crit care test 2 Flashcards
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Microcytic MCV level
MCV less than 80
Types of Microcytic Anemia (MCV <80 )
Iron defficiency- poor intake or blood loss (asymptomatic)
Tahlassemia minor
DX is unresponsive to iron supplemetation
Medeterranean- is beta
African American Alpha
Sideroblastic -primary 2nd or congential
Anemia of chronic disease- can have defficiency
microcytic anemia DX/TX(MCV less than 80)
Check serum: ferritin, iron, TIBC, reticulocyte count
Ferritin >100 rules out dx
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in mircrocytic anemia of chronic disease - iron will be —— ferritin will be ——
iron low
ferritin is normal
tx of mircrocytic anemia
theraputic iron trial
eval for GIB
if not responsive to iron consider thalassemia dx
Anemia of chronic disease- trapping of iron is present
HGB level-
Serum Iron and IBC
retic count-
serum ferritin
anemia is moderate 7-11
Serum Iron and IBC both down
reticulocyte count is down
serum ferritin increased
Macrocytic anemia MCV level
MCV >100
Macrocytic anemia MCV >100 types
B 12 deficiency-
Folate deficency
Hepatic disease
Macrocytic anemia B 12 deficiency causes and notes
reduced production of intrinsic factor, poor intake, occurs i the 6th decade with neuro issues and cerebral dysfunciton
Macocytic anemia folate deficiency causes and notes
poor intake, meds, this has a role in arterial and venous thrombus
macrocytic anemia hepatic disease causes and notes
booze and diet
Macrocytic anemia tx
give b12 and folate
normochromic and normocytic anemia
mcv level
80-100
causes of normochromic normocytic anemia
Chronic disease hemolytic sickle cell G6PD deficiency Drug induced aplastic renal failure hypothyroid
sickle cell disease with trait
Asymptomatic and no anemia, mild hematuria is usually present
sickle cell signs of intravascular sickling
fever and leukocytosis
sickle cell tx
Hydration, pain control, (pca vs ketorolac)
sickle cell tx when to give hydroxyurea
if 3 or more episodes in a year - kids get bone marrow transplant.
sickle cell complications
acute chest syndrome- can be caused bby infection or asthma, pulm edema, pneumonia, PE, priapism, retinoathy
g6pd deficiency episodic vs chronic notes
episodic - its sex linked
african americans
hemolysis after exposure to oxidant or infection- sulfonamides or antimalarials
chronic is Mediterranean
g6pd treatment
avoid triggers - folic acid supplemtation
drug induced hemolytic anemia will have a ——-test
caused by
tx
positive direct coombs test
caused by exposure to quinidine, PCN, or methyldopa
tx -avoid triggers
autoimmune hemolytic anemia
IGG
IGM
IGG- against RH antign, Lymphomas, Lupus, UC, CLL- (warm antibodies)
IGM- Mycoplasma, Epstien bar, Cytomegalo virus, cold antibodies
Aplastic anemia
is usually---- exposure to --- idiosyncratic-- Viral- onset is ------ and features
usually idopathic
marrow toxins like chemo or cytotoxic drugs
viral- HBV, Hep C, CMV, HIV parvo
gradual onset, fatigue bleeding and thrombocytopenia
Renal failure anemia
RBCs-
Severity parralels -
Once GFR is less than –anemia is present
RBCs reduce and decrease survival
Severity parallels azotemia
GFR below 60 = anemia
hypothyroid anemia is an——— response
autoimmune response
blood product admin
whole blood
Indications are rare
massive transfusion to correct hypovolemia (trauma or shock)
rare use- must be ABO identical
PRBC- to treat ——anemia and ———
treat symptomatic anemia and routine blood loss during sx
Platelets are used to
are prepared from
what about bacteria
theraputic dose for adults is —
some patients become —-
to prevent spontaneous bleeding or stop established bleeding in thrombocytopenic patients
prepared from a single unit of whole blood
due to storage this is most likley to be contaminated with bacteria
dose for adults is 6-10 units and some ptients become refractory
FFP
used to replace labile and non labile coag factors in massively bleeders or tx things like coum overdoses
DIC
excessive generation of ----- secondary activation of ------- Results in ----- Caused by -----
excessive generation of —–thrombin and formation of intravascular fibrin clots
secondary activation of
——-the fibrinolytic system
Results in —–consumption of platelets and coag factors
Caused by —–tissue injury, gram neg or positive sepsis, inflammatory disorders, endothelial sloughing secondary to acidosis, or obstetric disorders
DIC dx
FDP will be up
D dimer is specific but not sensitive
PT/PTT not reliable
platelets are low
DIC TX
Tx underlying cause Replace with whole blood heparin anti fibrinolytic factors activated protein C
ITP
autoimmune disorder where —– is formed and binds to ——
IGG- platelets
ITP and the role of the spleen-
ITP in adults presents with bleeding and splenomeagly
ITP thrombocytes
peripheral smear will have —-
<10,000 may be with anemia and normal CBC,
Megathrobocytes
ITP can be seen with
-------- anemia hematologic ----- myleodysplasia megaloblastic anemia chronic --------- and can be induced by
aplastic anemia
hematologic malignancies
chronic etoh
and induced by drugs or transfusion
Drug most common to cause ITP
Heparin
ITP tx
Prednisone 1-2 mg/kg/day increases the platelet count, and include high dose dexamethasone, slenectomy and high dose IVIG or danazol
HIT
——antibody reacts with platelets on the surface
rises after —– days
initially asymptomatic thrombocytopenia
dx is
TX is
IGG antibody
after four days
+ hit panel
stop heparin
TTP
is common or uncommon
uncommon
TTP - seen in ages with M/F predominance
20-50 with female prodominance
TTP causes
pregnancy, drugs or infection
TTP treatment
emergent large volume plasmapheresis, prednison and antiplatelets, splenectoy, immunosuppression
HUS
causes
labs
hemolytic uremic syndrome
caused by estrogen use, post partum state,familial
coumbs negative
AML - definition
neoplastic disease which clonal undifferentiated cells infiltrate the blood, bone marro and tissues
AML cuase
symptoms
- Caused by genetics, radiation, medications, chemical and occupational exposures but not viral
- S/S: nonspecific, general complaints, could have
AML- Exam
• PE: fever, organomeglia, lymphadenopathy, sternal tenderness, infection, hemorrhage
AML Treatment
- Treatment: Once diagnosis is made functional integrity of major organ systems need to be done, treat symptoms and blood disorders
- Induction chemotherapy
- Post remission therapy
CML definition
• Clonal hematopoietic stem cell disorder driven by genetics and the Philadelphia chromosome
CML S&S and Exam
- S/S: symptoms of anemia, fatigue, malaise,weight loss, early satiety, LUQ pain or mass, organomeglia, vasoocclusive events
- PE: splenomegaly, lymphadenopathy, complications of tumor burden on major organs
Treatment
complications
- Treatment: Once the Phila. Chromosome is identified, TKI therapy is initiated, can have stem cell transplant, splenectomy
- Complications: do not give TKI during pregnancy
Neutropenia
- Neutropenia: low neutrophils (susceptible to infection <1000, loss of control of endogenous flora <500, loss of local inflammatory process <200
- Causes: chemo, antibiotics
Thrombocytopenia
definition and causes
Thrombocytopenia: low platelets
• Causes: decreased bone marrow production, enlarged spleen, or platelet destruction (infection or drug induced)
Pancytopenia
- Pancytopenia: anemia, leukopenia, and thrombocytopenia
- Causes: aplastic anemia, myelodysplasia, leukemia, lymphoma, secondary to systemic diseases such as alcohol use, TB, sarcoidosis, infection, SLE
Imunosuppressive therapy
• Immunosuppressive therapy: suppresses all immune responses to bacteria, fungi, malignant tumors
• Used post-transplant and in some oncologic disorders
• Induction therapy: reduces the risk of acute rejection and
minimizes/eliminates the use of steroids
• Maintenance therapy: given once acute rejection timeframe over
• Complications: opportunistic infections
Tumor Lysis Syndrome
Oncological emergency
• Caused by a large number of rapidly proliferating neoplastic cells
• Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia
• Treatment
• Recognize early, • Prevent with allopurinol, urinary alkalization and aggressive hydration
Rheumatoid arthritis:
antibodies attach to the linings of the joints causing inflammation, swelling and pain. Treated with anti-inflammatories.
• SLE:
antibodies attach to tissues (joints, lungs, blood cells, nerve endings, kidneys). Treated with steroids
• MS:
immune system attacks nerve cells causing pain, blindness, weakness, poor coordination, muscle spasms.
Type I DM:
antibodies attack insulin producing cells from the pancreas.
Guillian-Barre Syndrome:
immune system attacks nerves that control the muscles in the legs, arms and upper body. Treated with plasmapheresis.
• Psoriasis:
overactive T cells in the skin
Chronic inflammatory demyelinating polyneuropathy:
similar to GBS
Grave’s Disease:
antibodies overstimulate the thyroid gland
Hashimotos thyroiditis:
antibodies attack the thyroid gland
Myasthenia Gravis
antibodies bind to the nerves and slow them down causing weakness
Vasculitis:
immune system attacks and damages the blood vessels
