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Flashcards in Anemia and coagulopathy Deck (100)
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1

What are some questions you might want to ask in regards to hematology?

Have you ever had a blood problem? Anemia? Leukemia?

Any clotting problems? Lots of bleeding from cuts, nosebleeds, surgery, dental work?

Have you ever required a blood transfusion?

Has a family member/blood relative ever had a serious bleeding condition or clotting problem?

2

What common medications would make you concerned in terms of possible hematological problems?

Aspirin/NSAIDS, Vitamin E, Ginseng, Gingko, Garlic, Saw Palmetto. How often, how much, and last dose?

3

Types of amenia

Acute- Acute blood loss

Chronic-
Nutritional
Hemolytic
Aplastic
Manifestation of another disease
Abnormal RBC structure (SS, Thalassemia)

4

What are the CLINICAL manifestations of amenia

Decreased oxygen carrying capacity and the accompanying decreased tissue oxygen delivery

5

What defines O2 carrying capacity

Hgb.

Anemia decreases it.

6

Bonus- What are the B/G coefficients of the common volatile agents?

N20- 0.47
Halothane- 2.3
Enflurane- 1.8
Isoflurane- 1.4
Sevoflurane- 0.69
Desflurane- 0.42

7

In anemia treatment, what two things must be considered

Treatment of the underlying cause, as well as the state of anemia itself

8

Calculation of arterial blood oxygen content

CaO2= (Hgb*1.39)SaO2+PaO2(0.003)

9

Compensation mechanisms for anemia

Increase CO
Increase 2,3-dpg
Increase plasma volume

Decreased blood viscosity
Decreased SVR

Blood shunting to organs with higher extraction ratios

10

In anemia, the oxy-hemoglobin dissociation curve...

Shifts to the RIGHT

11

Methemoglobin resembles a shift to

the LEFT

12

Curve shifts to the right are seen with

Decreased pH
Hgb variants with decreased oxygen affinity (fetal Hgb)
Increased 2,3-dpg
Increased Temp

13

Curve shifts to the left are seen with

Increased pH
High oxygen affinity Hgb variants
Decreased 2,3-dpg
Decreased Temp

14

Suspicion of anemia begins around

Hgb

15

What is the most effective treatment for anemia

Treating the underlying cause

16

Bonus- What are the maximum doses for Bupivacaine and Lidocaine?

Bupivacaine- 2.5mg/kg

Lidocaine- 4mg/kg (7 with epi)

17

In managing a pt with chronic anemia, what do we really want to avoid?

Disrupting their compensation methods. For example, most don't do well with alkalosis.

18

Anesthesia considerations for chronic anemia

Maximize O2 delivery- high FiO2

Avoid drug induced decrease in CO- consider etomidate induction, high opioid maintenance, hydrate/avoid hypovolemia

Avoid left shifts- no hyperventilation, no hypothermia

19

How do volatile agent kinetics change in a patient with anemia?

Lower B/G coefficient, faster on/off, may need less gas

20

In an anemic patient, what often offsets the lower B/G coefficient in regards to inhaled agents

Increased CO (That's Pharm and Coexisting colliding...)

21

What are the two possible goals of transfusion therapy?

Increase O2 carrying capacity

Correct a coagulation disorder

22

1 unit of RBCs will increase Hct by how much

3-5%

23

Nutritional anemias

Iron deficiency
Folic acid deficiency
B12 deficiency
Chronic illness (infections, cancer, RF, DM, AIDS, connective tissue disorders)

24

Iron deficiency anemia-
RBCs are?
Common causes in adults?

Microcytic (also hypochromic, right?)

In adults, depletion of iron stores is caused by chronic blood loss (GI bleed, menorrhagia, cancer)

Most common form of nutritional anemia in children

25

B12-def. anemia (pernicious)-
RBCs are?
May result in-

Macrocytic (Megaloblastic bone marrow)

Bilateral peripheral neuropathy
Loss of proprioception/vibratory sensation in lower limbs
Decreased tendon reflexes
Unsteady gait
Memory impairment/mental depression

26

Anesthesia considerations for pernicious anemia

Avoid regional blocks (neuropathys)
Avoid N2O (binds B12)
Maintain oxygenation
Emergency correction for surgery is RBC transfusion

27

Folic acid deficiency anemia-
RBCs are?
May result in-

Same are B12

Smooth tongue
Hyperpigmentation
Mental depression
Peripheral edema
Liver dysfunction
Severely ill patient

28

Anesthesia considerations for folic acid def. anemia

Thorough airway assessment- Have an alternative airway plan in place, often have difficult airways

29

Glucose-6-Phosphate dehydrogenase deficiency (hemolytic)- What is it? Who does it affect? What should you avoid?

Most common enzymopathy, leaves RBCs susceptible to oxidation. Acute and chronic episodes. Increased rigidity of RBCs, increased clearance.

Blacks, Asians, Mediterranean populations

Avoid oxidative drugs (LAs, Benzos, Meth. Blue)
Avoid hypothermia, acidosis, hyperglycemia, infection

30

Pyruvate kinase deficiency (hemolytic)

Deficiency of glycolic enzyme leads to K+ leak, results in rigid RBC and increased clearance.

2,3-dpg accumulates, causes right shift