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Flashcards in Anemia PPT -Josh Deck (101):
1


What is the most abundant cell in the body

Erythrocytes

25 trillion cells (thats kinda badass)

2


What s teh main function of erythrocytes


oxygen delivery to tissues

3


erythrocytes are biconcave disk, what the fuck does that mean?


ability to change shape

increases surface area

4


Erythrocytes (RBC):

what is the main function

 

  1. Transport Hgb for O2 delivery to tissue

5


Erythrocytes (RBC):

besides carring Hgb, RBCs also containa  large amount of what?


Carbonic anhydrase

6


Erythrocytes (RBC):

Produced where?


Bone marrow (vertebrae, sternum, ribs, pelvis, proximal ends of humerus and femur)

7


Erythrocytes (RBC):

RBC production is controlled by what?

 

  • the ability to transpot O2 to the tissues

8


Erythrocytes (RBC):

what cell or enzyme or whatever is responsible for producing RBCs


erythropoietin

9


Erythrocytes (RBC):

what 2 vitamins are required for RBC production

 

  • B12 (cyanocalamin)
  • Folic acid

10


Erythrocytes (RBC):

life span


120 days after leaving bone marow

11


Erythrocytes (RBC):

what is the protein-iron compound in the RBC?


Hgb

12


Erythrocytes (RBC):

what is Hgb for


allows RBCs to transport O2

13


Erythrocytes (RBC):

what is the ratio of packed RBCs to total blood volume?


Hct

14


Erythrocytes (RBC):

Normal Hgb


male- 13.9-16.3 g/dL

Female 12-15 g/dL

15


Erythrocytes (RBC):

what is normal Hct levels


Male- 39-55%

Female- 36-48%

16


Erythrocytes (RBC):

what is the total number of RBCs in a sample of blood


RBC count

normal values

male-4.3-5.9 x10^6

Females- 3.5-5.5 x10^6

17


Erythrocytes (RBC):

what is a measurement of the average size of the RBC, and indicated whether the RBC is small, large, or normal?


MCV

Mean Corpuscular Volume

18


Erythrocytes (RBC):

what is the concentration of Hgb in a given volume of blood?


MCHC count

Mean Corpuscular hemoglobin concentration

19


Erythrocytes (RBC):

explain the Hgb molecule (just basic)

 

  • 4 chians
    • 2 alpha
    • 2 Beta
  • each chain has a heme group
  • each heme group has an iron molecule

20


Erythrocytes (RBC):

what is a reduction in the total number of circulating erythrocytes or a decreased in the quantity or quality of hemoglobin


Anemia

21


Erythrocytes (RBC):

the WHO defines anemia as less than ___g/dL of Hgb for men and less than ___g/dL of Hgb for women


13

12

22


Erythrocytes (RBC):

postoperatively up to ___% of pts are anemic


80%

23


Erythrocytes (RBC):

___% of pts over 65 are anemic


75%

24


Erythrocytes (RBC):

___to ____ of pts preop are anemia


1/3-1/2

25


Anemia:

3 main causes

 

  1. Impaired RBC production
  2. Blood loss (aucte/chronic)
  3. Increased RBC destruction

26



Anemia:

is classified according to what?


morphology (size, shape, hgb coontent)

27



Anemia:

is classified as "-cytic" indicates what type of enemia


refers to cell size

28



Anemia:

if classified as "-Chromic" it indicated what


referes to Hgb content

29



Anemia:

so if classified as Normocytic or normochromic, it indicates what?


normal RBC volume and normal Hgb content

 

30



Anemia:

so if classified as Macrocytic or Hyperchromic what deos that mean


High RBC volume and High Hgb content

31



Anemia:

so if classified as Microcytic or Hypochromic, it would indicate what?


Low RBC volume or low hemoglobin content

32



Anemia: S/S

Eyes?

 


Jaundice

33



Anemia: S/S

skin


Paleness

coldness

jaundice

34



Anemia: S/S

respiratory


SOB

35



Anemia: S/S

muscular


weakness

36



Anemia: S/S

intestinal


Changes stool color

37


Anemia: S/S

central (brain/neuro)


fatigue

dizziness

FAINTING

38



Anemia: S/S

Blood vessels


Hypotension

39



Anemia: S/S

heart


Palpatations

rapid HR

CHEST PAIN

ANGINA

MI

40



Anemia: S/S

Spleen


enlargement

41



Anemia: Classification

name the 3 classifications

 

  1. Microcytic/ Hypochromic
  2. Normocytic/ Normochromic
  3. Macrocytic/Hyperchromic

42


Anemia: Classification

what 2 anemias fall under Microcytic/ hypochromic

(low RBC Volume and Low Hgb content)

 

  • Iron deficiency
  • Thalassemia

(small Itty ditty Titty)

43


Anemia: Classification

what 2 anemia fall under Macrocytic/ normochromic

(high RBC volume/ Hgb content)

  • Pernicious anemia
  • Folate deficiency

(macro large Fat Pussy)

44

Anemia: Classification

what 4 types of anemia fall under normocytic/normochromic

 


all the rest

  • Hemolytic
  • Posthemorragic
  • Aplastic
  • Chronic disease

 

45


Anemia: Classification

what is the most common tyoe of anemia


Iron deficiency

46


Anemia: Iron Deficiency

fall under what classification


Microcytic-Hypochromic

47


Anemia: Iron Deficiency

what are causes ?

 

  • Chronic blood loss
  • dietary deficiency
  • Lack of iron for Hgb production

48


Anemia: Iron Deficiency

what are high risk population


Elderly

women

infants

low income families

49


Anemia: Iron Deficiency

s/s

 

  • Gradual appearance
  • Fatigue, weakness
  • SOB
  • Pallor
  • Brittle nails
  • GLOSSITIS
  • drymouth
  • dyphagia

50


Anemia:

what anemia is an inherited defect in the globin chain synthesis?

 


Thalassemia

51


Anemia: Thalassemia

is what anemia classification


Microcytic-Hypochromic

52


Anemia: Thalassemia

has a strong geogaphical influence of where?


Africa

Mediterranean

southesat asi

53


Anemia: Thalassemia

s/s


Hepatomegaly

splenomegaly

skeletal malformations

CHF

54


Anemia:

what tyoe of anemia is premature, accelerated hemolysis of RBCs in circulation AKA the erythrocytes are "fragile"


Hemolytic

55


Anemia: Hemolytic Anemia

is what class


Normocytic-normochromic

56


Anemia: Hemolytic Anemia

what 2 ways is this caused?

 

  1. Hereditary
    • Structural defects, plasma menbrane protein mutations, enzyme deficiency
  2. Acquired
    • Drugs
    • Disease
    • Toxins
    • trauma

 

57


Anemia:

what type of anemia is caused by acute blood loss

 


Posthemorrhagic Anemia

58



Anemia: Posthemorrhagic Anemia

what class is this


Normocytic-Normochromic

59


Anemia: Posthemorrhagic Anemia

what occurs with this anemia

 

  • w/in 24hrs lost plasma is replaced via water and electrolytes from tissues
  • Hemodilution ensues
  • Decreased tissue perfusion causes increased erythropoietin
  • eventually depletes bidy stores of iron

60



Anemia: Posthemorrhagic Anemia

what are the different classes? what % and volume is lost? and is a transfusion needed?

 

 

  1. <15% or <750ml No need for transfusion
  2. 15-30% or 750-1000 ml no need for transfulsion
  3. 30-40% or 15000-2,000mL prob need transfusion
  4. >40% or >2,000mL Need transfusion

61



Anemia: Posthemorrhagic Anemia

Tell the S/S associated with % of blood loss

  1. 10%
  2. 20%
  3. 30%
  4. 40%
  5. 50%

  1. none
  2. Tachycardia w/ exercise
  3. Postural hypotension/ tachycardia
  4. CVP, CO, BP low; air hungry; cold clammy skin
  5. Severe shock; lactic acidosis, death

62



Anemia:

what  Anemia is reduction is all 3 cells RED, WHITE, PLATELETS (pancytopenia)


aplastic Anemia

63


Anemia: Aplastic Anemia

is what class

Normocytic-normochromic

64


Anemia: Aplastic Anemia

is caused but what?


Drugs

chemicals

radiation

iinfections (viruses)

65


Anemia:

what type of anemia if from a chronic infection or malignancy causing increased demand for new RBCs

 


Anemia of Chronic Disease

66


Anemia: Anemia of Chronic Disease

is what class


Normocytic-Normochromic

67


Anemia: Anemia of Chronic Disease

what are common causes

 

  • CKD
  • Ca
  • Liver cirrhosis
  • Infection (HIV, Hep B/C)
  • Autoimmune d/o

68


Anemia:

What tyoe of anemia is lack of cobalamin (vit B12)


Pernicious Anemia

69


Anemia: Pernicious Anemia

What class if this?


Macrocytic-NORMOchromic

(on a previous diagram Terra stated MacroChromic) I don't know which is correct yet

70


Anemia: Pernicious Anemia

Is caused by what?

 

  • Decreased erythropoises
  • abnormal DNA/RNA in erythroblast
  • Premature cell dealth
  • Congenital or aquired deficiency of IF

71


Anemia: Pernicious Anemia

is commonly associated w/ what d/o


end stage gastritis

72


Anemia: Pernicious Anemia

neuro effects

 

  • Parasthesias
  • Gait disturbance
  • weakness
  • muscle spasticity
  • Abnormal reflexes

73


Anemia:

what type occure due to an essential vitamin lacking fir erythrocyte maturation and production


folate deficiency

74

Anemia: Folate Deficiency Anemia

the essential vitamin is dependent on a daily intake of what?


50-200 mcg/day

75


Anemia: Folate Deficiency Anemia

folate is absorbed where


Small intestine

76


Anemia: Folate Deficiency Anemia

can be caused by what 2 disorders


Chronic malnutrition

Alcoholism

77


Anemia: Folate Deficiency Anemia

the megoblastic cells and apoptosis of RBCs places the indivisual at an increased risk for what?


Atherosclerosis

78

Explain why the body causes the Copensitory mech

Decreased afterload

 

 

  • Decreased viscosity
  • Hypoxemia causes Vasodilation and thus decreased SVR leading to increased SV and therfore increased CO
  • Redistribution of blood to tissues (organs w/ higher O2 requirement receive more blood)

79


Explain why the body causes the Copensitory mech

increased Preload

 

  • Decreased RBCs and decreased Blood volume lead to.....
  • osmotic pull of fluid into vasculature from tissues (maintains blood volume but very diluted)

80


Explain why the body causes the Copensitory mech

Increased HR


Anemia activated the SNS

81


Explain why the body causes the Copensitory mech

Inrcreased RR and depth


in attmpt to offset hypoxia being experienced by the tissues

82


Compensitory Mechanisms:

A decreased Arterial O2 content will shift the ODC to where?

 


right

to release O2 from Hgb to tissue

83


Compensitory Mechanisms:

why does the ODC shift to the right?

 

  • Rlease of O2 to tissues
  • Increased levels of 2,3,DPG

84


Compensitory Mechanisms:

During anemia blood is redistributed from where to where to compensate


from skin and kidney

to heart and brain

85


Compensitory Mechanisms:

______ stimulate bone marrow to produce more RBCs


the Kidneys

86


Anemia Preoperative:

what do you wanna assess or get or look at or anything else you can thinnk about

 

  • CBC w/ platelets
  • Complete H&P
  • Tyoe and Cross
  • Replace and deficiencies prior to sx
  • ESA (erythropoiesis-syimulating agent)
  • Possible transfussion prior to sx

87


Anemia Preoperative:

what type of pts (high risk) tolerate anemia more poorly?


Coronary thersclerosis

Advanced Pulm disease

Elderly pts

88


Anemia Intraoperative:

what do you wanna (want to) do or monitor or anything else you think of

 

  • Pulse ox (severe anemia can give inaccurate readings)
  • A-line (hemodynamics/ABGs)
  • Maintain adequate O2
  • Watch for S/S of anemia

89


Anemia Intraoperative:

what 3 factors increase the risk of MI

 

  • Pts w/ CAD
  • Decreases O2 dsupply (Anemia)
  • Increase in O2 demand (tachycardia)

90


Anemia Intraoperative:

what happens to VAAs w/ anemia


uptake faster

91


Anemia Intraoperative:

whats up with N2O and anemia?

 

  • use w/ caution
  • Prolonged exposure can mimic Vit B12 anemia

92


Anemia Intraoperative:

What occurs w/ cardiac depressent drugs w/ anemia


Further decrease O2 to tissues

93


Anemia Intraoperative:

how to you prevent a left shift on the ODC


avoid

Hyperventilation

and

Hypothermia

94


Anemia Postoperative:

what are 2 main things to do postop w/ anemic pts


Maintain Oxygenation

Draw H&H if blood loss significant

95


Anemia when to transfuse?

what was the old rule? Before 1980s


10/30 rule

96


Anemia when to transfuse?

but in 1988 the NIH stated the criteria was what?


"no evidence to support a single criterion"

97


Anemia when to transfuse?

again supporting the NIH tin 1996 the ASA advised against a "transfusion trigger", but however concluded that a transfusion is rarely indicated above Hgb______ and always indicated below hgb _____


10g/dL

6g/dL

98


Anemia when to transfuse?

you should assess what 3 factors before deciding to transfuse?

 

  1. Risk assiociated w/anemia during periop time
  2. Risk of transfusion itself
  3. What does the  research state?

99


Summary:

Anemia is what?


decreased in the number or function of RBC

100


Summary:

what to assess?


The individual

co-existing diseases

Degree of expected blood loss

101


Summary:

transfusion should be based on what?


YOUR best clinical judgement, as that each pt is unique