Hematology

Aim to maintain hemoglobin levels above 7.0.
Acknowledge risks: both hemolytic and non-hemolytic reactions may occur.
Monitor for Transfusion-Related Acute Lung Injury (TRALI).
Address coagulopathy by administering FFP and platelets alongside PRBCs.
Prevent hypothermia using a blood warmer during transfusion.
Be aware of potential hypocalcemia and hypomagnesemia due to citrate binding in transfused blood.
Reduced oxygen delivery to tissues can result from insufficient 2,3-DPG in stored blood.

Control the bleeding immediately.
Avoid the Deadly Triad:
- Acidosis
- Coagulopathy
- Hypothermia
Provide a balanced transfusion in a 1:1:1 ratio:
- Packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets.

DIC is a disorder of abnormal clotting and bleeding.

The coagulation system is excessively activated, leading to clot formation throughout the body.
As clotting factors are consumed, the body loses the ability to form stable clots, resulting in widespread bleeding.
DIC is always a secondary condition caused by an underlying issue, such as:
- Severe trauma
- Obstetric complications (e.g., amniotic fluid embolism, placental abruption)
- Aortic dissection
- Massive blood transfusions due to excessive bleeding
- Damage to blood vessel lining from conditions like cardiac arrest, sepsis, or abdominal aortic aneurysm (AAA)

Decreased platelet count (Plts)
Reduced hematocrit (Hct)
Lower fibrinogen levels
Elevated D-dimer (indicating high clot breakdown activity)
Prolonged clotting times:
- Increased prothrombin time (PT)
- Increased partial thromboplastin time (PTT)
- Increased international normalized ratio (INR)
Diagnostic Test:
- Increased fibrin degradation products (FDPs) along with high D-dimer levels

Address the underlying cause (e.g., treating sepsis, managing trauma).
Administer blood products (platelets, fresh frozen plasma, cryoprecipitate) as needed.
Provide vitamin K to aid in clotting factor synthesis.
Use low-dose heparin therapy to control excessive clotting while preventing further complications.

A reaction to heparin causing thrombosis and platelet consumption.
Clots can result in pulmonary embolism (PE), myocardial infarction (MI), or stroke.
Signs and Symptoms:
- Sudden drop in platelets (<150,000 or a decrease of 30-50%).
- Petechiae.
Treatment:
- Immediately discontinue heparin and switch to argatroban.
Monitoring:
- Monitor PTT levels.
- If platelets drop below 10,000, watch for decreased level of consciousness due to intracranial bleeding.

Hemodynamics Review

Heart Rate: 60-100 beats per minute
Blood Pressure:
- Systolic: 90-130 mmHg
- Diastolic: 60-90 mmHg
Mean Arterial Pressure: 70-100 mmHg
Cardiac Output: 4-8 L/min
Cardiac Index: 2.5-4.0 L/min/m²
Stroke Volume: 50-100 mL per beat
Stroke Index: 25-45 mL per beat/m²
Central Venous Pressure / Right Atrial Pressure: 2-6 mmHg
Pulmonary Artery Pressure:
- Systolic: 20-30 mmHg
- Diastolic: 8-15 mmHg
- Mean: <20 mmHg
Pulmonary Artery Occlusion Pressure: 8-12 mmHg
Systemic Vascular Resistance: 800-1200 dynes per second per cm⁵
Pulmonary Vascular Resistance: 50-250 dynes per second per cm⁵
Coronary Artery Perfusion Pressure: 60-80 mmHg
Mixed Venous Oxygen Saturation: 60-75%

Invasive Monitoring: Includes arterial line, central venous pressure (CVP), and Swan-Ganz catheter.
Preload Measures: CVP and PAOP/PAWP.
Afterload Measures: PVR and SVR.
Cardiac Output (CO): The volume of blood pumped by the heart per minute.
Systemic Vascular Resistance (SVR): The pressure the left ventricle must generate to eject blood.
Pulmonary Vascular Resistance (PVR): The pressure the right ventricle must generate to eject blood.
Mixed Venous Oxygen Saturation (SvO2): Indicates the balance between oxygen delivery and consumption.
Negative Inotropes: Decrease heart rate and contractility.
Positive Inotropes: Increase heart rate and contractility.

Crystalloids: 0.9% NS, LR, 5% Dextrose

Colloids: Albumin

Vasodilators:

Diuretics:

Positive Inotropes:

Negative Inotropes: