Heme

Question 1

Heme hx questions

Answer 1

blood disorders
bruise easy
bleeding/clotting problem
prolonged bleeing, nose, gums
blood tranfusion
family hx of blood disease 
Meds/herbs: ASA, vitE, ginseng, garlic

Question 2

what concerns you with physiology of heme

Answer 2

dec O2 carrying capacity

Question 3

O2 dissociation curve R and L

Answer 3

R: release, Inc: temp, 2,3dpg, anemia, dec: pH
-so avoid hypervent, and keep warm
L: Love DEC temp, 2,3dpg, INC: pH

Question 4

Chronic anemia compensation

Answer 4

Better than acute bc of Compensation
dec SVR to improve O2 delivery
Inc CO and plasma volume
Blood flow to organs with higher O2 need–brain, heart

Question 5

Anemia asmt

Answer 5

Shift to the right
H&H in context with fluid status? hemoconcentrated?
W

Question 6

Goal of transfusion

Answer 6

will it improve their O2 carry capacity? or correct coag disorder
**based on will this improve their O2 capacity and prevent the consumption from exceeding the delivery
only give if necessary

Question 7

Anemia of chronic disease

Answer 7

2nd to something else
dont disrupt compensatory mechanisms
Inc CO needed to maintain O2 delivery

Question 8

Acute blood loss

Answer 8

takes 3 days to reach new plateau…can take a while to see changes
need VOLUME have “pressures” aka catecholamines

Question 9

Hemolytic anemia

Answer 9

inc risk of tissue hypoxia
splenectomy-inc risk of infx
*EPO rx for 3days prior to OR
consider transfusion at

Question 10

Sickle cell dz

Answer 10

Right shift 
anemia is well tolerated
Keep warm
well hydrated 12hrs prior to surg
ECG (infarction) 
Exercise tolerance
When premed-- avoid resp depression or get acidosis 
**conservative transfusion at 10 for high risk surg

Question 11

Sickle cell crisis

Answer 11

Life-threatening
take measure to avoid vaso-occlusive
*Hydration, Oxygen, Warm, no stasis
Pain meds

Question 12

Thalassemia

Answer 12

CHF
difficult airway: facial deformities,
complications from iron loading from chronic transfusion:
DM, Adrenal insufficiency– get a dec response to pressures, Coag problems, Hypothyroid and hypoparathyroid, Arrhythmias, Liver dysfunction
**ECG, Elytes, LFT Coag–regional??
Monitor: invasive? HF

Question 13

Aplastic anemia

Answer 13

LV dysfunction (due to high output status)
Severe Congenital heart dz
Dec: Plt, RBC, neutrophil 
*CBC, may need pre op transfusion 
*risk for airway hemorrhage 
*reverse isolation
*prophylactic abx
*stress steroid dose
*Invasive monitoring 
*avoid  nasal intubation 
*labile hemodynamic responce to induction 
*regional --depends on coags

Question 14

Prophyria

Answer 14

errors in metabolism- Overproduction of prophyrins

Attack symptoms: PAC WAG: abd pain, GI disturbances, ANS instability, CNS disturbance Life threatening muscle weakness

Question 15

Unsafe meds for Prophyria

Answer 15

BED SPANK
Barbs
Etomidate
Diazepam

Sulfonamide abx
Phenytonin
Alcohol 
Nifedipine
Ketorolac

Question 16

Hemophilia A

Answer 16

def clotting factor 8, abn PTT 
tx: factor 8 and desmopressin

Question 17

Hemophilia B

Answer 17

problem clotting factor 9, abn PTT

tx: factor 9

Question 18

Von Willebrands

Answer 18

problem with vWF and 8, Inc Bleeding time

tx: cryo and desmopressin

Question 19

Minimum acceptable hgb and hct

Answer 19

Duration-acute/chronic
Etiology
IV fluid status 
Urgency of surgery
Anticipated blood loos in surg 
Co-existing dz