Flashcards in Anemia and coagulopathy Deck (100)
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?
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?
Types of amenia
Acute- Acute blood loss
Manifestation of another disease
Abnormal RBC structure (SS, Thalassemia)
What are the CLINICAL manifestations of amenia
Decreased oxygen carrying capacity and the accompanying decreased tissue oxygen delivery
What defines O2 carrying capacity
Anemia decreases it.
Bonus- What are the B/G coefficients of the common volatile agents?
In anemia treatment, what two things must be considered
Treatment of the underlying cause, as well as the state of anemia itself
Calculation of arterial blood oxygen content
Compensation mechanisms for anemia
Increase plasma volume
Decreased blood viscosity
Blood shunting to organs with higher extraction ratios
In anemia, the oxy-hemoglobin dissociation curve...
Shifts to the RIGHT
Methemoglobin resembles a shift to
Curve shifts to the right are seen with
Hgb variants with decreased oxygen affinity (fetal Hgb)
Curve shifts to the left are seen with
High oxygen affinity Hgb variants
Suspicion of anemia begins around
What is the most effective treatment for anemia
Treating the underlying cause
Bonus- What are the maximum doses for Bupivacaine and Lidocaine?
Lidocaine- 4mg/kg (7 with epi)
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.
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
How do volatile agent kinetics change in a patient with anemia?
Lower B/G coefficient, faster on/off, may need less gas
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...)
What are the two possible goals of transfusion therapy?
Increase O2 carrying capacity
Correct a coagulation disorder
1 unit of RBCs will increase Hct by how much
Folic acid deficiency
Chronic illness (infections, cancer, RF, DM, AIDS, connective tissue disorders)
Iron deficiency anemia-
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
B12-def. anemia (pernicious)-
May result in-
Macrocytic (Megaloblastic bone marrow)
Bilateral peripheral neuropathy
Loss of proprioception/vibratory sensation in lower limbs
Decreased tendon reflexes
Memory impairment/mental depression
Anesthesia considerations for pernicious anemia
Avoid regional blocks (neuropathys)
Avoid N2O (binds B12)
Emergency correction for surgery is RBC transfusion
Folic acid deficiency anemia-
May result in-
Same are B12
Severely ill patient
Anesthesia considerations for folic acid def. anemia
Thorough airway assessment- Have an alternative airway plan in place, often have difficult airways
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