Hematology #2 Flashcards Preview

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Flashcards in Hematology #2 Deck (30):
1

DIC excessive clotting cascade and lysis cascade results in:

-Exhausted factors and co-factors
-partially developed and broken down clots
-micro emboli caught in capillaries

2

Organs with most capillaries

Heart, liver, spleen, brain, lungs,

3

MODS and death result from DIC why?

Entire system losing blood due to mass micro emboli occlusion

4

DIC lab values

1. Positive D-Dimer (fibrin degradation products)
2. Low fibrinogen and platelets (clotting factors)
3. Hg PT, aPTT, INR, FSP

5

PT

Prothrombin Time
-measurement of intrinsic coagulation

6

aPTT

Activated partial thromboplastin time
-measurement of extrinsic coagulation

7

INR

International Normalized Ratio
-universalized rabbit serum to measure PT
-normal 1.0
-high INR suggest it is taking longer to clot

8

FSP or FDP

Fibrin Split / Degradation Product
-clot break down

9

DIC treatment #1 goal

Treat precipitating cause

10

DIC traditional treatment

Give FFP, Cryo, platelets to create clots
-May add to the problem

11

DIC and heparin treatment

Only studies to be beneficial when secondary yo neoplasms and CA

12

Antithrombin III (ATIII) therapy

Interferes with fibrinogen converting to fibrin (normal process in body)
-prevents coagulopathy
-primarily inhibits factors IIa (thrombin) and X (Stuart factor)
-in FFP

13

Chronic heparin therapy can cause what deficiency?

ATIII
-body processes out heparin bound w/ ATIII
- can cause DIC, tx w/ FFP

14

PRBC indication

Increase O2 carry capacity of blood
-volume expander only secondary to this qualification

15

PRBC HgB indications

Indicated for

16

RBC antigen that can cause a reaction

ABO

17

Rh(-) female

Can reach sensitization with Rh (+) blood.
-anaphylaxis possible
-Rh (+) fetus can be aborted (rogan can prevent this)

18

Rh(+) / Rh(-) blood to male or females

Females: Rh(-)
Males: Rh (+)
-can be sensitized, but does not have fetal complication for future.

19

How many ml are in one unit of PRBCs?

330 ccs

20

PRBC pediatric dose

10cc/kg

21

Citrate toxicity considerations

Multiple units: 4 units in less than 20 minutes
-citrate chelates ionized Ca- renders it useless in clotting cascade

22

Administer Ca if giving PRBCs at what rate

One unit in less than 5 minutes or 1 ml/kg/min
General rule: 1 amp of Ca q 4 units PRBCs.

23

Liver considerations with citrate

Liver processes citrate. Liver dysfunction can lead to citrate toxicity despite PRBC admin at slower rates.

24

Universal donor

O(-)

25

Universal recipient

AB(+)
Can take A, B, AB

26

1 unit of PRBCs increases the H&H by what?

1&3

27

Q unit of PRBCs at storage temp will decrease core temp by?

0.25 c

28

PRBC and acidosis considerations

Store blood continued metabolism = lactate = acidotic
-citrate converts to HCO3 = self correcting
-watch ABGs

29

PRBC and hyperkalemia considerations

RBCs die and release K in storage. Stored blood K levels can reach 17-24.
-administration rates greater than 90-120 ml/min can result in hyperkalemia. Watch ECG for changes.

30

DIC cause and mechanism

Causes: sepsis, massive trauma, hypoxia
Mechanism: systemic activation of clotting cascade by overwhelming release of thromboplastin factor. Lysis cascade goes into overdrive as a result to overwhelming clot formation. Clots broken down prematurely.