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BioScience II > Anemia PPT -Josh > Flashcards

Anemia PPT -Josh Flashcards

1
Q

What is the most abundant cell in the body

A

Erythrocytes

25 trillion cells (thats kinda badass)

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2
Q

What s teh main function of erythrocytes

A

oxygen delivery to tissues

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3
Q

erythrocytes are biconcave disk, what the fuck does that mean?

A

ability to change shape

increases surface area

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4
Q

Erythrocytes (RBC):

what is the main function

A
  1. Transport Hgb for O2 delivery to tissue
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5
Q

Erythrocytes (RBC):

besides carring Hgb, RBCs also containa large amount of what?

A

Carbonic anhydrase

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6
Q

Erythrocytes (RBC):

Produced where?

A

Bone marrow (vertebrae, sternum, ribs, pelvis, proximal ends of humerus and femur)

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7
Q

Erythrocytes (RBC):

RBC production is controlled by what?

A
  • the ability to transpot O2 to the tissues
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8
Q

Erythrocytes (RBC):

what cell or enzyme or whatever is responsible for producing RBCs

A

erythropoietin

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9
Q

Erythrocytes (RBC):

what 2 vitamins are required for RBC production

A
  • B12 (cyanocalamin)
  • Folic acid
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10
Q

Erythrocytes (RBC):

life span

A

120 days after leaving bone marow

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11
Q

Erythrocytes (RBC):

what is the protein-iron compound in the RBC?

A

Hgb

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12
Q

Erythrocytes (RBC):

what is Hgb for

A

allows RBCs to transport O2

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13
Q

Erythrocytes (RBC):

what is the ratio of packed RBCs to total blood volume?

A

Hct

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14
Q

Erythrocytes (RBC):

Normal Hgb

A

male- 13.9-16.3 g/dL

Female 12-15 g/dL

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15
Q

Erythrocytes (RBC):

what is normal Hct levels

A

Male- 39-55%

Female- 36-48%

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16
Q

Erythrocytes (RBC):

what is the total number of RBCs in a sample of blood

A

RBC count

normal values

male-4.3-5.9 x10^6

Females- 3.5-5.5 x10^6

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17
Q

Erythrocytes (RBC):

what is a measurement of the average size of the RBC, and indicated whether the RBC is small, large, or normal?

A

MCV

Mean Corpuscular Volume

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18
Q

Erythrocytes (RBC):

what is the concentration of Hgb in a given volume of blood?

A

MCHC count

Mean Corpuscular hemoglobin concentration

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19
Q

Erythrocytes (RBC):

explain the Hgb molecule (just basic)

A
  • 4 chians
    • 2 alpha
    • 2 Beta
  • each chain has a heme group
  • each heme group has an iron molecule
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20
Q

Erythrocytes (RBC):

what is a reduction in the total number of circulating erythrocytes or a decreased in the quantity or quality of hemoglobin

A

Anemia

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21
Q

Erythrocytes (RBC):

the WHO defines anemia as less than ___g/dL of Hgb for men and less than ___g/dL of Hgb for women

A

13

12

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22
Q

Erythrocytes (RBC):

postoperatively up to ___% of pts are anemic

A

80%

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23
Q

Erythrocytes (RBC):

___% of pts over 65 are anemic

A

75%

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24
Q

Erythrocytes (RBC):

___to ____ of pts preop are anemia

A

1/3-1/2

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25
Q

Anemia:

3 main causes

A
  1. Impaired RBC production
  2. Blood loss (aucte/chronic)
  3. Increased RBC destruction
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26
Q

Anemia:

is classified according to what?

A

morphology (size, shape, hgb coontent)

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27
Q

Anemia:

is classified as “-cytic” indicates what type of enemia

A

refers to cell size

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28
Q

Anemia:

if classified as “-Chromic” it indicated what

A

referes to Hgb content

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29
Q

Anemia:

so if classified as Normocytic or normochromic, it indicates what?

A

normal RBC volume and normal Hgb content

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30
Q

Anemia:

so if classified as Macrocytic or Hyperchromic what deos that mean

A

High RBC volume and High Hgb content

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31
Q

Anemia:

so if classified as Microcytic or Hypochromic, it would indicate what?

A

Low RBC volume or low hemoglobin content

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32
Q

Anemia: S/S

Eyes?

A

Jaundice

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33
Q

Anemia: S/S

skin

A

Paleness

coldness

jaundice

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34
Q

Anemia: S/S

respiratory

A

SOB

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35
Q

Anemia: S/S

muscular

A

weakness

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36
Q

Anemia: S/S

intestinal

A

Changes stool color

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37
Q

Anemia: S/S

central (brain/neuro)

A

fatigue

dizziness

FAINTING

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38
Q

Anemia: S/S

Blood vessels

A

Hypotension

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39
Q

Anemia: S/S

heart

A

Palpatations

rapid HR

CHEST PAIN

ANGINA

MI

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40
Q

Anemia: S/S

Spleen

A

enlargement

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41
Q

Anemia: Classification

name the 3 classifications

A
  1. Microcytic/ Hypochromic
  2. Normocytic/ Normochromic
  3. Macrocytic/Hyperchromic
42
Q

Anemia: Classification

what 2 anemias fall under Microcytic/ hypochromic

(low RBC Volume and Low Hgb content)

A
  • Iron deficiency
  • Thalassemia

(small Itty ditty Titty)

43
Q

Anemia: Classification

what 2 anemia fall under Macrocytic/ normochromic

(high RBC volume/ Hgb content)

A
  • Pernicious anemia
  • Folate deficiency

(macro large Fat Pussy)

44
Q

Anemia: Classification

what 4 types of anemia fall under normocytic/normochromic

A

all the rest

  • Hemolytic
  • Posthemorragic
  • Aplastic
  • Chronic disease
45
Q

Anemia: Classification

what is the most common tyoe of anemia

A

Iron deficiency

46
Q

Anemia: Iron Deficiency

fall under what classification

A

Microcytic-Hypochromic

47
Q

Anemia: Iron Deficiency

what are causes ?

A
  • Chronic blood loss
  • dietary deficiency
  • Lack of iron for Hgb production
48
Q

Anemia: Iron Deficiency

what are high risk population

A

Elderly

women

infants

low income families

49
Q

Anemia: Iron Deficiency

s/s

A
  • Gradual appearance
  • Fatigue, weakness
  • SOB
  • Pallor
  • Brittle nails
  • GLOSSITIS
  • drymouth
  • dyphagia
50
Q

Anemia:

what anemia is an inherited defect in the globin chain synthesis?

A

Thalassemia

51
Q

Anemia: Thalassemia

is what anemia classification

A

Microcytic-Hypochromic

52
Q

Anemia: Thalassemia

has a strong geogaphical influence of where?

A

Africa

Mediterranean

southesat asi

53
Q

Anemia: Thalassemia

s/s

A

Hepatomegaly

splenomegaly

skeletal malformations

CHF

54
Q

Anemia:

what tyoe of anemia is premature, accelerated hemolysis of RBCs in circulation AKA the erythrocytes are “fragile”

55
Q

Anemia: Hemolytic Anemia

is what class

A

Normocytic-normochromic

56
Q

Anemia: Hemolytic Anemia

what 2 ways is this caused?

A
  1. Hereditary
    • Structural defects, plasma menbrane protein mutations, enzyme deficiency
  2. Acquired
    • Drugs
    • Disease
    • Toxins
    • trauma
57
Q

Anemia:

what type of anemia is caused by acute blood loss

A

Posthemorrhagic Anemia

58
Q

Anemia: Posthemorrhagic Anemia

what class is this

A

Normocytic-Normochromic

59
Q

Anemia: Posthemorrhagic Anemia

what occurs with this anemia

A
  • w/in 24hrs lost plasma is replaced via water and electrolytes from tissues
  • Hemodilution ensues
  • Decreased tissue perfusion causes increased erythropoietin
  • eventually depletes bidy stores of iron
60
Q

Anemia: Posthemorrhagic Anemia

what are the different classes? what % and volume is lost? and is a transfusion needed?

A
  1. <15% or <750ml No need for transfusion
  2. 15-30% or 750-1000 ml no need for transfulsion
  3. 30-40% or 15000-2,000mL prob need transfusion
  4. >40% or >2,000mL Need transfusion
61
Q

Anemia: Posthemorrhagic Anemia

Tell the S/S associated with % of blood loss

  1. 10%
  2. 20%
  3. 30%
  4. 40%
  5. 50%
A
  1. none
  2. Tachycardia w/ exercise
  3. Postural hypotension/ tachycardia
  4. CVP, CO, BP low; air hungry; cold clammy skin
  5. Severe shock; lactic acidosis, death
62
Q

Anemia:

what Anemia is reduction is all 3 cells RED, WHITE, PLATELETS (pancytopenia)

A

aplastic Anemia

63
Q

Anemia: Aplastic Anemia

is what class

A

Normocytic-normochromic

64
Q

Anemia: Aplastic Anemia

is caused but what?

A

Drugs

chemicals

radiation

iinfections (viruses)

65
Q

Anemia:

what type of anemia if from a chronic infection or malignancy causing increased demand for new RBCs

A

Anemia of Chronic Disease

66
Q

Anemia: Anemia of Chronic Disease

is what class

A

Normocytic-Normochromic

67
Q

Anemia: Anemia of Chronic Disease

what are common causes

A
  • CKD
  • Ca
  • Liver cirrhosis
  • Infection (HIV, Hep B/C)
  • Autoimmune d/o
68
Q

Anemia:

What tyoe of anemia is lack of cobalamin (vit B12)

A

Pernicious Anemia

69
Q

Anemia: Pernicious Anemia

What class if this?

A

Macrocytic-NORMOchromic

(on a previous diagram Terra stated MacroChromic) I don’t know which is correct yet

70
Q

Anemia: Pernicious Anemia

Is caused by what?

A
  • Decreased erythropoises
  • abnormal DNA/RNA in erythroblast
  • Premature cell dealth
  • Congenital or aquired deficiency of IF
71
Q

Anemia: Pernicious Anemia

is commonly associated w/ what d/o

A

end stage gastritis

72
Q

Anemia: Pernicious Anemia

neuro effects

A
  • Parasthesias
  • Gait disturbance
  • weakness
  • muscle spasticity
  • Abnormal reflexes
73
Q

Anemia:

what type occure due to an essential vitamin lacking fir erythrocyte maturation and production

A

folate deficiency

74
Q

Anemia: Folate Deficiency Anemia

the essential vitamin is dependent on a daily intake of what?

A

50-200 mcg/day

75
Q

Anemia: Folate Deficiency Anemia

folate is absorbed where

A

Small intestine

76
Q

Anemia: Folate Deficiency Anemia

can be caused by what 2 disorders

A

Chronic malnutrition

Alcoholism

77
Q

Anemia: Folate Deficiency Anemia

the megoblastic cells and apoptosis of RBCs places the indivisual at an increased risk for what?

A

Atherosclerosis

78
Q

Explain why the body causes the Copensitory mech

Decreased afterload

A
  • Decreased viscosity
  • Hypoxemia causes Vasodilation and thus decreased SVR leading to increased SV and therfore increased CO
  • Redistribution of blood to tissues (organs w/ higher O2 requirement receive more blood)
79
Q

Explain why the body causes the Copensitory mech

increased Preload

A
  • Decreased RBCs and decreased Blood volume lead to…..
  • osmotic pull of fluid into vasculature from tissues (maintains blood volume but very diluted)
80
Q

Explain why the body causes the Copensitory mech

Increased HR

A

Anemia activated the SNS

81
Q

Explain why the body causes the Copensitory mech

Inrcreased RR and depth

A

in attmpt to offset hypoxia being experienced by the tissues

82
Q

Compensitory Mechanisms:

A decreased Arterial O2 content will shift the ODC to where?

A

right

to release O2 from Hgb to tissue

83
Q

Compensitory Mechanisms:

why does the ODC shift to the right?

A
  • Rlease of O2 to tissues
  • Increased levels of 2,3,DPG
84
Q

Compensitory Mechanisms:

During anemia blood is redistributed from where to where to compensate

A

from skin and kidney

to heart and brain

85
Q

Compensitory Mechanisms:

______ stimulate bone marrow to produce more RBCs

A

the Kidneys

86
Q

Anemia Preoperative:

what do you wanna assess or get or look at or anything else you can thinnk about

A
  • CBC w/ platelets
  • Complete H&P
  • Tyoe and Cross
  • Replace and deficiencies prior to sx
  • ESA (erythropoiesis-syimulating agent)
  • Possible transfussion prior to sx
87
Q

Anemia Preoperative:

what type of pts (high risk) tolerate anemia more poorly?

A

Coronary thersclerosis

Advanced Pulm disease

Elderly pts

88
Q

Anemia Intraoperative:

what do you wanna (want to) do or monitor or anything else you think of

A
  • Pulse ox (severe anemia can give inaccurate readings)
  • A-line (hemodynamics/ABGs)
  • Maintain adequate O2
  • Watch for S/S of anemia
89
Q

Anemia Intraoperative:

what 3 factors increase the risk of MI

A
  • Pts w/ CAD
  • Decreases O2 dsupply (Anemia)
  • Increase in O2 demand (tachycardia)
90
Q

Anemia Intraoperative:

what happens to VAAs w/ anemia

A

uptake faster

91
Q

Anemia Intraoperative:

whats up with N2O and anemia?

A
  • use w/ caution
  • Prolonged exposure can mimic Vit B12 anemia
92
Q

Anemia Intraoperative:

What occurs w/ cardiac depressent drugs w/ anemia

A

Further decrease O2 to tissues

93
Q

Anemia Intraoperative:

how to you prevent a left shift on the ODC

A

avoid

Hyperventilation

and

Hypothermia

94
Q

Anemia Postoperative:

what are 2 main things to do postop w/ anemic pts

A

Maintain Oxygenation

Draw H&H if blood loss significant

95
Q

Anemia when to transfuse?

what was the old rule? Before 1980s

A

10/30 rule

96
Q

Anemia when to transfuse?

but in 1988 the NIH stated the criteria was what?

A

“no evidence to support a single criterion”

97
Q

Anemia when to transfuse?

again supporting the NIH tin 1996 the ASA advised against a “transfusion trigger”, but however concluded that a transfusion is rarely indicated above Hgb______ and always indicated below hgb _____

A

10g/dL

6g/dL

98
Q

Anemia when to transfuse?

you should assess what 3 factors before deciding to transfuse?

A
  1. Risk assiociated w/anemia during periop time
  2. Risk of transfusion itself
  3. What does the research state?
99
Q

Summary:

Anemia is what?

A

decreased in the number or function of RBC

100
Q

Summary:

what to assess?

A

The individual

co-existing diseases

Degree of expected blood loss

101
Q

Summary:

transfusion should be based on what?

A

YOUR best clinical judgement, as that each pt is unique

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