Blood Borne Pathogens and Other Hematological Considerations in the Athlete Flashcards
What are the two subgroups of Contact Transmission?
- Direct Contact - Straight from one person to another with no intermediate object
- Indirect Contact - Intermediate object like doorknob, etc.
What is Droplet Transmission?
- Respiratory droplets carrying infectious pathogens transmit infection when they travel directly from the respiratory tract of the infectious individual to susceptible recipients
What is Airborne Transmission?
- Dissemination of airborne droplet nuclei or small particles in respirable size ranges containing an infective agent that remains infective over time and distance
- Includes Myobacterium Tuberculosis, Rubeola virus or Measles, and Varicella-Zoster virus or Chickenpox
What are the two tiers of precautions to prevent transmission of infectious agents?
- Standard Precautions - Primary strategy for prevention
- Transmission Based Precautions- Used when patient is known to be infected
What are the elements of Standard Precautions?
- Hand Hygiene
- Use of gloves gowns, masks, eye protection or face shields, depending on the anticipated exposure
- Safe injection practices
What is Hepatitis B Virus (HBV)?
- Virus that affects the Liver
- Stable on surfaces up to 7 days
What are symptoms of HBV?
- Jaundice
- Fever
- Nausea
- Abdominal pain
When and for how long should Anti Retroviral drugs be given after exposure to HIV?
- Start within 24 hours of exposure
- Continue for four weeks
- May have GI Side Effects
What are symptoms of HIV?
- Flu Like
- Fever, Chills, Night sweats, Swollen lymph nodes, Rashes and sore muscles and joints
- May also have Weight loss, Chronic diarrhea, Fatigue and Thrush in the mouth
- May take years for these symptoms to develop
What is Anemia?
- Low levels of red blood cells (RBCs) or hemoglobin
- Measured as a percentage of RBCs in a given volume of plasma
What is Sports Anemia?
- Catch-all term that is used to address any type of anemia that affects athletes
- Could be when Plasma Volume increases as a result to exercise
What is Dilutional Pseudoanemia?
- Secondary to plasma volume expansion
- Most common type of anemia in athletes
- Considered an anemia in that the hemoglobin concentration is lower than usually defined
What is “Foot Strike Hemolysis” or Intravascular Hemolysis?
- Impact of foot strike bursts Red Blood Cells in the vessels
- Hemoglobin spills into the plasma, where it binds to the plasma protein Haptoglobin
- Haptoglobin takes Heme to the liver where Iron is salvaged
- If enough RBCs are destroyed, you run out of Haptoglobin and start losing this Iron
- Negligible, not significant cause of iron loss
How do you diagnose and treat Foot Strike Hemolysis?
- Measurement of serum haptoglobin, serum free hemoglobin or the presence of hemoglobinuria
- Treat with new foot wear or activity modification
What are Clinical Signs of Chronic Iron Deficiency?
- Glossitis
- Angular stomatitis
- Koilonychia (spoon nails)
- Blue sclera
- Esophageal webbing
- Anemia
What are some Behavioral Disturbances Common in people with Chronic Iron Deficiency?
- Pica (Eating disorders below)
- Abnormal consumption of dirt [geophagia]
- Consumption of Ice [pagophagia]
What are the most powerful enhancers of non-heme iron absorption?
- Ascorbic Acid
- Meat
What is the Classic clinical presentation of iron deficiency?
- Female competitive endurance runner who presents with an insidious onset of fatigue or declining performance
- GI bleeding, abdominal symptoms or dark urine are common findings
What is the primary treatment approach for iron deficiency?
- Oral Ferrous Sulfate
- Improvement in weeks
- Treatment continued for six to twelve months
What is the Hallmark Finding or Iron Deficiency?
- Low Ferritin (< 10 mcg/L)……And
- Low iron saturation (Fe/TIBC < 15%)
How many milligrams of Iron do men and women need daily?
- Men: 10mg
- Women: 15mg
What are some possible underlying causes of Iron Deficiency?
- Bowel Diseases
- Celiac disease
- Crohn’s disease
- Cancer
- Thalassemia
- Sickle cell anemia
How can Sickle Cell Trait be harmful during exercise?
- Sickle cells accumulate and “logjam” blood vessels, causing explosive rhabdomyolysis
What are some Medical Problems that can occur as a result of Sickle Cells being destroyed more rapidly than normal RBCs?
- Anemia
- Jaundice
- Formation of gallstones
- Lung tissue damage
- Pain episodes
- Stroke
- Priapism (painful prolonged erections)
- Spleen Damage
What is primary treatment of Sickle Cell Anemia?
- Antibiotics
- Vaccinations
- Folic acid supplementation
How are Complications from Sickle Cell Treated?
- Antibiotics
- Pain Management
- IV Fluids
- Blood Transfusions
What is a possible complication that arises with Blood Transfusions to treat Sickle Cell?
- Excessive Iron
What are some Fatal and Non Fatal illnesses Associated with Sickle Cell?
- Sudden Death
- Non Fatal:
- Splenic Infarction (mostly at high altitudes)
- Hematuria
What are exercise precautions for Sickle Cell?
- Build up exercise intensity gradually
- Acclimatization
- Respond to an athlete reporting symptoms of physical distress
- Avoid overheating and dehydration
What are some symptoms of an athlete suffering from effects of Sickle Cell Anemia?
- Hematuria
- Reduced ability to concentrate urine
- Tendency to develop glaucoma secondary to hyphema after eye injuries
In the Event of a Sickling Collapse, what should you do?
- Check vital signs.
- Administer oxygen if available.
- Cool the athlete, if necessary.
- If that athlete is obtunded or as vital signs decline, call 911, attach an AED, start an IV and get the athlete to the hospital quickly.
- Consider advising medical professionals that rhabdomyolysis may be present.
- Have an Emergency Action Plan in place for all practices and competitions.
What is the Danger of Blood Doping?
- Increased Hematocrit (Percentage of whole blood occupied by RBCs)
- Can lead to concentrated or (thick) blood that can cause embolus
What is Paget-Schroetter Syndrome?
- Upper Extremity DVT
- Axillary-subclavian vein thrombosis (ASVT) associated with strenuous activity of the upper extremity
What are some anatomic abnormalities associated with Paget-Schroetter Syndrome?
- Thoracic outlet abnormalities (cervical rib, congenital bands, hypertrophy of the scalenes and abnormal insertion of the costoclavicular ligament)
What is Presentation of Paget-Schroetter Syndrome?
- Young Otherwise Healthy Men
- Typically Dominant Arm
- Swelling and Arm Discomfort
- Heaviness, redness of the arm, cyanosis and dilated visible veins across the shoulder and upper arm
- Could result in embolism
- Treat like Thoracic Outlet Syndrome
