4. Hematology Flashcards
1
Q
anemia
A
reduction in 1 of the following:
[Hg]
hct
RBC
2
Q
WHO anemia definition
A
Hb < 12 g/dL women
Hb < 13 g/dL men
3
Q
DLO2
A
CO*CaO2
4
Q
CaO2
A
1.34HbSaO2 + PaO2*0.003
5
Q
major contributor to amount of O2 in blood
A
hb
6
Q
anemia compensation
A
redistribution of blood from skin/muscles/kidneys to brain heart and lung
7
Q
shunt of blood from kidneys causes
A
EPO release
8
Q
trigger for transfusion
A
Hb < 10 g/dL
Hct < 30%
9
Q
in anemic pts we should try to _____ O2-Hb curve
A
aovid shifting O2-Hb left
10
Q
CADET face RIGHT
A
CO2
Acid
D 2,3 DPG
Exercise
Temp
11
Q
microcytic anemia
A
MCV < 80fL
12
Q
microcytic anemia common causes
A
iron deficiency
thalassemia
13
Q
iron deficiency causes infants
A
nutritional deficieny
14
Q
iron definciency primary cause adults
A
blood loss
15
Q
iron deficiency anemia labs
A
Hb 9-12 g/dL
ferritin < 41 ng/mL
16
Q
thalassemia diagnosis
A
Hb electrophoresis
17
Q
thalaseemia best anesthetic technique
A
all equal
18
Q
thalassemia SE
A
incr thrombotic risk
19
Q
normocytic anemia
A
MCV 80-100 fL
20
Q
normocytic anemia types
A
hemolytic anemia
chronic disease anemia
CKD anemia
aplastic anemia
21
Q
normocytic anemias trait
A
have enough material to make RBCs but RBCs dont last long enough or cant make enough RBCs to keep up
22
Q
hereditatry spherocytosis
A
autosomal dominant
deficiency in membran proteins
unable to mx RBC shape
23
Q
hereditary spheocytosis ahould avoid
A
mechanical valves
bypass
24
Q
hereditary elliptocytosis
A
autosomal dominant abnormalioty of membrane proteins spectrin/glycophorin
elliptical or rod shape
25
acanthocytosis
defective membrane structure due to lack of beta-lipoprotein
26
acanthocytosis comorbidities
cirrhosis
severe pancreatitis
27
paroxysmal nocturnal hymoglobinuria
stem cell disorder in 2nd - 8th decade of life
28
paroxysmal nocturnal hemoglobinuria S+S
dark urine overnight
29
paroxysmal nocturnal hemoglobinura treatment
exulizumab
30
what should you not use in paroxysmal noctunal hemoglobinura
cell saver
31
Glu-6-phos dehydrogenase deficiency
x-linked genetic disroder
RBC unable to handle stress so hemolysis occurs
32
Glu-6-phos dehydrogenase definiency avoid
oxidative drugs:
iso
sevo
reglan
penicillin
methylene blue
hypothermia
acidosis
hyperglycemia
33
what form of iron do we want
Fe2+ (ferrous)
34
does sickle cell trait cause incr M+M?
no - only sickle cell disease
35
SCA Hct goal
30%
36
SCA goals
decr anxiety
hydration
decr acidosis
decr hypothermia
37
Sickle C
cells lose water thorugh incr K+/Cl- transporter activity
38
warm autoimmune hemolytic anemia (WAHA)
red cell lysis due to warm agglutinis
IgG lysis at 37C+
39
WAHA associated with
lupus
lymphoma
leukemia
HIV
40
Cold autoimmune hemolytic anemia (CAHA)
red cel lysis due to cold exposure
ImM lysis at 0-10C
41
CAHA associated with
mycoplasma infections
neoplamss
42
CAHA treatment
avoid cold
rituximab
plasmapheresis
43
WAHA treatment
corticosteroids
splenectomy
rituximab
44
anemia of chronic disease (ACD)
decr production
+
decr lifespan of RBCs
45
ACD type
normocytic
normochromic
hyperproliferative
46
ACD mech
iron trapped in macrophages
decr [EPO]
47
ACD treatment
cure underlying dz
give Iron
give EPO
48
anemia of CKD
due to decr EPO production
49
ACKD treament
correct iron deficiency
give EPO
50
ACKD hb goal
Hb 10-12 g/dL
51
aplastic anemia
autosomal recessive
progressive failure of bone marrow that usually results in leukemia
52
macrocytic anemia
MCV: >100 fL
defects in nuclear maturation
53
most common macrocytic anemia
Folate/B-12 deficiency
54
macrocytic anemia treatment
vitamins
decr alcohol
55
HbM
ferrous iron oxidized to ferric iron
56
HbM treatment
methylene blue
1-2 mg/kg over 3-5 mins
57
polycythemia
incr RBC mass and Hct due to hypoxia-stimulated EPO production
58
optimal Hct for O2 transport
33-36%
59
optimal Hb for O2 transport
11-12 g/dL
60
what happens to blood viscosity at higher Hct/Hb?
incr blood viscosity
decr BF
decr O2 delivery
61
polycythemia vera
stem cell disorder
JAK2 gene mutation
incr RBC count
+/- incr plt count
+/- incr leukocyte count
62
polycythemia vera diagnosis
female:
Hb > 16
Hct > 48
male:
Hb > 16.5
Hct > 49
decr serum EPO
63
polycythemia cera treatment
dilute Hct < 45%
aspirin
myelosuppressive drugs
64
polycythemia vera risks
thrombosis
hemorrhage
65
Factor VII deficiency
rare autosomal recessive disease
66
Factor VII deficiency diagnosis
symptomatic bleeding when levels drop below 15%
67
Factor VII levels pre-op
20-25%
68
factor vii bleeding treatment
Factor VII
recombinant (novoseven)
PCC
FFP
69
Factor X
Factor V
Prothrombin deficiency treatment
FFP (15-20 ml/kg)
PCC (25-50 iu/kg)
70
FFP dosing
15-20 ml/kg
71
PCC dosing
25-50 iu/kg
72
PCC risks
thrombus
thromboembolism
DIC
73
Factor VIII (hemophilia A) chromosome
x
74
HemA severe
< 1% factor level
75
HemA mod
1-5% factor level
76
HemA mild
6-30% factor level
77
Haem A diagnosis
prolonged aPTT
normal PT
78
HemA treatment
factor VIII
DDAVP
emicizumbab
79
HemA level for major sx
80-100%
80
HemA level minor sx
50-80%
81
DDAVP day of surgery
incr F8 3-5x
82
HemA periop bleeding treatment
FFP
cryo
amicar
TXA
83
Factor IX deficiency (HemB) severe
<1% factor level
84
HemB mod
1-5% factor level
85
HemB mild
5-40% factor level
86
HemB diagnosis
prolonged aPTT
normal PT
87
HemB treatment
recombinant F9
F9 PCC
88
F9 half life
18-24 hrs
89
F9 infusion repeated
12-24 hrs
90
F11 deficiency bleeding
mild
91
F11 treatment
TXA
amicar
Factor Xi concenctrate
92
where is fibrinogen synthesized
liver (from 3 genes on chromosome 4)
93
fibrinogenemia treatment
fibrinogen
cryo
94
cryo dose minor sx
1U / 10kg
95
cryo dose major sx
1U/5kg
96
fibrinogen target major sx
> 100 mg/dL
97
fibrinogen target minor sx
> 50 mg/dL
98
thrombocytopenia
low plts
99
plt half life
9-10days
100
plts per day
15,000-45,000
101
treatment for bleeding and low plateelets
give platelets
102
plts for minor sx
20k-30k
103
plts for maj sx
50k
104
neuraxial plts
70k-100k
105
1 unit of plts
incr plts by 50k
106
do plts need ABO compatibility
no
107
do plts need RH compatibility
yes
108
DIC
coagulopathy due to excess intravascular thrombin and widespread clotting and bleeding
109
DIC states
procoagulant
hyperfibrinolytic
110
DIC labs
plts
PT
PTT
fibrinogen
D-dimers
111
thrombotic thrombocytopenia purpura (TTP)
plt rich thrombin in arterial and capillary microvasculatured leading to thrombocytopenia and microangiopathic hemolytic anemia
112
TTP cause
ADAMTS 13 protease deficiency
113
TTP treatment
plasma exchange
glucocorticpids
rituxiumab
caplacizuman
114
should you give plts in TTP
only in life threatening bleeding
- plts can incr thrombosis and organ damage
115
hemolytic uremic syndrome (HUS)
similar to TTP
caused by E.coli infection
116
HUS treatment
fluids
RBCs
plts
dialysis w/decr kidney function
117
HELLP
thrombocytopenia in pregnancy
118
HELLP characteristics
Hemolysis
Elevated Liver
Low Platelets
119
HELLP pts can develop _____ post-delivery
TTP
120
Heparin induced thrombocytopenia (HIT)
immunomediated response
decr plt count caused by heparin binding to plts
121
HIT treatment
stop heparin
give direct thrombin inhibitor (bivalrudin/dabigatran)
give anti-Xa inhibitor (aban)
give plts
corticosteroids
122
which drug do you give for recent HIT pts in CABG
bivalrudin
123
idiopathic thrombocytopenia purpura
not related to drugs, infection or autoimmune
124
ITP treatment
high dose corticosteroids
plt transfusion
IV immunoglobulin
125
most common inherited abnormality afffecting plt function
vwD
126
vwD managment
DDAVP
vwF
TXA
amicar
127
DDAVP should only be given for Type ___ vwD
Type 1
128
hypercoagulability
predisposes pts to VTE
129
hypercoag low risk
early ambulation
130
hypercoag mod risk
SCDs
early ambulation
131
hypercoag sev risk
subQ heparin
LMWH
