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Fa: Coexisting 2 > 4. Hematology > Flashcards

4. Hematology Flashcards

1
Q

anemia

A

reduction in 1 of the following:
[Hg]
hct
RBC

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2
Q

WHO anemia definition

A

Hb < 12 g/dL women
Hb < 13 g/dL men

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3
Q

DLO2

A

CO*CaO2

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4
Q

CaO2

A

1.34HbSaO2 + PaO2*0.003

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5
Q

major contributor to amount of O2 in blood

A

hb

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6
Q

anemia compensation

A

redistribution of blood from skin/muscles/kidneys to brain heart and lung

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7
Q

shunt of blood from kidneys causes

A

EPO release

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8
Q

trigger for transfusion

A

Hb < 10 g/dL
Hct < 30%

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9
Q

in anemic pts we should try to _____ O2-Hb curve

A

aovid shifting O2-Hb left

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10
Q

CADET face RIGHT

A

CO2
Acid
D 2,3 DPG
Exercise
Temp

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11
Q

microcytic anemia

A

MCV < 80fL

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12
Q

microcytic anemia common causes

A

iron deficiency
thalassemia

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13
Q

iron deficiency causes infants

A

nutritional deficieny

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14
Q

iron definciency primary cause adults

A

blood loss

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15
Q

iron deficiency anemia labs

A

Hb 9-12 g/dL
ferritin < 41 ng/mL

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16
Q

thalassemia diagnosis

A

Hb electrophoresis

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17
Q

thalaseemia best anesthetic technique

A

all equal

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18
Q

thalassemia SE

A

incr thrombotic risk

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19
Q

normocytic anemia

A

MCV 80-100 fL

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20
Q

normocytic anemia types

A

hemolytic anemia
chronic disease anemia
CKD anemia
aplastic anemia

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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

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22
Q

hereditatry spherocytosis

A

autosomal dominant
deficiency in membran proteins
unable to mx RBC shape

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23
Q

hereditary spheocytosis ahould avoid

A

mechanical valves
bypass

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24
Q

hereditary elliptocytosis

A

autosomal dominant abnormalioty of membrane proteins spectrin/glycophorin

elliptical or rod shape

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25
Q

acanthocytosis

A

defective membrane structure due to lack of beta-lipoprotein

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26
Q

acanthocytosis comorbidities

A

cirrhosis
severe pancreatitis

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27
Q

paroxysmal nocturnal hymoglobinuria

A

stem cell disorder in 2nd - 8th decade of life

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28
Q

paroxysmal nocturnal hemoglobinuria S+S

A

dark urine overnight

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29
Q

paroxysmal nocturnal hemoglobinura treatment

A

exulizumab

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30
Q

what should you not use in paroxysmal noctunal hemoglobinura

A

cell saver

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31
Q

Glu-6-phos dehydrogenase deficiency

A

x-linked genetic disroder
RBC unable to handle stress so hemolysis occurs

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32
Q

Glu-6-phos dehydrogenase definiency avoid

A

oxidative drugs:
iso
sevo
reglan
penicillin
methylene blue
hypothermia
acidosis
hyperglycemia

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33
Q

what form of iron do we want

A

Fe2+ (ferrous)

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34
Q

does sickle cell trait cause incr M+M?

A

no - only sickle cell disease

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35
Q

SCA Hct goal

A

30%

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36
Q

SCA goals

A

decr anxiety
hydration
decr acidosis
decr hypothermia

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37
Q

Sickle C

A

cells lose water thorugh incr K+/Cl- transporter activity

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38
Q

warm autoimmune hemolytic anemia (WAHA)

A

red cell lysis due to warm agglutinis

IgG lysis at 37C+

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39
Q

WAHA associated with

A

lupus
lymphoma
leukemia
HIV

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40
Q

Cold autoimmune hemolytic anemia (CAHA)

A

red cel lysis due to cold exposure

ImM lysis at 0-10C

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41
Q

CAHA associated with

A

mycoplasma infections
neoplamss

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42
Q

CAHA treatment

A

avoid cold
rituximab
plasmapheresis

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43
Q

WAHA treatment

A

corticosteroids
splenectomy
rituximab

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44
Q

anemia of chronic disease (ACD)

A

decr production
+
decr lifespan of RBCs

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45
Q

ACD type

A

normocytic
normochromic
hyperproliferative

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46
Q

ACD mech

A

iron trapped in macrophages
decr [EPO]

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47
Q

ACD treatment

A

cure underlying dz
give Iron
give EPO

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48
Q

anemia of CKD

A

due to decr EPO production

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49
Q

ACKD treament

A

correct iron deficiency
give EPO

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50
Q

ACKD hb goal

A

Hb 10-12 g/dL

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51
Q

aplastic anemia

A

autosomal recessive
progressive failure of bone marrow that usually results in leukemia

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52
Q

macrocytic anemia

A

MCV: >100 fL
defects in nuclear maturation

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53
Q

most common macrocytic anemia

A

Folate/B-12 deficiency

54
Q

macrocytic anemia treatment

A

vitamins
decr alcohol

55
Q

HbM

A

ferrous iron oxidized to ferric iron

56
Q

HbM treatment

A

methylene blue
1-2 mg/kg over 3-5 mins

57
Q

polycythemia

A

incr RBC mass and Hct due to hypoxia-stimulated EPO production

58
Q

optimal Hct for O2 transport

A

33-36%

59
Q

optimal Hb for O2 transport

A

11-12 g/dL

60
Q

what happens to blood viscosity at higher Hct/Hb?

A

incr blood viscosity
decr BF
decr O2 delivery

61
Q

polycythemia vera

A

stem cell disorder
JAK2 gene mutation

incr RBC count
+/- incr plt count
+/- incr leukocyte count

62
Q

polycythemia vera diagnosis

A

female:
Hb > 16
Hct > 48

male:
Hb > 16.5
Hct > 49

decr serum EPO

63
Q

polycythemia cera treatment

A

dilute Hct < 45%
aspirin
myelosuppressive drugs

64
Q

polycythemia vera risks

A

thrombosis
hemorrhage

65
Q

Factor VII deficiency

A

rare autosomal recessive disease

66
Q

Factor VII deficiency diagnosis

A

symptomatic bleeding when levels drop below 15%

67
Q

Factor VII levels pre-op

A

20-25%

68
Q

factor vii bleeding treatment

A

Factor VII
recombinant (novoseven)
PCC
FFP

69
Q

Factor X
Factor V
Prothrombin deficiency treatment

A

FFP (15-20 ml/kg)
PCC (25-50 iu/kg)

70
Q

FFP dosing

A

15-20 ml/kg

71
Q

PCC dosing

A

25-50 iu/kg

72
Q

PCC risks

A

thrombus
thromboembolism
DIC

73
Q

Factor VIII (hemophilia A) chromosome

A

x

74
Q

HemA severe

A

< 1% factor level

75
Q

HemA mod

A

1-5% factor level

76
Q

HemA mild

A

6-30% factor level

77
Q

Haem A diagnosis

A

prolonged aPTT
normal PT

78
Q

HemA treatment

A

factor VIII
DDAVP
emicizumbab

79
Q

HemA level for major sx

A

80-100%

80
Q

HemA level minor sx

A

50-80%

81
Q

DDAVP day of surgery

A

incr F8 3-5x

82
Q

HemA periop bleeding treatment

A

FFP
cryo
amicar
TXA

83
Q

Factor IX deficiency (HemB) severe

A

<1% factor level

84
Q

HemB mod

A

1-5% factor level

85
Q

HemB mild

A

5-40% factor level

86
Q

HemB diagnosis

A

prolonged aPTT
normal PT

87
Q

HemB treatment

A

recombinant F9
F9 PCC

88
Q

F9 half life

A

18-24 hrs

89
Q

F9 infusion repeated

A

12-24 hrs

90
Q

F11 deficiency bleeding

A

mild

91
Q

F11 treatment

A

TXA
amicar
Factor Xi concenctrate

92
Q

where is fibrinogen synthesized

A

liver (from 3 genes on chromosome 4)

93
Q

fibrinogenemia treatment

A

fibrinogen
cryo

94
Q

cryo dose minor sx

A

1U / 10kg

95
Q

cryo dose major sx

A

1U/5kg

96
Q

fibrinogen target major sx

A

> 100 mg/dL

97
Q

fibrinogen target minor sx

A

> 50 mg/dL

98
Q

thrombocytopenia

A

low plts

99
Q

plt half life

A

9-10days

100
Q

plts per day

A

15,000-45,000

101
Q

treatment for bleeding and low plateelets

A

give platelets

102
Q

plts for minor sx

A

20k-30k

103
Q

plts for maj sx

A

50k

104
Q

neuraxial plts

A

70k-100k

105
Q

1 unit of plts

A

incr plts by 50k

106
Q

do plts need ABO compatibility

A

no

107
Q

do plts need RH compatibility

A

yes

108
Q

DIC

A

coagulopathy due to excess intravascular thrombin and widespread clotting and bleeding

109
Q

DIC states

A

procoagulant
hyperfibrinolytic

110
Q

DIC labs

A

plts
PT
PTT
fibrinogen
D-dimers

111
Q

thrombotic thrombocytopenia purpura (TTP)

A

plt rich thrombin in arterial and capillary microvasculatured leading to thrombocytopenia and microangiopathic hemolytic anemia

112
Q

TTP cause

A

ADAMTS 13 protease deficiency

113
Q

TTP treatment

A

plasma exchange
glucocorticpids
rituxiumab
caplacizuman

114
Q

should you give plts in TTP

A

only in life threatening bleeding
- plts can incr thrombosis and organ damage

115
Q

hemolytic uremic syndrome (HUS)

A

similar to TTP
caused by E.coli infection

116
Q

HUS treatment

A

fluids
RBCs
plts
dialysis w/decr kidney function

117
Q

HELLP

A

thrombocytopenia in pregnancy

118
Q

HELLP characteristics

A

Hemolysis
Elevated Liver
Low Platelets

119
Q

HELLP pts can develop _____ post-delivery

A

TTP

120
Q

Heparin induced thrombocytopenia (HIT)

A

immunomediated response
decr plt count caused by heparin binding to plts

121
Q

HIT treatment

A

stop heparin
give direct thrombin inhibitor (bivalrudin/dabigatran)
give anti-Xa inhibitor (aban)
give plts
corticosteroids

122
Q

which drug do you give for recent HIT pts in CABG

A

bivalrudin

123
Q

idiopathic thrombocytopenia purpura

A

not related to drugs, infection or autoimmune

124
Q

ITP treatment

A

high dose corticosteroids
plt transfusion
IV immunoglobulin

125
Q

most common inherited abnormality afffecting plt function

A

vwD

126
Q

vwD managment

A

DDAVP
vwF
TXA
amicar

127
Q

DDAVP should only be given for Type ___ vwD

A

Type 1

128
Q

hypercoagulability

A

predisposes pts to VTE

129
Q

hypercoag low risk

A

early ambulation

130
Q

hypercoag mod risk

A

SCDs
early ambulation

131
Q

hypercoag sev risk

A

subQ heparin
LMWH

Fa: Coexisting 2 (7 decks)

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