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5-1). The extrinsic pathway involves exposure of plasma and, in particular, factor VIIa to tissue factor, a lipoprotein that is found only in extravascular tissues. The physiologic events that lead to intrinsic pathway initiation have not been elucidated thus far. , factors V and VIII), phospholipids from platelet and endothelial cell surfaces, and calcium are required for normal coagulation. Deficiencies of any of the coagulation factors (except factor XII, high–molecular-weight kininogen, and prekallikrein) can lead to abnormal bleeding.

These patients should receive IgA-deficient blood or washed RBCs. o. ), epinephrine, and glucocorticoid therapy. Meperidine (25–100 mg) is particularly helpful for shaking chills associated with transfusion reactions. ) should be used before future transfusions in patients who have experienced severe reactions. 4. Noncardiogenic pulmonary edema can be caused by preformed antileukocyte antibodies in the donor unit. This condition is transient and is managed with supportive care. 5. GVHD can occur after transfusion of immunocompetent T cells into immunocompromised recipients or human leukocyte antigen–identical family members.

Dialysis can be considered in the volume-overloaded patient with renal failure and intractable metabolic alkalosis. C. Primary respiratory disorders 1. Respiratory acidosis occurs when alveolar ventilation is insufficient to excrete metabolically produced CO 2. , drugs, organic disease), neuromuscular disorders, and cardiopulmonary arrest. Chronic respiratory acidosis may occur in pulmonary diseases, such as chronic emphysema and bronchitis. , pickwickian syndrome) or from thoracic skeletal abnormalities.

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