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ACNP 1 > Anemias and Blood Transfusions > Flashcards

Anemias and Blood Transfusions Flashcards

1
Q

What is the most sensitive indicator of Iron deficient anemia?

A

Ferritin level decreased (

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2
Q

What is the treatment for iron deficient anemia?

A

Oral iron

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3
Q

What are some causes of iron deficient anemia?

A 
Low iron intake
Chronic bleed
Malabsorption
Pregnancy
Menses
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4
Q

What kind of anemia is iron deficient anemia?

A

Microcytic hypochromic

MCV 80-100
MCH 27-31

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5
Q

How can you tell if oral iron treatment is working?

A

Check a reticulocyte count. It should be increasing

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6
Q

How long does it take for oral iron therapy to work?

A

4-6 weeks for full results

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7
Q

Name the microcytic hypochromic anemias

A

Thalassemia and IDA

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8
Q

How do you tell between Thalassemia and IDA

A

Ferritin level

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9
Q

Thalassemia A is common in which populations?

A

Black and Asian

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10
Q

Thalassemia B is more common in which population?

A

Mediterranean and middle eastern

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11
Q

What are the differences between heterozygous and homozygous thalassemia

A

Heterozygous- mild symptoms
Anemia, bronze skin, enlarged liver and spleen but normal life expectancy

Homozygous- CHF, fractures growth retardation

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12
Q

What is treatment for thalassemia?

A

Iron chelating and blood transfusions for severe forms

Genetic counseling

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13
Q

What can you NOT give to thalassemia patients?

A

Iron- can result in organ failure

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14
Q

Name 2 macrocytic anemias and how do you tell the difference?

A

Pernicious anemia and folic acid deficiency

Test B12 level and Folate levels

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15
Q

Mathylmalonic acid and homocysteine will show how in folate va B12 deficient anemias?

A

Both are elevated in B12 deficiency

Folate would have a normal methylmalonic acid and a increased homocysteine

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16
Q

What is different symptoms-wise in b12 deficient anemia?

A

Neurological symptoms

Ataxia, lack of coordination, memory loss

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17
Q

How do you treat B12 deficiency?

A

Parenteral B12 then 100mcg monthly IM

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18
Q

What is the treatment for folate deficiency?

A

Oral folic acid. 1mg/day

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19
Q

How do you ensure your oral folate is working for the deficiency?

A

Check a reticulocyte count. Will be elevated in 1 week

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20
Q

How to you treat anemia of chronic disease?

A

E-poietin stimulating agents

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21
Q

Epoiten Alfa you give how?

A

Initially 3x/week then weekly

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22
Q

Darbapoietin alpha you give how?

A

Initiate weekly

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23
Q

When treating with epoietin drugs you treat until a HGB of what?

A

11-12 to prevent cardiac sequelae

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24
Q

Hemolysis from transfusions can occur with which products?

A

IVIG and PRBC

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25
Q

What are lab signs of hemolytic anemia?

A

Shistocytes, bilirubin elevated, increased reticulocyte count

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26
Q

What is an important question you always ask a sickle cell patient about their pain?

A

Is it there usual pain pattern

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27
Q

What is the treatment for sickle cell?

A 
Hydration
Oxygen
Pain meds
Flu/PNA vaccine
Oral folate 
Oral iron
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28
Q

A patient with SSA has sudden chest pain. What would you expect?

A

Acute chest syndrome, Order a chest x Ray ABX and transfusion

29
Q

When a SSD patient has an aplastic crisis what occurs? How would you treat it?

A

Arrest of erythropoiesis due to inflammation

Treat by transfusing PRBCs

30
Q

A splenic sequestering crisis in SSD can occur. What would you see and what is the treatment?

A

Volume resuscitation and transfusion, splenectomy, stroke, priaprism, leg ulcers

Acute exacerbation of anemia with elevated reticulocyte and enlarged spleen with pain and hypovolemia

31
Q

G6PD deficiency, a genetic condition has signs and symptoms showing what?

A

Kernicterus, jaundice, family history

32
Q

What are triggers for G6PD deficiency?

A

Oxidative stress- medications, mothballs, fava beans

33
Q

The lab PT shows what part of the coagulation cascade?

A

The extensive pathway

34
Q

The lab PTT shows what part of the coagulation cascade?

A

The intrinsic pathway

35
Q

Warfarin works on which paths of the coagulation cascade?

A

2,7,9,10

36
Q

Hemophilia A is deficient in what?

A

Factor 8 deficiency

37
Q

Hemophilia B (Christmas Dx) is deficient in what?

A

Factor 9

38
Q

What is the treatment for Factor 8 or 9 deficiencies?

A

Treat with the lacking factor or plasma products (FFP or crypoprecipitate for type A)

39
Q

What is the most common bleeding disorder?

A

Von willebrands disorder

40
Q

How do you treat Von willebrands disorder?

A

DDAVP for minor bleeds or VWF for larger bleeds

41
Q

What is TTP

A

An unexplained hemolysis and thrombocytopenia with a negative Coombs (a sense of hemolytic anemia).

42
Q

What are the symptoms of TTP?

A

The Pentad- bleeding, low PLT, neurological changes, decreased kidney function, fever

43
Q

There are 2 types of TTP what are they?

A

Primary idiopathic or secondary

44
Q

What are some causes of secondary TTP?

A

Drug induced, pregnancy, SLE

45
Q

What would you expect to see (labs wise) in TTP?

A

Schistocytes, normal (to slightly elevated) coags , increased d dimer, normal fibrin, thrombocytopenia, negative Coombs

46
Q

What is the treatment for TTP?

A

Plasma exchange: FFP or Cryo

47
Q

What is the time frame for HIT to occur?

A

Primary (non immune mediated) 1-2 days

Secondary (immune mediated) 4-10 days

48
Q

What are signs of HIT?

A

Decreased PLT by 50%

Clotting

49
Q

What is the treatment for HiT?

A

D/c heparin. Start in new anticoagulant once PLT count rises. Can give FFP if needed

50
Q

How do you diagnose ITP?

A

Low PLT and all else is normal

51
Q

What is the treatment for ITP?

A

Steroids, splenectomy, IVIG

52
Q

CML is also known as what?

A

Philadelphia chromosome

53
Q

What occurs with CML?

A

A blast crisis. Increased blast cells that are unresponsive to chemotherapy

54
Q

Hodgkin’s lymphoma and non hodkins differ how?

A

Non-Hodgkin’s does not spread in a pattern.

Hodgkin’s has Reed-Steinberg cells

55
Q

Consider a transfusion reaction of the patients H/H is less than what?

A

7/21

Or HCT

56
Q

1 unit of PRBC will increase your H/H how much

A

Hemaglobin by 1

Hematocrit by 3

57
Q

What are some things you want to think about when ordering blood?

A 
Type and cross match
18 guage needle
IVNSS
Filter
Pre medicate with Tylenol and benedryl
Rapid transfusion for shock states
Administer over 2-4 hours
58
Q

What qualifies as a massive transfusion?

A

10 units in 12 hours OR 4 units in the first hour

59
Q

Multiple transfusions can cause what? What do you do to prevent this?

A

Hypocalcemia

Give calcium gluconate

60
Q

What are is the treatment for a hemolytic transfusion reaction?

A

Stop transfusion

Give fluids and maintain urine at 100cc/HR
Draw CBC Coags urine and bilirubin
Give benedryl and Tylenol and epinephrine of severe
Sodium bicarbonate to alkolyze urine
Diurese

61
Q

What lung problem can occur from blood and plasma products

A

Acute lung injury

62
Q

How do you treat an acute lung injury from transfusion reaction?

A

Ventilators support, diuretics not effective, resolves in 24 hours

63
Q

When do you give PLTs to thrombocytopenia patients?

A

A symptomatic outpatient with PLT

64
Q

Do you cross match for PLT?

A

No

65
Q

When to give FFP?

A

HIT, TTP, Clotting factor deficiencies, active bleeding to increase INR, mass transfusions

66
Q

If giving FFP to a warfarin patient to increase INR what do you have to keep in mind?

A

It will only bring the INR to 1.5 so give with vitamin K to lower more and it only lasts 6 hours so give with vitamin K to maintain

67
Q

Crypoprecipitate is given when?

A

DIC or hemophilia A

68
Q

What makes cryoprecipitate special?

A

It is the only product that replaces fibrinogen (hence why it’s used in DIC)

69
Q

When would you give vitamin K to a warfarin patient?

A

If there is any serious or life threatening bleeding or if INR >9

ACNP 1 (12 decks)

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