Anemia Flashcards
At every visit a pt with anemia should be monitored for what?
Hemodynamic instability
What are symptoms of hemodynamic instability?
DEC urine output (DEC urination)
Altered LOC or LOC
What exams would you want to do to assess for hemodynamic instability? And what findings would alert you that the pt may not be hemodynamically stable?
Vitals: tachycardia/bradycardia, low O2 sat (high CO2 output), HTN/hypotension, wide pulse pressure
Heart: arrhythmias, distant/muffled heart sounds, JVD, pericardial effusion
Lungs: agonal resps, pulmonary edema, pleural effusion
GI: ascites
Extremities: DEC peripheral pulses, slow cap refill, peripheral edema
Skin: pallor, cyanosis (peripheral/central), coolness (extremities), anasarca
If a pt who is not hemodynamically stable, what does HTN mean? What about hypotension?
HTN - compensated
Hypotension - progressive
If you have a patient’s HGB level (Hx of anemia), what are the criteria for referral/hospitalization…
HGB <7 g/dL
REFER TO ER!
RBC transfusion indicated (if pt stable 2 units of packed RBCs, then continual HGB monitoring)
If you have a patient’s HGB level (Hx of anemia), what are the criteria for referral/hospitalization…
HGB 7-10 g/dL
Unclear zone - clinical judgement and pt status.
Is pt hemodynamically stable? May not need transfusion or immediate hospital referral
Pt not hemodynamically stable? ER referral
Need to assess for location of acute bleed (r/o) and compare HGB with previous labs.
If you have a patient’s HGB level (Hx of anemia), what are the criteria for referral/hospitalization…
HGB >10 g/dL
No RBC transfusion needed
What patient’s are high risk and may need more immediate referral to ER or blood transfusion? What is the level of HGB would you transfuse these people?
> 65 yo
PMHx of Cardiovascular or Respiratory disease
HGB <8 g/dL
When a patient presents with anemia or has a first-time diagnosis of anemia, what should be your first step?
ID the underlying cause because treatment guidelines will vary depending on cause of anemia.
Blood transfusion should be reserved for who?
Pt hemodynamically unstable (orthostatic hypotension)
Unstable d/t active bleeding
And/or
Shows evidence for end-organ ischemia
What does the data show regarding blood transfusion for patient’s who are anemic?
Beneficial: HGB <6 g/dL
Not helpful: HGB >10 g/dL