Hematocrit (H&H)

Thrombocytosis

high platelet count

What is HIT?

HIT is a syndrome characterized by more than a 50% decrease from baseline platelet count within 5-14 days of heparin exposure. HIT is an adverse reaction to heparin. It is prothrombotic disorder that occurs when there is an immune mediated hypersensitivity reaction to the heparin-platelet factor 4 complex.

Hemoglobin

A protein molecule inside the RBS, carries oxygen from the lungs to the body's tissues and returns carbon dioxide to the lungs for exrcretion. Oxygen dlivery is imparied when the Hgb is low or dysfunctional. Normal ranges Male 14-18 g/dL Female 12-16

Bilirubin and LDH are used to evaluate liver function and assess for hemolysis.

Bilirubin is primarily a product of Hgb degradation from the normal or abnormal destruction of erythrocytes. It is used to evaluate liver function. An elevation of indirect indicates hemolysis.

Platelets transfusion indications

For patients with chronic thrombocytopenia, the goal platelet count is greater than 10,000/mm3, unless there's active bleeding. For patients with thrombocytopenia at risk for spontaneous bleeding, the goal platelet count is greater than 100,000/mm3 or greater than 50,000/mm3 for active bleeding with surgery.

Common types of anemia seen in hospitalized patients

Iron Deficiency Anemia Anemia of Chronic Disease Acute Blood Loss Anemia Hemolytic Anemia

White blood cell

Normal range 5,000-10,000/mm3

Types of Blood Products

Packed RBCs FFP Platelets Cryoprecipitate

Platelet count

Platelets are cell fragments produced in the bone marrow. They contain proteins that allow them to stick to each other and to damaged vascular walls. They are the first line of defense against endothelial wall damage. They clump together, change their shape, and form a clot at the site of injury. Patient's taking medications such as aspirin and clopidogral will have dysfunctional platelets, even if their platelet count is normal. Normal range 150,000-400,000/mm3

Hematocrit

Reflects the RBC mass in relation to the volume of blood and is sensitive to volume status changes, such as hypovolemia. If a patient is dehydrated, the Hct may be falsely elevated. If the patient receives aggressive fluid resuscitation, the Hct will precipitously drop. Male 42%-52% Female: 37%-47%

Adverse Events

The signs and symptoms of a transfusion reaction can occur immediately during transfusion, or up to 24 hours after a transfusion. Mild signs and symptoms: Fever, chills, rash, itching Severe signs and symptoms: dyspnea, chest pain, back pain, tachycardia, hematuria

Pulmonary Edema

This occurs when there is an imbalance between fluid filtration and reabsorption, leading to an abnormal accumulation of extravascular lung water. Pulmonary edema may occur within six hours of the administration of blood transfusion.

D-Dimer

This test measures D-Dimer, a type of FSP that is produced when cross linked fibrin is broken. D-Dimer is an indicator of fibrinolysis. Elevated d-dimer levels are commonly seen in clots formed from VTE, DIC, Cancer states, and sickle cell crisis.

Anto-Xa

Used to mesure the anticoagulant effects of heparin, including both UFH and LMWH, and fondaparinux.

What is the correct order of interventions to assess and manage HIT?

1. Assess for a 50% drop in platelet count from baseline 2. Notify provider and stop all heparin products 3. Evaluate for thrombosis 4. Start DTI if no contraindications 5. Transition to an oral anticoagulant

Thrombocytopenia treatment is aimed at correcting the underlying cause

1. Control bleeding 2. Treat the infection 3. Discontinue agent: discontinue the medication likely responsible for thrombocytopenia and remove any other medications that can cause thrombocytopenia. 4. Transfuse Platelets To gauge a patient's response to platelet transfusion, monitor bleeding and vital signs for stabilization, along with the platelet count.

Thrombocytopenia

low platelet count

Thrombocyte

Another word for platelet

Half life of warfarin

36-42 hours, with a peak effect up to 72 hours after administration.

Anemia

Anemia is not a disease but a manifestation of another disorder. It occurs when there is a decrease in the number of circulating red blood cells, hemoglobin concentration, or both.

Patient at risk for thrombocytopenia

Bacterial infections, viral infections, liver failure, bone marrow toxicity, alchohol abuse, leukemias, and cancer infiltrations

FFP transfusion indications

Contains all clotting factors except for fibrinogen. The recommended dose is 10-30 mL/kg, which will increase factor levels by20-30% The decision to tranfuse FFP should be based upon patient symptoms and not upon an isolated value, such as an INR greater than 4. Indications for the transfusion of FFP may include: Active bleeding, high risk of bleeding with a planned procedure, the need to reverse anticoagulants

what is DIC?

DIC is a syndrome associated with a variety of conditions, such as sepsis and cancers, that results in systemic activation of both clotting and fibrinolysis.