Hb Structures Flashcards
1
Q
Slight pallor and tachycardia Hb level?
A
9-11
2
Q
More pronounced pallor, plus dyspnea on exertion Hb level?
A
7-8
3
Q
Pallor, tachycardia, dyspnea, plus many complain of weakness Hb level?
A
6
4
Q
Pallor, tachycardia, weakness, plus people complain of dyspnea at rest Hb level?
A
3
5
Q
Pallor, tachycardia, dyspnea, weakness plus many complain of CHF Hb level?
A
2-2.5
6
Q
Normal RBCs lifespan
A
120 days
7
Q
Acute anemia (2)
A
Blood loss and hemolysis
8
Q
4 chronic anemia situations
A
- Hemolytic (G6PDH-deficiency, immune mediated, drug induced)
- Hemoglobinopathies (sickle cell, thalassemia)
- Nutritional/consumptive
- Folate deficiency
9
Q
Shortening of RBC survival to less than 100 days due to an increased rate of destruction of RBCs
A
Hemolytic anemia
10
Q
2 mechanism for hemolytic anemia?
A
- Abnormalities within RBC &/or it’s membrane
2. Abnormalities in environment (extrinsic due to immune mechanisms due to warm and cold agglutinin)
11
Q
4 hemolytic anemia’s
A
- Disorder of RBC structure
- Disorder of RBC metabolism
- Immune hemolytic anemia
- Non immune hemolytic anemia
12
Q
Most common enzyme defect?
A
G6PDH
13
Q
Treatment for G6PDH deficiency (3)
A
- Remove trigger or stop drug
- O2 and fluids
- Transfusion
14
Q
Main G6PDH deficiency anesthesia consideration?
A
Some pts cannot reduce methemoglobin
- lidocaine and nitroprusside are contraindicated
- methylene blued can be life threatening
15
Q
Detected at birth but some present during times of great physiological stress such as pregnancy, or acute illness
A
Pyruvate kinase deficiency
16
Q
Destruction of RBCs by autoantibodies may occur suddenly, or it may develop gradually.
A
Immune hemolytic anemia
17
Q
What is more common immune hemolytic anemia: cold antibody or warm antibody?
A
Warm antibody
18
Q
Cold antibody hemolytic anemia temp:
A
28-31
19
Q
Warm antibody hemolytic anemia temp:
A
37
20
Q
Severity of anemia is determined by what?
A
Length of time that RBCs survive and by rate at which bone marrow continue to create new RBC production
21
Q
CAHA is associated with? (2)
A
- Idiopathic cold hemagglutinin syndrome
2. Infectious mononucleosis and mycoplasma pneumonia
22
Q
WAHA is associate with? (3)
A
- Systemic lupus erythematosus (SLE)
- Lymphoma
- Chronic lymphocytic leukemia
23
Q
Occurs if body makes antibodies against RBCs that you get from an incompatible blood transfusion; occurs during pregnancy if woman has Rh- and baby is Rh+; drug induced (chemo, acetaminophen, quinine, PCN,)
A
Alloimmune hemolysis
24
Q
Non immune hemolytic anemia direct Coombs test result?
A
Negative
25
Common causes of non immune hemolytic anemia (7)
1. Drugs (ribavirin)
2. toxins (snake venom, plant poisons)
3. trauma
4. mechanical
5. Microangiopathic hemolytic anemia (TTP, HUS, DIC, HELLP)
6. Infection malaria (babesiosis, sepsis)
7. Membrane disorders (liver disease, paroxysmal nocturnal hemoglobinuria)
26
Minimize disruption of O2 delivery to tissues by avoiding what? (6)
Oxyhemoglobin dissociation curve to the L
1. Alkalosis
2. Hypocarbia
3. Decreased temp
4. Carbon monoxide
5. Methemoglobin
6. Hypophosphatemia
27
Consider blood transfusion when Hb is what for:
- acute blood loss from healthy person <60
- healthy person with asymptomatic chronic anemia
<6.4g/100ml
28
Consider blood transfusion when Hb is what for:
- acute blood loss from healthy >60 yrs
- acute blood loss from multi trauma pt
- preop in pt with periop blood loss >500ml
- fever
- postop after uncomplicated cardiac surgery
- uncomplicated operation in pt with ASA 2and3
<8g/100ml
29
Consider blood transfusion when Hb is what for:
- ASA 4 pts
- HF or valvular disease unable to raise CO
- severe lung disease (COPD)
- septic and toxic
- symptomatic cerebrovascular disease
<10g/100ml
30
Underlying genetic defect of sickle cell disease
1 amino acid exchanged in beta-chain of hemoglobin
31
Suckling and subsequent hemolysis starts at what and becomes pronounced at what?
PaO2 50 and 20
32
Sickle cell disease occurs when (3)
1. High altitude
2. Severe dehydration
3. Very high intensity physics activity
33
Complications with sickle cell disease (3)
1. Muscle breakdown (rhabdomyolysis)
2. Reduced blood supply to spleen
3. Increased pressure in eye (glaucoma)
34
How to prevent sickling? (6)
1. Avoid excessive premed with vent depression
2. Adequate hydration
3. Maintain normothermia
4. Tourniquet
5. Transfuse to reduce fraction of HbS
6. Volatile anesthetics prompt sickling
35
Abnormal formation of hemoglobin with tendency for hemolysis; defect in either alpha or beta globin chain
Alpha and beta thalassemia
36
What is the main consideration for thalassemia and anesthetic considerations?
Maintenance of sufficient O2 carrying capacity, often require frequent blood transfusions (every few weeks)
37
Polycythemia causes: an increase in HCT from reduction in plasma volume with no increase in red cell mass
Relative
38
Polycythemia causes: increased number of RBCs
Absolute
39
Polycythemia causes: over transfusion
Latrogenic
40
Polycythemia causes: blood cancers known as “myeloproliferative neoplasms”
Polycythemia Vera
41
DNA of developing stem cell in bone marrow is damaged, “acquired mutation”
Polycythemia Vera
42
Can minimize need for allogenic blood products; removed blood is replaced with IV fluids to maintain euvolemia
Preop phlebotomy
43
Iron in heme group is what for methemoglobinemia pts?
Fe3+ NOT Fe2+
44
What can cause methemoglobinemia (2)
Sodium nitroprusside and benzocaine
45
3 benzocaine toxicity treatment
1. Supplemental O2
2. 1% methylene blue IV administration
3. Ascorbic acid (give slower than methylene blue)
46
4 methemoglobinemia treatment:
1. 100% O2
2. 1% methylene blue (1-2mg/kg over 5min and repeat after 1hr)
3. ABGs
4. A-line placement
47
CF 1:
Fibrinogen
48
CF 2:
Prothrombin
49
CF 3:
Thromboplastin (tissue factor)
50
CF 4:
Calcium
51
CF 8:
Von willebrand factor
52
Normal blood clotting factor level:
50-150%
53
Mild hemophilia blood clotting factor level:
6-49%
54
Moderate hemophilia blood clotting factor level:
1-5%
55
Severe hemophilia blood clotting factor level:
<1%
56
Bleeding occurs only after injury, trauma, or surgery (25% of population)
Mild hemophilia
57
Bleeding tends to occur after minor injuries, spontaneous bleeding episodes may occur (15% of population)
Moderate hemophilia
58
Bleeding after injury, trauma, or surgery, spontaneous bleeding into joints and muscles, average 2-5 spontaneous bleeding episodes each month (60%)
Severe hemophilia
59
Factor 8 is what hemophilia?
A
60
Factor 9 is what hemophilia?
B
61
Factor 8 and 9 PT, PTT, BT?
PT: normal
PTT: prolonged
BT: normal
62
Hemophilia A affects what gender mostly?
Males
63
Treatment of hemophilia A (4)
1. Factor 8
2. Cryoprecipitate
3. FFP
4. Desmopressin (DDAVP)
64
FVIII content in cryoprecipitate per bag?
60-100 in 30-40ml
65
1ml of FFP contains how much CF 8?
1unit
66
Synthetic vasopressin analogue; increase CF8 and VWF
Desmopressin DDAVP
67
DDAVP pretesting?
Infusion: slowly over 15-30 min
| Post infusion: 30-60min
68
Desired factor level change with DDAVP?
2-3 fold increase
69
Hemophilia B is also called what?
Christmas’ Disease
70
Hereditary pattern with hemophilia B?
X-linked recessive
71
Hemophilia B treatment? (2)
1. Pure coagulation F9 products
| 2. FFP; only in life threatening emergency and F9 isn’t available (15-20ml/kg)
72
Hemophilia A and B goal for surgical prophylaxis?
Level 80-100% for 72hrs
73
Works fine, not enough; have reduced level of vWD
Type 1 vWD
74
What is vWD gender affect?
Autosomal (F and M)
75
Enough, factor doesn’t work properly
Type 2 vWD
76
Platelets don’t bind
Type 2A
77
Platelets bind in blood stream
Type 2B
78
Most severe and rarest; very low levels
Type 3 vWD
79
Treatment for vWD for type 1and2, type 2and3, and both
Type 1and 2: DDAVP
Type 2 and 3: factor 8
Cryoprecipitate, FFP
Antifibrinolytic drugs
80
Elective procedure levels of hemophiliac should be at what?
Stabilized to 40% of normal
81
What to avoid in hemophiliac pts? (2)
1. IM injections, spinal, epidural
| 2. NSAIDs
82
Most common cause of AKI in children; occur when small blood vessels in kidneys become damaged and inflamed
Hemolytic uremic syndrome
83
Low plt count leading to bruising
Thrombotic thrombocytopenic purpura (TTP)
84
Excessive shear or turbulence in the circulation causes trauma to RBCs
Microangiopathic hemolytic anemia
85
Mild DIC (3)
1. Prolonged PT, PTT, TT
2. Decreased PLTs
3. Increase fibrin degradation products
86
Severe DIC (2)
1. Reduced fibrinogen
| 2. Fragmented RBCs
87
Main clinical feature for DIC?
Bleeding at sites of vein puncture/IV catheters
88
Blood transfusion is recommended for what DIC situations? (2)
1. Bleeding type
| 2. Massive bleeding type
89
Heparin is recommended for what DIC situation?
Non-symptomatic type
90
Treat thrombocytopenia
PLTs
91
Treat elevated PT and PTT
FFP
92
Treat low fibrinogen level
Cryoprecipitate or fibrinogen
93
Heparin induced thombocytopenia (HIT) treatment (3)
1. PLTs
2. Corticosteroids
3. Direct thrombin inhibitor
94
Managing anticoagulation therapy: warfarin
Stop 5 days before
95
Managing anticoagulation therapy: heparin
Started 36 later
96
Managing anticoagulation therapy: bridging choice
Unfractionated LMWH
97
Managing anticoagulation therapy: last dose heparin stopped; infusion and bolus
Infusion: 6 hrs
Bolus: BID 18hrs, OD 30hrs
