Anemia PPT -Josh Flashcards
1
Q
What is the most abundant cell in the body
A
Erythrocytes
25 trillion cells (thats kinda badass)
2
Q
What s teh main function of erythrocytes
A
oxygen delivery to tissues
3
Q
erythrocytes are biconcave disk, what the fuck does that mean?
A
ability to change shape
increases surface area
4
Q
Erythrocytes (RBC):
what is the main function
A
- Transport Hgb for O2 delivery to tissue
5
Q
Erythrocytes (RBC):
besides carring Hgb, RBCs also containa large amount of what?
A
Carbonic anhydrase
6
Q
Erythrocytes (RBC):
Produced where?
A
Bone marrow (vertebrae, sternum, ribs, pelvis, proximal ends of humerus and femur)
7
Q
Erythrocytes (RBC):
RBC production is controlled by what?
A
- the ability to transpot O2 to the tissues
8
Q
Erythrocytes (RBC):
what cell or enzyme or whatever is responsible for producing RBCs
A
erythropoietin
9
Q
Erythrocytes (RBC):
what 2 vitamins are required for RBC production
A
- B12 (cyanocalamin)
- Folic acid
10
Q
Erythrocytes (RBC):
life span
A
120 days after leaving bone marow
11
Q
Erythrocytes (RBC):
what is the protein-iron compound in the RBC?
A
Hgb
12
Q
Erythrocytes (RBC):
what is Hgb for
A
allows RBCs to transport O2
13
Q
Erythrocytes (RBC):
what is the ratio of packed RBCs to total blood volume?
A
Hct
14
Q
Erythrocytes (RBC):
Normal Hgb
A
male- 13.9-16.3 g/dL
Female 12-15 g/dL
15
Q
Erythrocytes (RBC):
what is normal Hct levels
A
Male- 39-55%
Female- 36-48%
16
Q
Erythrocytes (RBC):
what is the total number of RBCs in a sample of blood
A
RBC count
normal values
male-4.3-5.9 x10^6
Females- 3.5-5.5 x10^6
17
Q
Erythrocytes (RBC):
what is a measurement of the average size of the RBC, and indicated whether the RBC is small, large, or normal?
A
MCV
Mean Corpuscular Volume
18
Q
Erythrocytes (RBC):
what is the concentration of Hgb in a given volume of blood?
A
MCHC count
Mean Corpuscular hemoglobin concentration
19
Q
Erythrocytes (RBC):
explain the Hgb molecule (just basic)
A
- 4 chians
- 2 alpha
- 2 Beta
- each chain has a heme group
- each heme group has an iron molecule
20
Q
Erythrocytes (RBC):
what is a reduction in the total number of circulating erythrocytes or a decreased in the quantity or quality of hemoglobin
A
Anemia
21
Q
Erythrocytes (RBC):
the WHO defines anemia as less than ___g/dL of Hgb for men and less than ___g/dL of Hgb for women
A
13
12
22
Q
Erythrocytes (RBC):
postoperatively up to ___% of pts are anemic
A
80%
23
Q
Erythrocytes (RBC):
___% of pts over 65 are anemic
A
75%
24
Q
Erythrocytes (RBC):
___to ____ of pts preop are anemia
A
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
