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monster management > bloody > Flashcards

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
Q

iron normal #

A

50-175 ug/dL

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26
Q

total iron binding capacity (TIBC)

A

250-400 ug/dL

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27
Q

most common cause of anemia

A

Fe deficiency

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28
Q

Fe deficiency anemia

A

most common cause of anemia, more common in Fusually asymp until hct lt 30%

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29
Q

pica unique to

A

Fe deficiency anemia

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30
Q

Fe def anemia mgmt & eval

A

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
Q

PO Fe replacement considerations

A

Take on empty stomach w ascorbic acid (Vitamin C)

GI Side Effects: dark stools, constipation, nausea

32
Q

thalassemias + classifications x3

A

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
Q

alpha thalassemia

A

primarily in Asian descentgene deletions ↓ alpha-globin chain synthesis

34
Q

poikilocytes

A

abnormally shaped red blood cells

35
Q

alpha thalassemia tx x3

A

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
Q

beta thalassemia + types x2

A

primarily mediterranean descent

  • ↓ beta-globin chain: beta*
  • absent beta-globin chain expression: beta0
37
Q

thalassemia punnett

A

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
Q

most severe beta thalassemias genotypes x2

A

beta-beta (severe)

OR

beta0-beta0: thalassemia major + 0 - 10% hgb A

39
Q

beta thalassemia major physical characteristics

A

Bone structure abn skull & long bones

Bone marrow spaces ↑
- attempt ↑erythropoiesis

Growth retardation
Frontal bossing
“Chipmunk” cheeks
Exposed frontal teeth
Hepatosplenomegaly
40
Q

skull + long bone abn, growth retardation, chipmunk cheeks + teeth, hepatosplentomegaly

A

beta thalassemia major

41
Q

beta thalassemia tx

A

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
Q

Fe and thalassemias

43
Q

Fe, transferrin, TIBC ↓ = ? anemia

A

Anemia of Chronic Disease - inflammation

44
Q

Anemia of Chronic Disease & transfusions

A

PRBC @ hgb lt 7

45
Q

TIBC ↓ = ? anemia

A

Anemia of Chronic Disease - inflammation

46
Q

Anemia of Chronic Disease that is dx of exclusion

A

in elderly d/t ↓ erythropoietin production or red bone marrow ↑ resistant to erythropoiesis

47
Q

who does not usually present with anemia sx?

A

vit B12 deficiency (pernicious)

48
Q

pernicious anemia tx

A

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
Q

% PO iron abs by GI

50
Q

required for heme chain formatino

A

folic acid

51
Q

B12 vs folic acid: sources

A

B12: animal folic: fruits/veggies

52
Q

aplastic anemia

A

d/t issues w red bone marrow → suppression/injury to hematopoietic stem cell

causes → idiopathic, pregnancy, chemo & rad, viruses inc hepatitis

53
Q

aplastic anemia s/s

A

d/t pancytopenia = classic anemia sx, inf (bacterial &/or fungal), bleeding/hematoma out of proportion to injurysigns: pallor, purpura, petechiae

54
Q

sickle cell anemia & hgb

A

S instead of A d/t DNA alteration in B-globin chain

55
Q

sickle cell carrier vs disease

A

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
Q

hgb S reacts to what?

A

hypoxia, dehydration, infection, &/or acidosis by solidifying & stretching erythrocyte into elongated “sickle” → causes ↓ RBC life

57
Q

where will you see sickle cells lab-wise

A

peripheral blood smear

58
Q

sickle cell anemia labs

A

MCV –↓to normal

MCHC & ret count – ↑leuko & thrombo -cytosis

↑ bilirubin & LDH

Electrophoresis (initial dx) – HbS present

Peripheral blood smear: elongated & “sickle” cell

59
Q

vasoocclusive crisis + s/s

A

sickle cell disease

THINK! hemolysis & ischemia

  • hemolysis: pallor, fatigue, jaundice
  • ischemia: pain (chest, abd, legs & arms)
  • end organ damage
60
Q

presentation hemolysis & ischemia

A

sickle cell vasoocclusive crisis

61
Q

hgb target for vasooclusive crisis + transfusion considerations

A

hgb 6-9 transfusion during crisis ↑ risk of vaso-occlusive issues!!

62
Q

sickle cell vasoocclusive crisis: acute mgmt

A
  • 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
Q

sickle cell vasoocclusive crisis: maintenance mgmt

A 
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
Q

pernicious anemia vs B12 deficiency anemia

A

pernicious: lack of intrinsic factor, prevents abs B12

65
Q

most common anemia

A

Fe deficiency, more common in female

66
Q

anemia of chronic disease

A

anemia categories associated with chronic disease states & aging processes: inflammation, organ failure, elderly

67
Q

folic acid d/t

A

commonly poor nutritional intake rather than GI absorption issue

68
Q

*pica: ice chips eating sign of

A

Fe deficiency anemia

69
Q

Fe deficiency anemia causes

A

pregnancy, GI & menstrual blood loss, poor dietary intake or GI abs

70
Q

B12 deficiency anemia (not pernicious) causes

A

gastrectomy
↓ ileal abs d/t surgical resection, Crohn’s
H. Pylori infection
dietary deficiency (vegetarian/vegan, poor nutritional supplementation)

71
Q

associate macrocytic anemia with ?

A

peripheral neuropathy -assess B6, B12, folate

72
Q

thrombocytopenia etiologies

A

chemo, heparin, idiopathic (↑ destruction, ↓ production)

73
Q

thrombocytopenia labs

A
  • plt under 100k

- PT, PTT normal

74
Q

thrombocytopenia tx

A
  • 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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