ITE Heme

Question 1

Hypothermia (increases/decreases) risk of bacterial infection compared to normothermic pts

Answer 1

increases

- hypothermia decreases regional blood flow, oxygen tension, and chemotaxis

Question 2

Trauma triad of death

Answer 2

1. Hypothermia
2. Coagulopathy
3. Acidosis

Question 3

(Hyper/Hypo)ventilation increases the risk of citrate toxicity

Answer 3

Hyperventilation

Question 4

_____ is more likely to cause citrate toxicity compared with other blood products bc more citrate is used

Answer 4

FFP

Question 5

________ contains all clotting factors, fibrinogen, albumin, electrolytes, physiologic anticoagulants (prot C and S), and citrate

Answer 5

FFP

Question 6

Recipients serum is mixed with commercially supplied RBCs containing selected antigens commonly implicated in hemolytic transfusion reactions

Answer 6

Antibody screen

Question 7

Recipients serum is mixed with donor RBCs

Answer 7

Crossmatching

Question 8

Recipients RBCs are mixed with commercially supplied anti-A and anti-B sera

Answer 8

ABO typing

• most important
• ABO incompatibility will cause hemolytic rxns

Question 9

4 Ts of HIT

Answer 9

1. Thrombocytopenia
2. Timing of reduced plt count
3. Presence of thrombosis
4. Exclusion of oTher thrombocytopenia

Question 10

Having a platelet count of > _____ is a risk factor for heparin resistance

Answer 10

300,000/mm^3

Question 11

Heparin resistance is defined as an ACT of _____ after 500 U/kg of IV heparin has been administered

Answer 11

< 480

Question 12

Antithrombin levels ____ of normal is a risk factor for development of heparin resistance

Answer 12

< 60% of normal

Question 13

Treatment of heparin resistance

Answer 13

1. supplemental heparin
2. AT3
3. FFP

Question 14

_____ are separated from RRBCs mainly by centrifugation, and from leukocytes by leukocyte reduction filters

Answer 14

Platelets

*but small amounts of RBCs and leukocytes are still present in platelet concentrates and cause RH sensitization

Question 15

______ is the most common blood product associated with TRALI

Answer 15

Plasma

Question 16

Platelets lose their activity if ______ and should be stored at ____ deg C

Answer 16

refridgerated

20 deg C

Question 17

If a pt develops contrast-induced nephropathy and continues to take metformin it can ________

Answer 17

accumulate to toxic levels resulting in lactic acidosis

Question 18

Can metformin be continued through the perioperative period?

Answer 18

Yes

Question 19

Anemia causes a (Right/Left) shift of oxygen hgb dissociation curve? This allows for (Higher/lower) hgb affinity to oxygen, which results in greater oxygen release into tissue.

Answer 19

Right shift
lower

*anemia is a disease state of low hgb. The oxygen extraction ratio is increased

Question 20

The body compensates for anemia by (3)

Answer 20

1. increasing CO
2. redistributing flow to favor heart and brain
3. oxygen extraction ratio is increased (R shift)

Question 21

_______ is given to pts with Type 1 von willebrand disease (partial decrease in VWF) prior to surgery

Answer 21

desmopressin (DDAVP)

- increases release of von Willebrand factor from endothelial cells

Question 22

________ is a common genetically inherited quantitative or qualitative dysfunction of von willebrand factor

Answer 22

Von willebrand disease

Question 23

vWD is divided into 3 major categories:

Answer 23

1. Partial quantitative deficiency (type I)
2. Qualitative deficiency (type II)
3. Total deficiency (type III)

Question 24

_______ is given to pts with Type III von willebrand disease (total depletion) prior to surgery

Answer 24

vWF concentrate

- DDAVP has no effect

Question 25

DDAVP trials are contraindicated in pts with type IIB von Willebrand Disease bc of _____ and ____

Answer 25

thrombocytopenia and thrombotic complications | by decreasing plt count

Question 26

The anticoagulant response to enoxaparin (LMWH) can be monitored by measuring _____ activity

Answer 26

factor Xa activity

Question 27

(LMWH/UFH) is suitable for outpt use

Answer 27

LMWH - one or twice daily dosing - more predictable level of ac - does not need routine monitoring

Question 28

Unfractionated heparin exerts its anticoagulation effects by _____

Answer 28

binding to and enhancing effects of AT3 by several thousand folds *AT3 inactivates multiple coagulant factors, esp factor II (thrombin)

Question 29

Most preferred way to reverse INR?

Answer 29

Prothrombin complex concentrate - contains all Vit K dependent coag factors II, VII, IX, X (2790) *more consistent and rapid than FFP

Question 30

Warfarin MOA

Answer 30

interferes with hepatic synthesis of Vit K dependent coagulation factors II, VII, IX, X (2790), Protein C and S

Question 31

Half life of warfarin

Answer 31

2-4 days

Question 32

________ is the most common inherited bleeding disorder

Answer 32

Von Willebrand disease

Question 33

Von willebrand factor is a protein that _____

Answer 33

assists platelets to adhere to sites of vascular injury | and stabilizes clotting factor VIII

Question 34

What are all of the blood products that can be given to pts with von willebrand disease?

Answer 34

1. VWF concentrates 2. desmopressin (DDAVP) 3. Cryoprecipitate

Question 35

Cryoprecipitate contains what?

Answer 35

1. Factor VIII 2. VWF 3. Factor XIII 4. Fibrinogen

Question 36

PTT measures the speed of clotting of the ______ pathway, which involves factors ______

Answer 36

intrinsic I, II, V, VIII, IX, X, XI, XII (89 11 13)

Question 37

PT measures the speed of clotting of the ______ pathway, which involves factors ______

Answer 37

Extrinsic I, II, V, VII, X (710)