
When should prophylactic administration of PLT be considered?
During massive transfusion Closed surgical procedures with a high risk of hemorrhage
59
What does TACO stand for?
Transfusion-Associated Circulatory Overload
60
TACO occurs when
There is overload of a poor cardiovascular system (HF) related to transfusion of blood products
61
Symptoms of TACO
Acute onset of dyspnea & tachypnea HTN Tachycardia HF exacerbation Pulmonary edema
62
What lab value will be elevated in TACO?
BNP
63
An echocardiography in relation to TACO will show
Ventricular & valvular dysfunction
64
What does TRALI stand for?
Transfusion-related acute lung injury
65
How is TRALI defined?
New & acute lung injury within 6 hours of transfusion
66
On the cellular level int he lungs, what happens during TRALI?
Neutrophils &/or endothelial activation in the lungs Pulmonary vascular injury Pulmonary edema
67
Symptoms of TRALI
Acute onset hypoxia (<90% on RA, PaO2/FiO2<300mmHg) Bilateral pulmonary infiltrates NO evidence of HF or volume overload
68
Related factors of TRALI
Initiating inflammatory event Lipids from stored blood Viral infection Cardiopulmonary Bypass Secondary transfusion event triggers further inflammation & injury Antibody specific Underlying condition
68
Life threatening 7 uncontrolled bleeding can be caused by
Massive transfusion coagulopathy Trauma induced coagulopathy
69
Thawed plasma will restore
Endothelial tight junctions Proteins to help with osmotic maintenance Anti-inflammation
70
Coagulopathy is the depletion or decrease in
The function of clotting factors & PLTs
71
Coagulopathy will worsen in the presence of
Hypothermia & acidosis
72
Coagulopathy will accelerate
Clot breakdown
73
Coagulopathy is the lost balance between
Physiologic anti- & pro- coaagulant effects
74
What is dilutional coagulopathy?
Giving too much volume by administering crystalloids, colloids, RBCs & cell salvage Blood loss
75
Fibrin is needed for
Clot formation
76
Frbrinolysis is the break down of a clot & is excessive in
The trauma patient & can lead to increased bleeding
77
Hypofibrinogenemia is NOT corrected by
FFP
78
Hypofibrinogenemia is the
Excess reduction in fibrinogen (~80-100mg/dL), which will prolong PT/PTT
79
How is Hypofibrinogenemia corrected?
Giving Cryo or fibrinogen concentrate
80
Citrate toxicity can cause
Hypocalcemia
81
Hyperkalemia associated with transfusions is caused by
Potassium leakage during RBC storage, which places the patient at risk for arrhythmias, especially in ECMO, heart lung machines, or using older blood
82
Hypothermia occurs when?
Reduces core temperature abruptly 10 units can reduce body temperature by ~3 degrees, risking exacerbation of hemorrhage, arrhythmias & other complications
83
Which laboratory monitoring test is the best to monitor during transfusion
TEG/TEM
84
Why is TEG/TEM the better lab value to monitor?
Goal directed management Gives information on clot formation, strength, firmness, fibrin polymerization & coagulopathy
85
What other lab value can be monitor but does not provide as much information as TEG/TEM?
PT/aPTT PT--> loss of factors & hemodilution
85
What defines a massive transfusion?
>10 units RBC in 24 hrs Higher mortality Indicative of severity of injury Protocol to rapidly secure products Ideal ratio
86
What blood products are given in the 1:1:1 ratio?
Frozen plasma/thawed plasma/other plasma product Apheresis PLT PRBCs
87
Volume of frozen plasma?
~200-300ml
88
Volume of apheresis PLTs
Contains ~300 billion PLTs ~25% of normal amount circulation PLTs Only 50% is circulated
89
Volume of PRBCs
~325mL
90
Plasma is given for
Clotting factor replacement
91
What are the goals for plasma infusion?
PT<18 aPTT<35 ACT>128 Cryo goal fibrinogen >180
92
What is the indication for giving PLTs
PLT replacement (.150,000)
93
Goal for RBC transfusion
HGB.8-10g/dL
94
RBCs release________, which activates_____
ADP; Activated PLTs
95
When are antifibrinolytic agents given?
Preserved for clot formation Indication is based on TEG (LY30 value)
96
Hypocalcemia, due to citrate toxicity is depletion of
Serum free Ca+ (ionized) concentration
97
Hypocalcemia risks
paresthesia & arrhythmias
98
There is a higher risk of hypocalcemia in
Hepatic dysfunctions
99
Chloride does not require
Normal liver function
100
10% Ca+ chloride is _____mL per blood unit
2-5
101
10% Ca+ gluconate is _______mL per blood unit
10-20
102
Large volume resuscitation risks
Dilutional coagulopathy Severe edema Lung stiffness ABD compartment syndrome
103
When is the massive transfusion protocol used?
Trauma Cardiac surgery Obstetrics Liver patient
104
What is the goal maintenance of fibrinogen in obstetrics?
>200mg/dL
105
Obstetric patients are already in a _________ with________
Hypercoagulable state; compensatory increase in fibrinolysis
106
Liver patient have a reduction in
Production of normal coagulation factors Hepatic clearance coagulation factor fragments, which increases the risk for hemorrhage
107
Liver patients have a dysfunction in
Vit-K dependent factors & fibrinogen
108
Caution with this in liver patients
Consider blood volume and portal circulation
109
Correct acidosis with
Bicarb
110
Minimize the use of
Crystalloids in massive transfusion
111
With massive transfusion, use these products sooner rather than later
Plasma PLT RBCs
112
What is postpartum hemorrhage?
>500mL vaginal or >1,000mL section with ongoing bleeding; symptomatic within 24hrs
113
Potential causes of postpartum hemorrhage
Uterine atony Placental retention Uterine Abnormalities or inversion Lacerations Coagulopathies
114
PPH can be treated with
Antifibrinolytics Uterotonics
115
When treating PPH, an antifibrinolytic like tranexamic acid dose is
1 gram over 10-20 min & repeat after 30 min if needed
116
Oxytocin MOA
Increases intracellular Ca+ for uterine contractions 10-40 units IM/IV diluted
117
Adverse effects of oxytocin
Maternal arrhythmias & HOTN
118
MOA of Methylergonovine, an uterotonic
Potent vasoconstrictor than increases the strength & frequency of uterine contractions 0.2mg IV every 2-4 hrs The alternative to oxytocin & TXA
119
When is Methylergonovine, an uterotonic contraindicated?
HTN CVD Preeclampsia
120
MOA of carboprost, an uterotonic
Stimulates uterine smooth muscle contraction 250mcg IM or directly into uterine muscle
121
Adverse effects of carboprost, an uterotonic
Nausea Bronchospasm Increase in PVR

Pharm 2-EXAM #2 (5 decks)

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