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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
What are lab signs of hemolytic anemia?
Shistocytes, bilirubin elevated, increased reticulocyte count
26
What is an important question you always ask a sickle cell patient about their pain?
Is it there usual pain pattern
27
What is the treatment for sickle cell?
``` Hydration Oxygen Pain meds Flu/PNA vaccine Oral folate Oral iron ```
28
A patient with SSA has sudden chest pain. What would you expect?
Acute chest syndrome, Order a chest x Ray ABX and transfusion
29
When a SSD patient has an aplastic crisis what occurs? How would you treat it?
Arrest of erythropoiesis due to inflammation | Treat by transfusing PRBCs
30
A splenic sequestering crisis in SSD can occur. What would you see and what is the treatment?
Volume resuscitation and transfusion, splenectomy, stroke, priaprism, leg ulcers Acute exacerbation of anemia with elevated reticulocyte and enlarged spleen with pain and hypovolemia
31
G6PD deficiency, a genetic condition has signs and symptoms showing what?
Kernicterus, jaundice, family history
32
What are triggers for G6PD deficiency?
Oxidative stress- medications, mothballs, fava beans
33
The lab PT shows what part of the coagulation cascade?
The extensive pathway
34
The lab PTT shows what part of the coagulation cascade?
The intrinsic pathway
35
Warfarin works on which paths of the coagulation cascade?
2,7,9,10
36
Hemophilia A is deficient in what?
Factor 8 deficiency
37
Hemophilia B (Christmas Dx) is deficient in what?
Factor 9
38
What is the treatment for Factor 8 or 9 deficiencies?
Treat with the lacking factor or plasma products (FFP or crypoprecipitate for type A)
39
What is the most common bleeding disorder?
Von willebrands disorder
40
How do you treat Von willebrands disorder?
DDAVP for minor bleeds or VWF for larger bleeds
41
What is TTP
An unexplained hemolysis and thrombocytopenia with a negative Coombs (a sense of hemolytic anemia).
42
What are the symptoms of TTP?
The Pentad- bleeding, low PLT, neurological changes, decreased kidney function, fever
43
There are 2 types of TTP what are they?
Primary idiopathic or secondary
44
What are some causes of secondary TTP?
Drug induced, pregnancy, SLE
45
What would you expect to see (labs wise) in TTP?
Schistocytes, normal (to slightly elevated) coags , increased d dimer, normal fibrin, thrombocytopenia, negative Coombs
46
What is the treatment for TTP?
Plasma exchange: FFP or Cryo
47
What is the time frame for HIT to occur?
Primary (non immune mediated) 1-2 days Secondary (immune mediated) 4-10 days
48
What are signs of HIT?
Decreased PLT by 50% Clotting
49
What is the treatment for HiT?
D/c heparin. Start in new anticoagulant once PLT count rises. Can give FFP if needed
50
How do you diagnose ITP?
Low PLT and all else is normal
51
What is the treatment for ITP?
Steroids, splenectomy, IVIG
52
CML is also known as what?
Philadelphia chromosome
53
What occurs with CML?
A blast crisis. Increased blast cells that are unresponsive to chemotherapy
54
Hodgkin's lymphoma and non hodkins differ how?
Non-Hodgkin's does not spread in a pattern. Hodgkin's has Reed-Steinberg cells
55
Consider a transfusion reaction of the patients H/H is less than what?
7/21 | Or HCT
56
1 unit of PRBC will increase your H/H how much
Hemaglobin by 1 | Hematocrit by 3
57
What are some things you want to think about when ordering blood?
``` 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
What qualifies as a massive transfusion?
10 units in 12 hours OR 4 units in the first hour
59
Multiple transfusions can cause what? What do you do to prevent this?
Hypocalcemia Give calcium gluconate
60
What are is the treatment for a hemolytic transfusion reaction?
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
What lung problem can occur from blood and plasma products
Acute lung injury
62
How do you treat an acute lung injury from transfusion reaction?
Ventilators support, diuretics not effective, resolves in 24 hours
63
When do you give PLTs to thrombocytopenia patients?
A symptomatic outpatient with PLT
64
Do you cross match for PLT?
No
65
When to give FFP?
HIT, TTP, Clotting factor deficiencies, active bleeding to increase INR, mass transfusions
66
If giving FFP to a warfarin patient to increase INR what do you have to keep in mind?
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
Crypoprecipitate is given when?
DIC or hemophilia A
68
What makes cryoprecipitate special?
It is the only product that replaces fibrinogen (hence why it's used in DIC)
69
When would you give vitamin K to a warfarin patient?
If there is any serious or life threatening bleeding or if INR >9

ACNP 1 (12 decks)

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