Chapter 16

Rapid Blood Loss 

Hemorrhage 

Shock caused by low blood volume

Hypovolemic Shock

Replacement of blood volume within 24 hours

Massive Transfusion

Blood loss caused by treatment

Iatrogenic

Removal of abnormal cells, plasma, or plasma components from blood to provide therapeutic benefits

Therapeutic Apheresis

Identify 3 clinical characteristics of hemostatic disorders:

Prolonged/Subcutaneous Bleeding and Bleeding into joints

What is the most common hemostatic disorder?

von Willebrand’s Disease

Alloantibodies are produced against transfused red cells or fetal cells in HDFN:

Alloimmune Hemolytic Anemia

Drugs may be absorbed directly onto membrane or drug-antibody complex is absorbed:

Drug-Induced Hemolytic Anemia

Autoantibody that causes red cells to be removed by the spleen, causing anemia:

Autoimmune Hemolytic Anemia

List 4 negative effects of sickled red cells:

Blocks Blood Vessels, Endothelial Damage, Pain, Thrombosis

List 3 complications of sickle cell anemia:

Acute Chest Syndrome, Multiorgan Failure, Stroke

Chest Pain, Fever, and Pneumonia-Like Cough

Acute Chest Syndrome

3 conditions that TTP and HUS are sequela of:

Bacterial Gastroenteritis, Severe Viral Infection, Cytotoxic Drug Treatment

Explain overlapping signs and symptoms of HUS and TTP: 

CNS Involvement, Microangiopathic Hemolytic Anemia, Renal Dysfunction, Thrombocytopenia 

3 complications of chemotherapy:

Anemia, Bleeding, Infection

5 reasons to perform therapeutic aphaeresis:

Clear immune complexes, Modify mediators of inflammation, Reduce antibody levels, Replace cellular elements, Supply essential substance that is absent

Identify 2 tests that should be performed to detect hemolysis in organ and tissue transplant: 

DAT and AHG 

List 3 effects that hypothermia can have on infants:

Cardiac Arrest, Hypotension, Hypoxia

Contrast neonatal and pediatric transfusions with those of adults: 

Erythropoietin Response, Hemoglobin Changes, Small Size 

Identify 3 systems that hemorrhage can affect:

Circulatory, Hormonal, Nervous

Signs/Symptoms of hemorrhagic shock:

Cold/Clammy Skin, CNS Depression, Decreased Htc and CVP, Pallor/Cyanosis, Hypotension, Oliguria, Metabolic Shock, Tachycardia 

State hemoglobin level that indicates severe anemia for the neonate during the first 24 hours of life:

<13

Identify three products that are used for transfusion alternatives: 

Factor Concentrates, Hematopoietic Growth Factors, Volume Expanders 

What product used for transfusion alternative is considered sterile, stable, and lyophilized?

Factor Concentrates

What product used for transfusion alternative includes crystalloids, colloids, albumin, and plasma protein fraction? 

Volume Expanders 

What product used for transfusion alternatives stimulates bone marrow to produce RBCs, WBCs, and platelets?

Hematopoietic Growth Factors

Identify the age group that is most likely to receive red cell transfusions:

Neonates

How is platelet function affected during heart surgery?

Exposure to extracorporeal surfaces, hypothermia, and vasoconstriction

How is Hemostasis affected during heart surgery?

Heparin, Platelet Function, and Decreased Platelet Counts

5 priorities of massive transfusions:

Correct/Avoid metabolic disturbances, Optimize oxygen carrying capacity, Plasma colloid osmotic pressure, Maintain hemostasis, Replace/Maintain blood volume

Identify 3 adverse effects that massive transfusion can have on the patient if the blood is transfused within 3-4 hours:

Coagulation abnormalities, Hypothermia, Citrate toxicity with hypocalcemia

What are coagulation abnormalities due to if blood is transfused within 3-4 hours?

Dilution of platelets/coagulation factors occurring within 2-3 volume exchanges, Consumption of platelets/coagulation factors from bleeding, Hypotension

4 causes of decreased red cell counts in chronic renal disease:

Decreased erythropoietin, Nutritional deficiencies, Blood loss, Uremic toxins suppressing bone marrow function