Hemostasis, Surgical Bleeding, & Transfusion Flashcards Preview

Surgery > Hemostasis, Surgical Bleeding, & Transfusion > Flashcards

Flashcards in Hemostasis, Surgical Bleeding, & Transfusion Deck (18)
Loading flashcards...
1
Q

Extrinsic Pathway

A

Tissue Factor - III

VII

Triggered by Tissue Damage

2
Q

Intrinsic Pathway

A

XII

XI

IX

VIII

3
Q

Common Pathway

A

X

V

II (prothrombin)

I (fibrinogen)

X is activated by both Extrinsic and Intrinsic pathways to cause fibrin clot formation

4
Q

Only factor deficiency that doesn’t cause coagulopathy

A

Factor XII

5
Q

Platelet Count

A

Normal is 150,000-400,000

If abnormal get smear

Low platelets may be caused by: Lasix, NSAIDs, sulfonamides, PCN, Autoimmune disease

6
Q

Prothrombin Time

A

Used to monitor Warfarin (INR)

Normal uncoagulated INR: 0.8-1.2

Evaluates VII (extrinsic), X, V, prothrombin, fibrinogen

7
Q

Partial Thromboplastin Time (PTT)

A

Monitor unfractionated Heparin therapy - also Warfarin

Not effective monitor for LMWH

Evaluates fibrinogen, prothrombin, V, VIII, IX, X, XI, XII (intrinsic and common pathway)

8
Q

Thrombin Time

A

Fibrinogen to fibrin conversion with abundant thrombin time

Prolonged: low/abnormal fibrinogen, low split products, Heparin

Used to check for DIC and chronic liver disease

9
Q

Bleeding time

A

Gash time for bleeding sensation X2

Normal 5-10 minutes

Prolonged: thrombocytopenia, medication (ASA), von Willebrand Disease

10
Q

Von Willebrand Disease

A

Most common congenital bleeding disorder

Reduced VIII and vWF activity

vWF binds to factor VIII to prevent degradation

Mucocutaneous bleed

Prolonged PTT and abnormal platelet function

PT normal

Treat with Cryoprecipitate infusion or Desmopressin (DDAVP)

11
Q

Hemophilia A

A

Reduced/absent factor VIII activity

Males only

Joint or intramuscular bleed

Prolonged PTT

Normal PT and platelet function

Tx: Purified factor VIII products

12
Q

Liver Disease Acquired Bleeding Disorder

A

Most common - no protein synthesis

Results in low prothrombin, V, VII, X

Obstructive jaundice and cirrhosis may also cause these

-Will respond well to Vitamin K

13
Q

Warfarin

A

Effects II, VII, IX, X

Reverse with FFP or Vitamin K in a hurry

14
Q

Heparin

A

Increases antithrombin III

Neutralizes IXa, Xa, XIIa and thrombin

Prolonged PTT and thrombin time

Often given during vascular surgery

Reverse with protamine sulfate

15
Q

OTC Herbal Supplements that Affect Bleeding

A

Dong quai

Garlic

Ginger

Ginko Biloba

Ginseng

St. John’s Wort

16
Q

Primary, Secondary, and Reactive Bleeding

A

Primary: happens during surgery

Secondary: happens 7-10 days post-op; caused by erosion commonly w/ infection into vessel

Reactive: w/in 24 hours operation; from untied vessels or reduced vasospasm and adequate perfusion

17
Q

Immunologic Reaction MC Presentations

A

Febrile reaction: MC with anti-leukocyte antibodies

Hemolytic reaction: MC with ABO mismatch

Graft v Host reaction: MC with immunosuppressed - get delayed sx onset

18
Q

Metabolic Derangements Common Causes

A

Hypocalcemia with rapid infusion: get ST segment prolongation, delayed T waves, and muscle tremors

Hyperkalemia: Blood >35 days old

Hypokalemia: red cells take up potassium after infusion

Hypothermic: Fluid warmer with multiple transfusions