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4th semester test 4

forward grouping test the patient's RBCs are mixed with reagent anti-A and anti-B anti-sera. Agglutination indicates a positive test.
reverse grouping test the patient's plasma is mixed with reagent A and B RBCs. Agglutination indicates a positive test.
Immediate spin crossmatch this test which takes 5-10 minutes is performed at room temperature and confirms ABO compatibility as the patient’s plasma is tested against donor RBCs and observed for agglutination and/or hemolysis.
Antiglobulin crossmatch this test which takes 30-60 minutes is performed at 37°C and an antiglobulin test is carried out on the mixture of patient’s plasma and donor RBCs to check for agglutination. This test is mandatory for patients with RBC alloantibodies.
electronic crossmatch a computer matches compatible units of blood from the blood bank to patients directly.
Each unit of blood is screened for the following transmissible diseases: Hepatitis B Hepatitis C West Nile Virus Human Immunodeficiency Virus (HIV-1 and HIV-2) Human T-Cell Lymphotropic Virus (HTLV-I and HTLV-II) Syphilis
Red Blood Cells Red blood cells are indicated for the patient with increasing oxygen demands, for example in a case of acute blood loss. Normally, a rise in hemoglobin concentration of about 10 g/L is expected with every unit of red cells transfused into an adult.
Platelet Concentrations in the setting of bleeding secondary to thrombocytopenia, platelets should be transfused prophylactically in the patient whose platelet count is <10 Each unit of platelets contains a small volume of RBCs.
Frozen Plasma Reversal of warfarin therapy in the patient with life-threatening bleeding or undergoing emergency surgery. Active bleeding or major surgery with a PT or PTT 1.5 times normal Patients with liver disease related coagulopathy for certain procedures.
Rh negative women should be given Rh immunoglobulin if receiving an Rh positive platelet transfusion to prevent hemolytic disease of the newborn in future pregnancies
Cryoprecipitate Cryoprecipitate is a rich source of fibrinogen and also contains VWF, Factor VIII and XIII. Microvascular or massive bleeding in patients with either a clinical picture suggestive of a low fibrinogen concentration (for example DIC)
acute hemolytic transfusion reaction (AHTR). acute hemolytic transfusion reaction (AHTR). The most common cause for AHTRs remains patient misidentification and clerical error The classical signs and symptoms of an AHTR include fever, chills and hemoglobinuria. BACK PAIN VERY COMMON
AHTR acute hemolytic transfusion reaction A suspicion of AHTR may be confirmed by laboratory results showing a positive DAT, hemoglobinemia, hemoglobinuria, reduced haptoglobin, elevated bilirubin, elevated urine hemosiderin and renal abnormalities
TRALI Transfusion-related acute lung injury
Transfusion-related acute lung injury (TRALI) an acute respiratory distress syndrome secondary to transfusion of blood products and causes hypoxia and bilateral non-cardiogenic pulmonary edema. Symptoms include dyspnea, hypoxemia, hypotension and fever.
TACO Transfusion-associated circulatory overload
Transfusion-associated circulatory overload (TACO) a volume overload resulting from impaired cardiac function and/or too rapid a rate of transfusion. Symptoms include dyspnea, hypoxemia, hypertension and tachycardia.
Volume expanders crystalloid or colloid solutions can be used when it is necessary to increase blood volume but an increase in the number of blood cells is not indicated.
Growth factors naturally occurring hormones that can be made in the laboratory and can be used to increase the population of certain cell lines when given to a patient.
febrile nonhemolytic transfusion reaction (FNHTR). defined as an otherwise unexplained rise in temperature of at least 1 C during or after transfusion with a blood product.
FNHTR a febrile non-hemolytic transfusion reaction
Disseminated Intravascular Coagulation Syndrome of diffuse clotting and simultaneous hemorrhage What triggers Inappropriate/Excessive Clotting
Conditions That Increase Risk for DIC Arterial hypotension Hypoxemia Acidemia Liver dysfunction Patients with cancer
Signs/Symptoms of DIC Bleeding First and most obvious sign May develop in GI tract, GU tract, or CNS as well May go into shock Clotting Thrombosis – might see some cynosis on extremititys
Lab Values for DIC Clotting factors decrease See prolonged Prothrombin time or INR Activated partial thromboplastin time Low platelet count and fibrinogen levels D-dimer test - strong indicator
Commonly Ordered Therapies for DIC Packed red blood cells Fresh frozen plasma Cryoprecipitate Platelet transfusions Heparin
To interrupt the complex cycle of DIC Inhibitors of fibrinolysis - amicore Epsilon-aminocaproic acid Recombinant human activated protein C (xigris) To restore the normal physiologic anticoagulant pathway Antithrombin concentrate Undergoing investigation
Immunologic Role of Neutrophils Neutrophils make up about 55% to 70% of the total WBC count Their primary function is phagocytosis – they engulf and digest microorganisms and cell fragments
immature neutrophil forms Called bands or stab cells
Neutropenia refers to an abnormally low ANC Normally, the ANC exceeds 2,500/mm3 A value above 1,000/mm3 usually means it is safe to continue chemotherapy A value below 1,000/mm3 sharply increases the risk of infection
ANC By percent of neutrophils Multiply the white blood cell (WBC) count by the percent of neutrophils as listed on the WBC differential using this formula ANC = WBC X (% neutrophils + % bands)
ANC By Absolute Numbers Alternatively, if the lab report shows absolute numbers in addition to percentages (as most reports do), you can calculate ANC using this formula ANC = (absolute neutrophils + absolute bands) X 1,000
Neutrophils “Shift to left” when increased immature cells released from bone marrow Nucleus of neutrophil is segmented, thus nickname “segs” Have strong phagocytic activity and involved in acute inflammatory responses
Eosinophils Engulf antigen-antibody complexes formed during allergic response
Anemia A condition in which the hemoglobin content of the blood is insufficient to satisfy bodily demands decrease in the number of circulating RBCs insufficient or defective hemoglobin
Heparin Induced Thrombocytopenia Type I – most common Type 2 – Platelet clumps Watch platelet counts (50% reduction to 100,000) Stop heparin Use Direct Thrombin Inhibitors (DTI’s) Binds the thrombin molecule Lepirudin (Refudan) a yeast derivative Argatroban (Argatraban)
Disseminated Intravascular Coagulation Characterized by the simultaneous blood clotting and hemorrhage in the vascular system Precipitated by: disease processes, trauma, infections, and obstetric complications such as shock with arterial hypotension, decreased oxygen in circulating blood, stasis of capillary blood flow, and acidemia
The Complement System proteins can quickly reach the site of an invasion where they can react directly with antigens - When activated, the complement proteins can trigger inflammation   Attract macrophages & coat intruders so that macrophages devour them kill intruders
Granulocyte attack any invaders in large numbers, and consume the invaders until they die. The pus in an infected wound consists chiefly of dead granulocytes.
Neutrophils most important but short life span 24 – 48 hrs. Pus – dead neutrophils . Produced in the bone marrow. Immature neutrophils are bands. Shift to the left (immature neutrophils – happens during an infection.)
Metaplasia reversible transformation from one type of cell to another
Dysplasia abnormal differentiation
Anaplasia cell differentiation to a more immature form
West Nile Virus Mild symptoms include: A fever. Headaches, body aches, or pain in your eyes. A rash, usually on the chest, back, and arms. Feeling very tired. Not feeling hungry. Nausea. Swollen glands ( lymph nodes ), in rare cases.
West Nile Virus Recovery Most of the time, people fully recover from it. But permanent problems such as seizures, memory loss, and brain damage can occur, especially in children and older people. The older the patient the more risk
Nonsteroidal anti-inflammatory drugs (NSAIDs) aspirin, celecoxib (Celebrex). diclofenac (Voltaren), diflunisal (Dolobid) etodolac (Lodine) ibuprofen (Indocin) (Orudis) (Toradol) (Relafen) naproxen, Naprosyn)oxaprozin (Daypro)(Feldene)salsalate (Amigesic) (Clinoril) (Tolectin Celecoxib (Celebrex)
Systemic glycocorticoids prednisone, prednisolone, methylprednisolone, beclamethasone, betamethasone, dexamethasone, fludrocortisone, hydrocortisone and triamcinolone.
Allergy Drugs H1 receptor antagonists (antihistamines) serves to reduce or eliminate effects mediated by histamine Diphenhydramine (Benadryl, others) Fexofenadine (Allegra
Intranasal glucocorticoids Fluticasone (Flonase)
Sympathomimetic Oxymetazoline (Afrin, others)
Anaphylaxis Drugs Epinephrine (Adrenalin)
Antifungal Drugs Agents for systemic infections Amphotericin B (Fungizone) Fluconazole (Diflucan) Agents for topical infection Nystatin (mycostatin
Antiprotozoan Drugs Antimalarial agents Chloroquine (Aralen) Nonmalarial antiprotozoan agents Metronidazole (Flagyl)
Antihelmintic Drugs Mebendazole (Vermox)
Chloroquine used to treat and prevent malaria caused by Plasmodium malariae. It is also used in rheumatoid arthritis and discoid lupus. It is taken up inside the infected erythrocyte and interrupts the synthesis of RNA and DNA.
Chloroquine (Aralen) Common adverse effects hypotension, EKG changes, nausea, vomiting, diarrhea, abdominal pain, and discolored urine. Have patient take with food to minimize GI problems. Encourage patients to change positions slowly to minimize symptoms of hypotension.
Metronidazole, (Flagyl) a synthetic antibacterial and antiprotozoal drug, is used to treat various organisms causing infection.
Pentamidine used to prevent or treat Pneumocystis carinii pneumonia (PCP).
Amphotericin B a polyene antifungal, is fungicidal or fungistatic, and works by binding to membrane sterols in fungal cell membranes, resulting in increased cell permeability, cell leakage, and death.
Adverse effects of amphotericin B nephrotoxicity (in more than 80% of patients), infusion-related reactions, electrolyte abnormalities, anemia, leukopenia, thrombocytope­nia, and others.
Nystatin, an antifungal related to amphotericin B, is not used for systemic infections. It is used to treat topical, vaginal, and oral fungal infections. Oral suspension of nystatin should be swished through the mouth and then swallowed or spit out, as directed by prescriber. Oral troches should be dissolved in mouth.
Fluconazole used to treat esophageal, oropharyngeal, and vulvovaginal candidiasis, and in systemic fungal infections where the patient cannot tolerate amphotericin B. It may be used prophylactically in immunocompromised patients.
Mebendazole (Vermox) an oral broad-spectrum synthetic antihelminthic that treat cestodes and nematodes, and enterobiasis. Common adverse effects are transient GI, CNS, and fever during expulsion of worms. serious adverse effects are blood abnormalities and hepatotoxicity.
Lindane, antiectoparasitic drug, is used to treat scabies and pediculosis.
Characteristics of Cancer Cells Cancer cells can divide without appropriate external signals Cancer cells do not exhibit contact inhibition Cancer cells can divide without receiving the 'all clear' signal
Proto-oncogene Genetic portion of DNA that regulates normal cell growth
Oncogene Altered forms of proto-oncogenes, give rise to cancer
Example of Oncogenes HER-2/neu – Breast cancer RAS – transcription error MYC BCL-2 SRC – first one discovered hTERT - telomorase protien that adds telomeres to the chormosome ends so cells continue to divide.
Telomeres The end segments of chromosomes believed to determine cellular life span
Tumor Suppressor Genes p53 (TP53): a transcription factor that regulates cell division Rb: alters the activity of trancription factors and therefore controls cell division APC: contols the availability of a transcription factor BRCA: involved in DNA repair
cancer results from genetic alterations in multiple genes
Cancer cells look & act different Divide continually (given space and nutrients) Heritable mutations: Transplantable Dedifferentiated: Different appearance: Lack contact inhibition: Induce angiogenesis (local blood vessel formation) Increased mutation rate Invasive: Metasta
Staging - T TNM tumor system utilized for classifying tumors T indicates tumor size T0 indicates no evidence of tumor Tis indicates tumor in situ T1, T2, T3, T4 indicate progressive degrees of tumor size and involvement
Staging - N indicates lymph node involvement N0 indicates no abnormal lymph nodes detected N1a, N2a indicate regional nodes involved with increasing degree from N1a to N2a no metastases detected
N1b, N2b, N3b indicates regional lymph nodes involvement with increasing degree from N1b to N3b metastasis suspected Nx indicates inability to assess regional nodes
M indicates distant metastases M0 indicates no evidence of distant metastasis M1, M2, M3 indicate ascending degrees of distant metastasis and includes distant lymph nodes
Mitotic inhibitors Vincristin (Oncovin) affect the M phase
Antimetabolites Fluorouracil (Adrucil) most effective during S phase
Alkylating agents Cyclophosphamide (Cytoxan) generally independent of the phases of the cell cycle
Diabetes mellitus type I more common in young persons that can occur at any age. Accounts for 5 to 10% of all types of diabetes. Absent Or minimal insulin production. insulin is required. Environmental factors, viruses and toxins
type II diabetes mellitus onset usually 35 years or older but can occur at any age. Accounts for 90% of all types of diabetes. Environmental factors obesity and lack of exercise. Frequently no symptoms. Sometimes, fatigue or recurrent infections.
Metformin (Glucophage) inhibits production of glucose by liver, increases bodies tissue sensitivity to insulin, used in type II diabetes to control blood glucose levels. Patients taking metformin are at risk for acute renal failure and lactic acidosis caution with contrast
acarbose (Precose) delays absorption of complex carbohydrates and intestines and slows entry of glucose into the systemic circulation. Must be taken with 1st bite of food to be effective.
Glyburide (Diabeta) stimulates beta cells of pancreas to secrete insulin. Used in type II diabetes. Monitor patient for hypoglycemia. Monitor blood glucose and urine ketone levels to assess effectiveness of therapy.
Neuropathy nerve damage that occurs because of the metabolic derangements associated with diabetes mellitus
diabetic foot care wash feet daily with mild soap and warm water. Pat feet dry gently especially between toes. Examine feet daily for cats, blisters, swelling, and red, tender areas. Use mild foot powder and sweaty feet. Do not go barefoot.
Rapid acting insulin - Humalog, onset - 15 min. Peaked: 60 to 90 min. Duration: 3 to 4 hours
short acting insulin - regular onset: 1/2 to 1 hour Peak: 2 to 3 hours. Duration: 3 to 6 hours
intermediate acting insulin - NPH Onset: 2 to 4 hours. Peak: 4 to 10 hours duration: 10 to 16 hours
long-acting insulin onset 1 to 2 hours Peak: no pronounced peak duration: 24+ hours
diabetic ketoacidosis. Acute complication of insulin-dependent diabetes characterized by hyperglycemia ketosis metabolic acidosis with resulted dehydration and electrolyte imbalance. Triggers: stress, surgery, infection, analgesics, psychogenic medications, inadequate insulin
pathophysiology of diabetic ketoacidosis not enough insulin, glucose cannot be used, body uses fat, ketones formed from fat metabolism, ketosis alters the pH balance, metabolic acidosis, depleted electrolytes.
Clinical manifestations of diabetic ketoacidosis lethargy and weakness, dehydration, abdominal pain (may be accompanied by anorexia and vomiting) kissable respirations, sweet, fruity breath, blood glucose level above 300, pH below 7.3 bicarb less than 15, ketones in blood and urine.
Hyperglycemic hyperosmolar non-ketotic associated with non-insulin-dependent diabetes type II. Precipitated often by illness, physical or emotional stressors trauma or surgery increased HCT due to hemo concentration,Mild acidosis, Anion gap Usually greater than 15
pathophysiology of hyperglycemic hyperosmolar nonketotic type II diabetes, able to produce enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia osmotic diuresis Extracellular and fluid depletion. ketone bodies are absent or minimal in both blood and urine. glucose usually over 400
Treatment for hyperglycemic hyperosmolar nonon-ketotic fluid replacement is vital, glucose should be lowered gradually with regular insulin, hourly finger sticks, the management for both DKA and HHS is similar, except that HHS requires greater fluid replacement.
Hypoglycemia low blood sugar cognitive and perceptual changes usually 1st, headache impaired mentation, irritability, inability to concentrate, dizziness, shaky, sweaty, cool clammy skin. Check blood glucose gives simple, fast acting carbohydrates
hyperglycemia - high blood sugar polyuria, polydipsia, polyphase yet, weakness, lethargy, malaise, blurring of vision, or headache.
Pheochromocytoma tumor in the adrenal Padula, which secretes inappropriately high amounts of epinephrine and/or norepinephrine. Stimulation of tumor may result in life-threatening high blood pressure and heart rate. Tx: adrenal ectomy; postop - monitor for hypotension.
Treatment for pheochromocytoma primary treatment consists of surgical removal of the tumor.
Nicardipine (cardene) calcium channel blocker used to control blood pressure and other excessive catecholamine symptoms
phenoxybenzamine (Dibenzyline) reduce BP and alleviate other symptoms of catecholamine excess
prazosin (Minipress) reduce blood pressure and alleviate other symptoms of catecholamine excess.
Diabetes insipidus associated with a deficiency of production or secretions of ADH or a decreased renal response to ADH. The decrease in ADH results in fluid and electrolyte imbalances caused by increased urinary output and increase plasma osmolality.
Signs and symptoms of diabetes insipidus extremely high urine output predisposing to hypovolemia and shock. Polyuria, dry mucous membranes, poor skin turgor, excessive thirst, increased appetite, generalized weakness. Increased serum osmolality and sodium, increased Hematocrit/hemoglobin
Diabetes insipidus treatment treat primary cause, eyes and nose, daily weights, monitor, CBC, electrolytes, administer ADH: desmopressin (DDAVP) can be taken orally are intranasally, headache, nausea and other signs of hyponatremia may indicate overdosage
hyperthyroidism hyperactivity of the thyroid gland. Graves' disease, Thyroid storm, medications PTU - results in rapid reduction of circulating thyroid hormone, Methimazole (Tapazole)
thyroidectomy care assess patient every 2 hours for 1st 24 hours for signs of hemorrhage or tracheal compression monitor vital signs, check for trousseau sign and Chvostek's sign.
hypothyroidism results from insufficient circulating thyroid hormone. As a result of a variety of abnormalities
signs and symptoms of hypothyroidism intolerance to cold, receding hairline, facial edema, extreme fatigue, thick tongue and slow speech, brittle hair and nails, constipation, muscle aches and weakness, lethargy, apathy, hair loss
signs and symptoms ofhyperthyroidism Intolerance to heat, find street here, bulging eyes, facial flushing, enlarged thyroid, tachycardia, breast enlargement, weight loss, muscle wasting, diarrhea, tremors, finger clubbing
Myexedema Coma hypothyroid symptoms may progress to a notable impairment of consciousness or coma. Can be precipitated by infection, drugs, exposure to cold, and trauma. It is characterized by sub normal temperatures, hypotension, and hypoventilation.
Levothyroxine (Synthroid) dose based on age, weight, and cardiac status; take an empty stomach and monitor TSH levels.
Hyperparathyroidism a condition involving an increased secretion of parathyroid hormone PTH helps regulate calcium and phosphate levels by stimulating bone reabsorption of calcium, renal tubular reabsorption of calcium, and activation of vitamin D
Cushing's syndrome(excessive corticosteroids) personality changes, hyperglycemia, irritability, moon phase, increased susceptibility to infection, sodium and fluid retention, through thin extremities, G.I. distress, osteoporosis, thin-skinned, bruises and petechiae
Addison's disease (adrenocortical insufficiency) Disease often advanced before diagnosed, manifestations have insidious onset progressive weakness, fatigue, weight loss, and anorexia. Skin hyperpigmentation, hyponatremia hyperkalemia
adisonian crisis acute adrenal insufficiency and need for adrenocortical steroids exceeds availability symptoms: tachycardia, hypovolemia, hyponatremia, hyperkalemia treatment: replace steroids, large volumes of 0.9% saline and 5% dextrose
acute pancreatitis abdominal pain is the predominant symptom usually located in the left upper quadrant but may be med epigastric
acute pancreatitis diagnostic testing serum amylase and lipase. The serum amylase level is usually elevated early in remains elevated for 24 to 72 hours. Hey LT greater than 150 has a positive predictive value for acute gallstone pancreatitis.
Cirrhosis of the liver a chronic, progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells.
Hepatic encephalopathy a neuropsychiatric manifestation of liver damage.it is considered a terminal complication in liver disease. Hepatic encephalopathy can occur in any condition in which liver damage causes ammonia to enter systemic circulation without liver detoxification.
Clinical manifestations of hepatic encephalopathy changes in neurologic and mental responsiveness, ranging from sleep disturbances to lethargy to deep coma. Characteristics symptom is asterixis (flapping tremor's)
Apheresis A blood component removed from blood using a cell separator Remaining blood components returned to donor or patient Many types available to treat various conditions
Erythrocytopheresis (RBC exchange) Removes RBCs while giving replacement RBC infusions. Commonly used with sickle-cell disease, thalassemia, malaria. Also may be performed before bone marrow or stem cell transplant in patients with ABO incompatibility
Plasmapheresis (plasma exchange) Removal of plasma which is replaced with another fluid based on component being removed and disease being treated, i.e. Guillian-Barre syndrome. Replaces plasma with FFP providing necessary clotting factors without increasing fluid load
Leukopheresis (leukocyte depletion) Brings WBC counts down to acceptable levels before chemotherapy and prevents or lessens tumor lysis syndrome from chemotherapy
Plateletpheresis (platelet depletion) Reduce platelet levels to acceptable levels before chemotherapy. Excess platelets can occur in thrombocytosis, some leukemias and rarely after splenectomy
function of monocyte phagocytic cell in the blood, leaves blood and becomes a macrophage which phagocites bacteria, dead cells, cell fragments, and other debris within tissues
HLA (Human Leukocyte Antigens) Cell markers that appear on the surface of white blood cells and aid the immune system in normal functioning. The markers are encoded by genes in human DNA. Certain HLA markers are more commonly found in those people prone to autoimmune diseases
Zidovudine (Retrovir, AZT) Nucleoside and nucleotide reverse transcriptase inhibitor
Nevirapine (Viramune) Nonnucleoside reverse transcriptase inhibitors
Saquinavir mesylate (Fortovase, Invirase) Protease inhibitors
Agents for herpes viruses Acyclovir (Zovirax) an antiviral drug, competes for a position in the DNA chain of the herpes virus and then terminates DNA synthesis.
Agents for influenza oseltamivir phosphate (Tamiflu) Zanamivar (Relenza)
Agents for hepatitis Interferons noninterferons
Penicillin bactericidal, inhibiting the bacterial cell wall synthe­sis. It is commonly used PO and IV, although it is the antibiotic with the most frequent allergic reactions.
Cefazolin a cephalosporin, is bactericidal, which prevents the bacteria from biosynthesiz­ing the cell wall framework, causing them to swell and burst. It has similar chemical structure to penicillins and may have cross-sensitivity.
Ciprofloxacin is bactericidal, and works by inhibiting DNA gyrase, an enzyme needed for bacterial DNA replication. It has a prolonged postantibiotic effect. Oral therapy is as effective as IV therapy of other antibiotics; give PO doses on empty stomach.
Gentamicin works by entering the bacterial cell and binding to ribosomes; this causes the cell to produce amino acids that do not link correctly, thus preventing bacterial reproduction. Gentamicin is reserved for serious infections due to severe adverse effects
Erythromycin bactericidal and bacteriostatic; it binds to the bacterial cell membrane causing a change in protein function and either prevents the cell from dividing or causes cell death. It is the drug of choice for penicillin-allergic patients.
Clindamycin is bactericidal. Used to treat serious to life-threatening infections, it works by entering the bacterial cell, binding to bacterial ribosomes, suppressing protein synthesis, and causing cell death.
Tetracycline bacteriostatic, retarding bacterial growth by inhibiting protein synthesis and preventing cell division and replication. It is used to treat a variety of serious infections, acne vulgaris, and chlamydia
Vancomycin inhibits cell wall synthesis by altering the cell's permeability. It also inhibits the synthesis of RNA. Because of serious toxicity, vancomycin is used only in serious infections when other antibiotics have not been successful.
Sulfamethoxazole-trimethoprim used to treat a variety of organisms and illnesses, including UTIs and respiratory infections (such as Pneumocystis carinii pneumonia seen in HIV and AIDS).
Isoniazid an antitubercular, is bactericidal or bacteriostatic; it works by disrupting the synthesis of the tuberculin bacterial cell wall. It can be used alone as prophylaxis or with other drugs as prophylaxis or treatment of TB.
Created by: kcorkinsnctc