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Flashcards in bloody Deck (74)
1

DO2

CO x Hgb x 1.36 x SaO2

2

TRALI

Transfusion-Related Acute Lung Injury
--non-cardiogenic pulmonary edema
- develops 6 hrs after any blood component
- theory: ab (donor) + ag (recip) rxn --> inflam response

3

TACO

Transfusion-Associated Circulatory Overload- s/s fluid overload

4

TRALI tx

stop transfusion immediately r/o other possible causes
supportive: ventilation, ↓TV & plateau pressure

5

TACO tx

slow or stop infusion, diuretics

6

TRIM

Transfusion-Related Immunomodulation
down-regulation of immune system as result of transfusion
theory: leads to malignancy recurrence, post-op bacterial infections, new cancers

7

proteins (aa)
role in erythropoesis & consequence of deficiency

cellular membrane component, impaired hgb synthesis
impaired cell membrane integrity, hemolytic anemia, ↓ RBC lifespan

8

vitamin B12
role in erythropoesis & consequence of deficiency

synthesis of DNA, facilitator of folate metabolism
Macrocytic (Megaloblastic) anemia

9

folate (folic acid)
role in erythropoesis & consequence of deficiency

Synthesis of DNA & RNA, maturation of erythrocytesMacrocytic (Megaloblastic) anemia

10

vitamin C
role in erythropoesis & consequence of deficiency

Fe metab (reducing agent → ferrous sulfate Fe2+ form)
normocytic-normochromic anemia

11

iron
role in erythropoesis & consequence of deficiency

hgb synthesis
normocytic-normochromic & iron-deficiency anemia

12

hct & hgb

Most common & sensitive test for anemia
– not specific to type of anemia
HCT (PCV)
– %age RBCs in total blood vol
- M: 42-54%
- F: 38-46%
hgb – total meas hgb in the blood
- M: 13.5-17.5g/dL
- F: 12-15.5g/dL

13

erythrocyte count

# erythrocytes per vol blood
M: 4.5-5.9 x 1012/LF: 4.1-5.1 x 1012/L

14

reticulocyte count

%age reticulocytes in vol of blood (a reflection of erythropoiesis)
values ↑ during ongoing arterial hypoxia or O2 demand
0.5-1.5%

15

red cell distribution width (RDW)

variation in RBC width (“diversity” in RBC size)
anistocytosis: RBC size highly variable
11.5-14.5%

16

*mean corpuscular volume (MCV)*

avg vol of a single RBC (size or stature)
80-100 femtoliter per RBC

17

mean corpuscular hgb (MCH)

amt hgb in a RBC (“content” or “weight” of hgb in avg RBC in circulation)

27-31 picograms/cell

18

mean corpuscular hgb concentration (MCHC)

avg concentration of hgb in given vol of RBCs (hgb density)

33-36g/dL

19

how to dx specific anemia

1. Get CBC w differential
2. MCV: micro, normo, macro -cytic?
3. MCH & MCHC: hypo, normo, hyper -chromic?
4. Reticulocyte count (↓ or ↑?)
5. Consider peripheral blood smear, Fe studies, other specific dx tests based on info from above steps

20

microcytic anemias x2

MCV lt 80
Fe Deficiency Thalassemias

21

normocytic anemias x3

MCV 80-100
Acute Blood Loss
Chronic Disease
Sickle Cell

22

macrocytic anemias x2

MCV gt 100
Pernicious (B12)
Folate Deficiency

23

ferritin

iron storage protein
18-270 ng/mL

24

transferrin saturation

transports iron
20-50%

25

iron normal #

50-175 ug/dL

26

total iron binding capacity (TIBC)

250-400 ug/dL

27

most common cause of anemia

Fe deficiency

28

Fe deficiency anemia

most common cause of anemia, more common in Fusually asymp until hct lt 30%

29

pica unique to

Fe deficiency anemia

30

Fe def anemia mgmt & eval

tx cause
PO Fe replacement 6 mo min

Repeat labs @ 1 mo
- Correction 1/2 HCT deficit
- Rer count normal
- Improved Fe studies

Repeat labs @ 2 mo → normalization of all laboratory values

31

*PO Fe replacement considerations*

Take on empty stomach w ascorbic acid (Vitamin C)

GI Side Effects: dark stools, constipation, nausea

32

*thalassemias + classifications x3*

genetic disorders char by ↓synth globin chains (alpha or beta) = ↓ hgb synthesis; poikilocytosis happens

1. Trait: lab features w/o clinical impact

2. Intermedia:
occasional transfusion

3. Major: Life threatening, transfusion dependent

33

alpha thalassemia

primarily in Asian descentgene deletions ↓ alpha-globin chain synthesis

34

poikilocytes

abnormally shaped red blood cells

35

alpha thalassemia tx x3

Silent carrier = no treatment

Thalassemia minor or trait = no treatment, no Fe supplements!!!

hgb H dz = folic acid supp, no Fe supp, if PRBC transfusion needed consider Fe chelation

36

beta thalassemia + types x2

primarily mediterranean descent
- ↓ beta-globin chain: beta*
- absent beta-globin chain expression: beta0

37

thalassemia punnett

beta-beta: healthy A & B
beta0-beta*: thalassemia minor + 80-95% hgbA

beta*-beta* (mild): thalassemia intermedia + 0 - 30% hgb A

beta*-beta* (severe) OR
beta0-beta0: thalassemia major + 0 - 10% hgb A

38

most severe beta thalassemias genotypes x2

beta*-beta* (severe)

OR

beta0-beta0: thalassemia major + 0 - 10% hgb A

39

beta thalassemia major physical characteristics

Bone structure abn skull & long bones

Bone marrow spaces ↑
- attempt ↑erythropoiesis

Growth retardation
Frontal bossing
“Chipmunk” cheeks
Exposed frontal teeth
Hepatosplenomegaly

40

skull + long bone abn, growth retardation, chipmunk cheeks + teeth, hepatosplentomegaly

beta thalassemia major

41

beta thalassemia tx

Minor = no treatment

Intermedia = folic acid supp, occasional RBC transfusion, no Fe supp

Major = routine RBC transfusion, folic acid supp, no Fe supp, Fe chelation tx, allogenic stem cell transplant???

42

Fe and thalassemias

NOPE

43

Fe, transferrin, *TIBC* ↓ = ? anemia

Anemia of Chronic Disease - inflammation

44

Anemia of Chronic Disease & transfusions

PRBC @ hgb lt 7

45

*TIBC* ↓ = ? anemia

Anemia of Chronic Disease - inflammation

46

Anemia of Chronic Disease that is dx of exclusion

in elderly d/t ↓ erythropoietin production or red bone marrow ↑ resistant to erythropoiesis

47

who does not usually present with anemia sx?

vit B12 deficiency (pernicious)

48

pernicious anemia tx

Parenteral (recommended) → B12 IM or SC qd 1 wk/wkly 1 mo THEN

1x/mo until B12 levels normalize – typically takes 2-3 mos

PO or SL methylcobalamin – only approp after deficiency corrected & evidence of improved/changed GI abs

49

% PO iron abs by GI

1%

50

required for heme chain formatino

folic acid

51

B12 vs folic acid: sources

B12: animal folic: fruits/veggies

52

*aplastic anemia*

d/t issues w red bone marrow → suppression/injury to hematopoietic stem cell

causes → idiopathic, pregnancy, chemo & rad, viruses inc hepatitis

53

aplastic anemia s/s

d/t pancytopenia = classic anemia sx, inf (bacterial &/or fungal), bleeding/hematoma out of proportion to injurysigns: pallor, purpura, petechiae

54

sickle cell anemia & hgb

S instead of A d/t DNA alteration in B-globin chain

55

sickle cell carrier vs disease

CARRIER
Each erythrocyte carries ~40% HbS

Normal shaped erythrocyte

Typically do not have any health related issues

DISEASE
Each erythrocyte carries about 80-96% HbS

Classic “sickle” cell RBC’s

Multiple health issues

56

hgb S reacts to what?

hypoxia, dehydration, infection, &/or acidosis by solidifying & stretching erythrocyte into elongated “sickle” → causes ↓ RBC life

57

where will you see sickle cells lab-wise

peripheral blood smear

58

sickle cell anemia labs

MCV –↓to normal

MCHC & ret count – ↑leuko & thrombo -cytosis

↑ bilirubin & LDH

Electrophoresis (initial dx) – HbS present

Peripheral blood smear: elongated & “sickle” cell

59

vasoocclusive crisis + s/s

sickle cell disease

THINK! hemolysis & ischemia
- hemolysis: pallor, fatigue, jaundice
- ischemia: pain (chest, abd, legs & arms)
- end organ damage

60

presentation hemolysis & ischemia

sickle cell vasoocclusive crisis

61

hgb target for vasooclusive crisis + transfusion considerations

hgb 6-9 transfusion during crisis ↑ risk of vaso-occlusive issues!!

62

sickle cell vasoocclusive crisis: acute mgmt

- eval for other sx causes
- IV fluids (rehydration): NS +/- D5
- pain mgmt – ↑↑↑↑↑ amt
- Supplemental O2
- Infection mgmt
- PRBC transf if indicated → Hgb 6-9 target
-- NOTE: transf ↑ risk of issues!!

63

sickle cell vasoocclusive crisis: maintenance mgmt

hematology referral
Allogenic hematopoietic stem cell tx
Folic acid
Hydroxyurea – turns HgbS to HgbF
Immunizations
Opioid pain mgmt
Education: stay hydrated, wash h&s, get shots, avoid heights

64

*pernicious anemia vs B12 deficiency anemia*

pernicious: lack of intrinsic factor, prevents abs B12

65

*most common anemia*

Fe deficiency, more common in female

66

*anemia of chronic disease*

anemia categories associated with chronic disease states & aging processes: inflammation, organ failure, elderly

67

*folic acid d/t*

commonly poor nutritional intake rather than GI absorption issue

68

*pica: ice chips eating sign of

Fe deficiency anemia

69

*Fe deficiency anemia causes*

pregnancy, GI & menstrual blood loss, poor dietary intake or GI abs

70

*B12 deficiency anemia (not pernicious) causes*

gastrectomy
↓ ileal abs d/t surgical resection, Crohn's
H. Pylori infection
dietary deficiency (vegetarian/vegan, poor nutritional supplementation)

71

associate macrocytic anemia with ?

peripheral neuropathy -assess B6, B12, folate

72

*thrombocytopenia etiologies*

chemo, heparin, idiopathic (↑ destruction, ↓ production)

73

*thrombocytopenia labs*

- plt under 100k
- PT, PTT normal

74

*thrombocytopenia tx*

- pt ed: risk of bleeding!
- plt under 20k: hospitalize
- monitor plts
- avoid rx that interfere w plt production
- chronic: consider splenectomy
- consider bone marrow aspirate
- prednisone is an option