Heme Platelets/Transfusions BOLDED stuff - from quizlet

Primary hemostasis

1. adhesion to injured vessels (vWF and collagen)
2. Activate
3. Aggregated through fibrinogen

Secondary hemostasis

Coagulation cascade starts
Thrombin joints the party and converts fibrinogen to fibrin

Tertiary hemostasis

Cross linking of fibrin
Clot maturation
Wound healing

Spontaneous bleeding does not occur unless patient count is....

Less than 10,000

Thrombocytopenia

Platelet <100,000

ITP (immune thrombocytopenia purpura) presentation/cause

New onset thrombocytopenia

Cause: idiopathic in healthy adults, autoantibodies attack itself randomly

acute ITP

More common in kids
Often preceded by viral illness

Chronic ITP

-adults
-idiopathic
-more common in women 20-40

How to diagnose ITP

diagnosis of exclusion

ITP treatment

1st line:
-steroids
-IVIG

Second line:
-splenectomy
-rituximab
-romiplostim
-eltrombopag

Patho of HIT

Auto-antibodies that react with platelets in the presence of heparin

HIT presentation

Platelets create hypercoagulable state
-venous/arterial thrombus

Clotting with heparin!!
Platelets DROP

HIT can happen with LMW heparins too!!

:)

HIT treatment

-discontinue heparin
-avoid platelet transfusions
-argatraban

TTP patho

Dec of ADAMSTS13 makes extra sticky Willy

(Sticky Willy = excessive clots)

What factor can falsely trigger platelet plug formation

HIV

classic pentad of TTP

FAT RN

Fever
Anemia (microangiopathic hemolytic anemia- MAHA)
Thrombocytopenia

Renal failure
Neuro

What is seen with MAHA

Schistocytes (sign of TTP)

TTP treatment

Plasma exchange

AVOID platelet transfusion

Thrombocytosis

Platelets >450,000

What platelet level are you concerned for clots?

> 1 mil

congenital platelet disorders

-von willebrand disease
-Bernard-soulier syndrome

Myeloproliferative neoplasms

-polycythemia Vera
-essential thrombocythemia
-CML

Polycythemia presentation

Typical asymptomatic

IF symptomatic: due to hypo-oxygenation of tissues d/t blood hyper viscosity

Polycythemia Vera treatment

Therapeutic phlebotomy
Stem cell transplant (only curative option)

Essential thrombocythemia etiology

Primary: myeloproliferative neoplasm

Secondary: reactive, severe thrombocytosis

Inherited iron overload causes

Classic Hemochromatosis (type 1)
Juvenile hemochromatosis (type 2)

Most common inherited liver disease

Hemochromatosis

Most common cause of severe iron overload

Hemochromatosis

Bronze diabetes

Hemochromatosis

Hemochromatosis presentation

-Hepatomegaly
-skin pigmentation
-arthritis

How to diagnose hemochromatosis

Genetic testing for HFE1 gene

Sole recommended treatment for hemochromatosis

Phlebotomy

When should you give blood transfusions

Only after careful evaluation!

What should you always do before a transfusion

Obtain written patient consent

Which blood transfusion includes coag factors

FFP
Cryoprecipitate

What is whole blood and when is it used?

Whole blood minus platelets (PRBC)
Used for large volume loss

What is RBC transfusions used for?

Improve O2 deliver to tissues

Examples of platelet transfusions

Pooled random donor platelets
Single donor heresies platelets
HLA matched single donor platelets

When do you used FFP

-Massive blood loss
-emergency reversal of warfarin
-DIC
-liver disease
-inherited coagulopathies

What will develop with repeated platelet transfusions

HLA alloantibodies

How to detect HLA alloimmunization

Order platelet count 1 hr post transfusion

Hemolysis presentation

-fever/chills
-chest/back pain
-feeling of impending doom
-hypotension

Hemolysis treatment

STOP TRANSFUSION

What does mismatched blood types cause

Agglutination

Type of antigens/ antibody for each blood type

A: A antigen, B antibody
B: B antigen, A antibody
AB: A&B antigen, no antibodies
O: no antigen, A&B antibodies

Most Americans are Rh+ or Rh-

Rh+

Antibodies forming when Rh- receives Rh+ is called

Sensitization

When does hemolysis of Rh- transfusion occur

2nd transfusion of Rh+ to Rh-