CCRN Exam Review Hematology Concepts

what reverses heparin?

Protamine

what reverses warfarin?

Vitamin K

Disseminated Intravascular Coagulopathy (DIC) definition

a complex condition caused by activation of clotting (fibrinolytic system) with resultant consumption of clotting factors results in deposition of thrombi in microvasculature (microembolism) and consumption of clotting factors (hemorrhage)

DIC is primarily a ____ problem, not a ____ problem

clotting problem not a bleeding problem

Lab values of DIC

decre platelets decre fibrinogen decre hematocrit incr FSP (D/T incr fibrinolysis) incr PT, PTT, INR and bleeding time incr D-dimer assesses presence of clotting, incr Antithrombin III

Etiology of Heparin induced thrombocytopenia

due to an immune (IgG) response results in thrombis (white clots) that consume platelets

etiology of DIC

endothelial damage from sepsis, hypoexmia, shock, ARDS, AAA, acidemia, cardiopulmonary arest release of tissue thromboplastin from extensive trauma, malignancies, OB emergencies, and dissecting aortic aneurysm Factor X activation from acute pancreatitis and liver disease massive transfusion, PE, hemolytic anemia, fresh H2O drowning, ASA poisoning

S/S of ITP

expected: petechiae, purpura, and easy bruising common: epistaxis, gingival bleeding, menorrhagia rare: GI bleeding, hematuria, intracranial hemorrhage

Immune (idiopathic) thrombocytopenic purpura (ITP) definition

only a decrease in platelets is present, rest of the blood count is normal drugs that lead to thrombocytopenis and other clinical conditions are not present

bleeding time measures

platelet function (how well platelets work)

platelet count measures

platelet quantity

S/S of HIT

platelets decrease to <150,000 or precipitously drop to 30% or 50% early sign- petechiae clots may lead to PE, MI, stroke, amputation frequently unrecognized

DIC is always ____ to another problem

secondary

Treatment of HIT

stop heparin test for heparin antibodies (ELISA), but do not wait for test results to stop heparin and start treatment start direct thrombin inhibitor and continue until platelets stabilize, monitor PTTs, start warfarin platelets <10,000, monitor for changes in LOC (intracranial bleed)

S/S of transfusion reaction

tachypnea dyspnea wheezing hypoxia stridor tachycardia bradycardia hypertension hypotension JVD arrhythmia fever chills rigors N/V pruritus flushing cyanosis HA

definition of plasmapheresis

the filtering and separation of plasma from whole blood via semipermeable membranes, done via a central line similar to the catheters used for HD

extrinsive coagulation pathway is stimulated by ____. Examples?

tissue injury, releases "tissue thromboplastin" extensive trauma OB emergencies malignancies dissecting aortic aneurysm extensive MI

treatment of DIC

treat and eliminate underlying cause vitamin K blood component therapy (FFP, cryoprecipitate, platelets) low dose heparin is controversial but may be used for patients with chronic, low grade DIC who have predominantly thrombotic manifestations maintain hemodynamic stability

intrinsic coagulation pathway is stimulated by ____. Examples?

vascular endothelium injury cell trauma (Vavle, IABP) sepsis shock ARDS hypoxemia, acidemia cardiopulmonary arrest

____ must be elevated; however it is not a definitive test for DIC

D-dimer

elevated ____ is the definitive lab test for the presence of DIC

FSP