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bloody Flashcards

1
Q

DO2

A

CO x Hgb x 1.36 x SaO2

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2
Q

TRALI

A

Transfusion-Related Acute Lung Injury

  • -non-cardiogenic pulmonary edema
  • develops 6 hrs after any blood component
  • theory: ab (donor) + ag (recip) rxn –> inflam response
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3
Q

TACO

A

Transfusion-Associated Circulatory Overload- s/s fluid overload

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4
Q

TRALI tx

A

stop transfusion immediately r/o other possible causes

supportive: ventilation, ↓TV & plateau pressure

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5
Q

TACO tx

A

slow or stop infusion, diuretics

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6
Q

TRIM

A

Transfusion-Related Immunomodulation
down-regulation of immune system as result of transfusion
theory: leads to malignancy recurrence, post-op bacterial infections, new cancers

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7
Q

proteins (aa)

role in erythropoesis & consequence of deficiency

A

cellular membrane component, impaired hgb synthesis

impaired cell membrane integrity, hemolytic anemia, ↓ RBC lifespan

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8
Q

vitamin B12

role in erythropoesis & consequence of deficiency

A

synthesis of DNA, facilitator of folate metabolism

Macrocytic (Megaloblastic) anemia

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9
Q

folate (folic acid)

role in erythropoesis & consequence of deficiency

A

Synthesis of DNA & RNA, maturation of erythrocytesMacrocytic (Megaloblastic) anemia

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10
Q

vitamin C

role in erythropoesis & consequence of deficiency

A 
Fe metab (reducing agent → ferrous sulfate Fe2+ form)
normocytic-normochromic anemia
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11
Q

iron

role in erythropoesis & consequence of deficiency

A

hgb synthesis

normocytic-normochromic & iron-deficiency anemia

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12
Q

hct & hgb

A 
Most common & sensitive test for anemia 
– not specific to type of anemia
HCT (PCV) 
– %age RBCs in total blood vol
- M: 42-54%
- F: 38-46%
hgb – total meas hgb in the blood
- M: 13.5-17.5g/dL
- F: 12-15.5g/dL
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13
Q

erythrocyte count

A 
# erythrocytes per vol blood
M: 4.5-5.9 x 1012/LF: 4.1-5.1 x 1012/L
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14
Q

reticulocyte count

A

%age reticulocytes in vol of blood (a reflection of erythropoiesis)
values ↑ during ongoing arterial hypoxia or O2 demand
0.5-1.5%

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15
Q

red cell distribution width (RDW)

A

variation in RBC width (“diversity” in RBC size)

anistocytosis: RBC size highly variable
11. 5-14.5%

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16
Q

mean corpuscular volume (MCV)

A

avg vol of a single RBC (size or stature)

80-100 femtoliter per RBC

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17
Q

mean corpuscular hgb (MCH)

A

amt hgb in a RBC (“content” or “weight” of hgb in avg RBC in circulation)

27-31 picograms/cell

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18
Q

mean corpuscular hgb concentration (MCHC)

A

avg concentration of hgb in given vol of RBCs (hgb density)

33-36g/dL

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19
Q

how to dx specific anemia

A
  1. Get CBC w differential
  2. MCV: micro, normo, macro -cytic?
  3. MCH & MCHC: hypo, normo, hyper -chromic?
  4. Reticulocyte count (↓ or ↑?)
  5. Consider peripheral blood smear, Fe studies, other specific dx tests based on info from above steps
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20
Q

microcytic anemias x2

A

MCV lt 80

Fe Deficiency Thalassemias

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21
Q

normocytic anemias x3

A

MCV 80-100
Acute Blood Loss
Chronic Disease
Sickle Cell

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22
Q

macrocytic anemias x2

A

MCV gt 100
Pernicious (B12)
Folate Deficiency

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23
Q

ferritin

A

iron storage protein

18-270 ng/mL

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24
Q

transferrin saturation

A

transports iron

20-50%

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25
iron normal #
50-175 ug/dL
26
total iron binding capacity (TIBC)
250-400 ug/dL
27
most common cause of anemia
Fe deficiency
28
Fe deficiency anemia
most common cause of anemia, more common in Fusually asymp until hct lt 30%
29
pica unique to
Fe deficiency anemia
30
Fe def anemia mgmt & eval
tx cause PO Fe replacement 6 mo min Repeat labs @ 1 mo - Correction 1/2 HCT deficit - Rer count normal - Improved Fe studies Repeat labs @ 2 mo → normalization of all laboratory values
31
*PO Fe replacement considerations*
Take on empty stomach w ascorbic acid (Vitamin C) GI Side Effects: dark stools, constipation, nausea
32
*thalassemias + classifications x3*
genetic disorders char by ↓synth globin chains (alpha or beta) = ↓ hgb synthesis; poikilocytosis happens 1. Trait: lab features w/o clinical impact 2. Intermedia: occasional transfusion 3. Major: Life threatening, transfusion dependent
33
alpha thalassemia
primarily in Asian descentgene deletions ↓ alpha-globin chain synthesis
34
poikilocytes
abnormally shaped red blood cells
35
alpha thalassemia tx x3
Silent carrier = no treatment Thalassemia minor or trait = no treatment, no Fe supplements!!! hgb H dz = folic acid supp, no Fe supp, if PRBC transfusion needed consider Fe chelation
36
beta thalassemia + types x2
primarily mediterranean descent - ↓ beta-globin chain: beta* - absent beta-globin chain expression: beta0
37
thalassemia punnett
beta-beta: healthy A & B beta0-beta*: thalassemia minor + 80-95% hgbA beta*-beta* (mild): thalassemia intermedia + 0 - 30% hgb A beta*-beta* (severe) OR beta0-beta0: thalassemia major + 0 - 10% hgb A
38
most severe beta thalassemias genotypes x2
beta*-beta* (severe) OR beta0-beta0: thalassemia major + 0 - 10% hgb A
39
beta thalassemia major physical characteristics
Bone structure abn skull & long bones Bone marrow spaces ↑ - attempt ↑erythropoiesis ``` Growth retardation Frontal bossing “Chipmunk” cheeks Exposed frontal teeth Hepatosplenomegaly ```
40
skull + long bone abn, growth retardation, chipmunk cheeks + teeth, hepatosplentomegaly
beta thalassemia major
41
beta thalassemia tx
Minor = no treatment Intermedia = folic acid supp, occasional RBC transfusion, no Fe supp Major = routine RBC transfusion, folic acid supp, no Fe supp, Fe chelation tx, allogenic stem cell transplant???
42
Fe and thalassemias
NOPE
43
Fe, transferrin, *TIBC* ↓ = ? anemia
Anemia of Chronic Disease - inflammation
44
Anemia of Chronic Disease & transfusions
PRBC @ hgb lt 7
45
*TIBC* ↓ = ? anemia
Anemia of Chronic Disease - inflammation
46
Anemia of Chronic Disease that is dx of exclusion
in elderly d/t ↓ erythropoietin production or red bone marrow ↑ resistant to erythropoiesis
47
who does not usually present with anemia sx?
vit B12 deficiency (pernicious)
48
pernicious anemia tx
Parenteral (recommended) → B12 IM or SC qd 1 wk/wkly 1 mo THEN 1x/mo until B12 levels normalize – typically takes 2-3 mos PO or SL methylcobalamin – only approp after deficiency corrected & evidence of improved/changed GI abs
49
% PO iron abs by GI
1%
50
required for heme chain formatino
folic acid
51
B12 vs folic acid: sources
B12: animal folic: fruits/veggies
52
*aplastic anemia*
d/t issues w red bone marrow → suppression/injury to hematopoietic stem cell causes → idiopathic, pregnancy, chemo & rad, viruses inc hepatitis
53
aplastic anemia s/s
d/t pancytopenia = classic anemia sx, inf (bacterial &/or fungal), bleeding/hematoma out of proportion to injurysigns: pallor, purpura, petechiae
54
sickle cell anemia & hgb
S instead of A d/t DNA alteration in B-globin chain
55
sickle cell carrier vs disease
CARRIER Each erythrocyte carries ~40% HbS Normal shaped erythrocyte Typically do not have any health related issues DISEASE Each erythrocyte carries about 80-96% HbS Classic “sickle” cell RBC’s Multiple health issues
56
hgb S reacts to what?
hypoxia, dehydration, infection, &/or acidosis by solidifying & stretching erythrocyte into elongated “sickle” → causes ↓ RBC life
57
where will you see sickle cells lab-wise
peripheral blood smear
58
sickle cell anemia labs
MCV –↓to normal MCHC & ret count – ↑leuko & thrombo -cytosis ↑ bilirubin & LDH Electrophoresis (initial dx) – HbS present Peripheral blood smear: elongated & “sickle” cell
59
vasoocclusive crisis + s/s
sickle cell disease THINK! hemolysis & ischemia - hemolysis: pallor, fatigue, jaundice - ischemia: pain (chest, abd, legs & arms) - end organ damage
60
presentation hemolysis & ischemia
sickle cell vasoocclusive crisis
61
hgb target for vasooclusive crisis + transfusion considerations
hgb 6-9 transfusion during crisis ↑ risk of vaso-occlusive issues!!
62
sickle cell vasoocclusive crisis: acute mgmt
- eval for other sx causes - IV fluids (rehydration): NS +/- D5 - pain mgmt – ↑↑↑↑↑ amt - Supplemental O2 - Infection mgmt - PRBC transf if indicated → Hgb 6-9 target - - NOTE: transf ↑ risk of issues!!
63
sickle cell vasoocclusive crisis: maintenance mgmt
``` hematology referral Allogenic hematopoietic stem cell tx Folic acid Hydroxyurea – turns HgbS to HgbF Immunizations Opioid pain mgmt Education: stay hydrated, wash h&s, get shots, avoid heights ```
64
*pernicious anemia vs B12 deficiency anemia*
pernicious: lack of intrinsic factor, prevents abs B12
65
*most common anemia*
Fe deficiency, more common in female
66
*anemia of chronic disease*
anemia categories associated with chronic disease states & aging processes: inflammation, organ failure, elderly
67
*folic acid d/t*
commonly poor nutritional intake rather than GI absorption issue
68
*pica: ice chips eating sign of
Fe deficiency anemia
69
*Fe deficiency anemia causes*
pregnancy, GI & menstrual blood loss, poor dietary intake or GI abs
70
*B12 deficiency anemia (not pernicious) causes*
gastrectomy ↓ ileal abs d/t surgical resection, Crohn's H. Pylori infection dietary deficiency (vegetarian/vegan, poor nutritional supplementation)
71
associate macrocytic anemia with ?
peripheral neuropathy -assess B6, B12, folate
72
*thrombocytopenia etiologies*
chemo, heparin, idiopathic (↑ destruction, ↓ production)
73
*thrombocytopenia labs*
- plt under 100k | - PT, PTT normal
74
*thrombocytopenia tx*
- pt ed: risk of bleeding! - plt under 20k: hospitalize - monitor plts - avoid rx that interfere w plt production - chronic: consider splenectomy - consider bone marrow aspirate - prednisone is an option

monster management (29 decks)

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