Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment Oral > Heme Assessment > Flashcards

Heme Assessment Flashcards

1
Q

What should be your preoperative considerations for a patient with Sickle Cell Disease?

A

Disease versus Trait

  • TRAIT: don’t go into crisis→ no anesthesia considerations
  • Disease: thinking about all those ischemic areas that may be damaged

High risk predictors of perioperative vasooclusion complication

    1. Infection
    1. Advanced Age
    1. Recent hospitalizations
  • (4). Level of dehydration

Preoperative assessment should focus on identification of organ dysfunction and acute exacerbations

  • Neuro: Stroke- residual deficits?
  • Pulmonary: Pulmonary hypertension/pulmonary infarctions (pulmonary components)
    • do they use O2 at night or during the day?
  • CV: Heart failure
  • Renal insufficiency- are they on HD? Do they urinate a lot because they’ve lost the ability to concentrate urine?
    • Dehydration (loss of renal concentration ability)
  • Splenomegaly- infected now?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some diagnostics you would obtain preoperatively for a sickle cell disease patient?

A
  • CBC **
    • Hct- perioperative transfusion may be necessary. Consult with hematologist.
  • BUN, Cr→ kidney insuff.
  • EKG
  • CXR
  • ECHO and ABG as indicated
  • Pulse ox
  • +/- invasive monitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some preoperative considerations of a patient with Aplastic Anemia?

A
  • CBC!
    • WBC differential- help Infectious Disease (ID) determine what ABX needed for coverage
  • Coags!
    • need labs → want to look at their WBCs too
    • May need preop infusions of RBC/Platelets/Coags etc (usually will get them to be optimized b4 sx)-
  • Type and crossmatch concerns
    • ncreased difficulty with multiple transfusions. Need T&C early on
  • Baseline medications?
    • Steroids?
  • Airway hemorrhage possible with DVL
    • Preoperative airway plans? Dep on your comfort lvl & how good you are at DL vs glidescope etc
  • Reverse isolation
    • Prophylactic antibiotics based on CBC studies (degree of neutropenia)
    • Bypass preop, take from room to OR
  • Monitors
    • +/- invasive monitors (a. line); based on CBC and surgical risk
    • almost always invasive monitors will be necessary.
    • Anticipate taking out their A line if not going to ICU. → hold for 20 minutes
  • Regional? Dep on coag status, plt lvls etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe considerations for perioperative transfusion

A

C- Coexisting conditions/comorbidities

A- Anticipated blood loss

R- Risk vs benefit

D- degree of anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some preoperative considerations of a patient with Thalassemia?

A
  • Potential for difficult airway secondary to maxillary deformities
    • frontal head and maxillary growth
      • FIBEROPTIC intubation
  • Cardiac arrhythmias due to high CO heart failure
    • Echo, EKG may be necessary
  • Coagulopathy
    • Regional?
    • Coags – if major sx
  • Monitoring
    • Routine
    • +/- invasive monitors with presence of heart failure or invasive sx
  • Check electrolytes
  • CBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe some findings of a physical exam for a patient with anemia

A
  • pallor
  • high HR
  • palpitations
  • murmurs
  • dyspnea
  • fatigue
  • hepatosplenomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a TEG? Information you can obtain from it? Treatment considerations?

A

Thromboelastography → provides real time visual representation of blood coagulation and fibrinolysis (clotting and breakdown of clot)

  • R time - time to start clot
    • *Coag factors
    • Low (Anticoagulants) → FFP
  • K time- time for fixed strength
    • *fibrinogen
    • Tx: Cryo
  • Alpha angle- speed of fibrin accumulation
    • *fibrinogen
    • Tx: Cryo
  • Max amplitude- highest amp of TEG
    • *plts
    • tx: plts, cryo, DDAVP
  • Lysis at 30 - clot breakdown
    • *excessive clotting
    • Tx: TXA, Amicar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What would you enquire to a patient with a coagulopathy disorder?

A
  • M- medications and herbals
    • (g’s and fish oil)
  • S. - steroids → duration of treatment
  • C.- coexisting conditions (renal/liver ds, malnutrition, cancer, recent drug exposure)
  • P.- petechiae → bruising, hematomas, jaundice, and frank bleeding
  • F- family history
  • E- episodes of bleeding/history of transfusions) → recent changes?
  • D- diagnosis (hemophilia, vWD, thrombocytopenia, polycythemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Your patient has hemophilia. What are some preoperative considerations for your patient?

A
  • History of unexplained bleeding
    • spontaneous hemorrhage involving joints and deep muscles
  • Coagulation studies:
    • anticipate prolonged aPTT, normal PT
  • Consult hematologist
  • Detailed plan for monitoring and replacement of factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Your patient has vWF deficiency. What are some preoperative considerations for your patient?

A
  • History of easy bruising, mucosal bleeding v comm, epistaxis, menorrhagia, spontaneous hemorrhage (type III)
  • Coagulation studies:
    • anticipate prolonged bleeding time, and aPTT, RPFA bc bleeding time not specific
    • Often factor VIII is low resulting in prolonged aPTT
  • Depending on type and severity consult hematologist (type 3 consult)
  • Tx: Desmopressin (in type 1 or 2), factor VIII or cryoprecipitate may be required preop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Your patient has polycythemia. What are some preoperative considerations for your patient?

A
  • Polycythemia HCT >54%; increase viscocsity increases r/f clots
  • Increased r/f thrombosis and cardiac disease (MI, HF, recent hx DVT or recent infactions)
  • Focus on pulm and CV system
    • Cyanosis, clubbing, wheezing, murmurs, exercise tolerance
  • Diagnostic studies should include:
    • Pulse ox
    • EKG
    • CBC
    • ABG
    • CXR (if hgb is excessive)
  • Consult hematology and potentially postpone elective surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which patients would be at an increased risk for a thromboembolic disorder and preoperative considerations for that patient?

A
  1. Hereditary hypercoagulable states (antithrombin III, protein C or S deficiencies)
  2. Pregnancy
  3. obesity
  4. Cancer
  5. Multiple episodes of past thromboembolisms
  6. Atrial fibrillation
  7. Mechanical heart valves
  8. Inflammation associated w/ sx can increase risk of blood clots on its own
    1. Careful history focusing on prior thrombotic events, family history and concurrent drug therapies; random screening is not beneficial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Your patient is on Coumadin. What are some preoperative considerations you have for your patient?

A
  • Inhibits vit k dependent clotting factors (II, VII, IX, X)
  • Minor procedures → do NOT require d/c
    • Dental, endoscopic, cataract, superficial operations
  • Other more invasive procedures require withholding Coumadin 4-5 days preoperatively
    • Monitor PT/INR - Get 3 days prior and day of sx (PT would be above 10-14 sec (Normal value))
    • INR < 1.5 -considered safe for surgical procedures/neuraxial blockade
  • Consult hematologist, cardiologist or treating physician concerning need for bridging treatment with heparin
  • Reversal with vitamin K, 4-factor PCCs, FFP
    • FFP- emergent reversal
    • Vit K- 12-24 hrs to start working
    • PCC (prothrombin complex concentrate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Your patient is on Heparin. What are some preoperative considerations you have for your patient?

A
  • Discontinue:
    • surgical procedures: 6 hours before
    • neuraxial block placement: 6-8 hours before
      • Wait at least 1 hour after block to give/restart
  • Monitor aPTT/ACT
    • Expect your aPTT > 25-35 seconds and ACT > 90-120 sec
  • Reverse with protamine if required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Your patient is on LMWH. What are some preoperative considerations you have for your patient?

A
  • Therapeutic: hold 24 hours preoperatively for surgical and neuraxial block placement
  • Prophylactic: hold 12 hours preoperatively for surgical and neuraxial block placement
  • Subsequent dose of LMWH must occur > 2 hours after neuraxial block
  • Monitoring is rarely required
    • PT and aPTT normal
    • Evaluate anti-factor Xa activity if required
  • If emergent reversal is required- protamine is only partially effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Your patient is on Aspirin. What are some preoperative considerations you have for your patient?

A
  • Traditionally d/ced 7-10 days preop. More realistically can be d/ced →
  • D/C 3-4 days preop typically
    • ALWAYS evaluate risk of bleeding versus risk of clot (high risk CAD)
  • Withdrawing ASA SUDDENLY → results in hypercoagulable state
    • If taking ASA long term → talk to cardiologist
    • Associated with threefold increase in the risk of major cardiac events;
    • low dose management → dont stop it completely (if not major sx)
  • Regional anesthesia: as long as not on any other anticoags while taking aspirin→ OKAY
17
Q

How would you set up the room knowing you had a sickle cell patient coming in?

A

Have OR warm

5 lead EKG

Warm fluids

Have positioning equipment available

(more stuff??)

18
Q

What are the diagnostic considerations for coagulopathies?

A
  • Routine screening is not indicated, well-conducted history is more important
  • Additional lab testing justified:
    • If H/P indicate bleeding disorder or
    • surgical risk of bleeding is high
      • Platelet count
      • CBC
      • PT/aPTT/INR
  • If specific cause of bleeding is known/suspected from coexisting dx process then follow with appropriate targeted testing
    • ex: Liver enzymes, protein and albumin levels etc
  • Elective surgical procedures should be postponed if significant coagulopathy is present to determine cause and start treatment
19
Q

What causes increase bleeding in any platelet count?

A
  1. Anemia
  2. Fever
  3. Infections
  4. Hypothermia
  5. antiplatelet drugs
20
Q

What are the postponing recommendations for a patient with a recent blood clot? Statistics?

A
  • Without anticoagulation:
    • → risk of recurrent DVT within 3 months = 50%
  • 1 month of warfarin → reduces risk to 10%
  • 3-month of warfarin → reduces risk to 5%
    • SHOULD POSTPONE 3 MONTHS IDEALLY
    • If pt hx for DVT/blood clot- wait at least 1 month before elective sx, preferably 3 months
21
Q

Normal CBC

A
  • RBC
    • 4.6-6.2 million/mm3 men (just realized the 1.6 is probably a typo on her ppt…)
    • 4.2-5.4 million/mm3 women
  • Hct
    • 42-52% men
    • 37-47% women
  • Hgb
    • 13.5-17.5 g/dL men
    • 12-15.5 g/dL women
  • WBC
    • 5,000-10,000/mm3
  • Bleeding time: 3-10 minutes
  • Plt count: 150,000-400,000
  • PT: 10-14 sec
  • INR: 1/2-3 for coumadin therapy
  • aPTT: 25-35 sec
  • ACT: 90-120 sec
  • Thrombin time: 9-14 sec
  • Fibringogen: 160-350
22
Q

What does PT/INR assess for?

A
  • PT:
    • extrinsic pathway: CF 3, 7
    • Common pathway: 1, 2, 5, 10, 13
  • INR: COUMADIN
    • standardized PT results
      • Extrinsic
      • common pathway
23
Q

What does aPTT/ACT assess for?

A
  • aPTT:
    • Intrinsic pathway: CF 12, 11, 8, 9
    • Common pathway: CF 1, 2, 5, 10, 13
  • ACT: HEPARIN
    • intrinsic
    • common
24
Q

What are preoperative platelet ranges and associated risks?

A
  • Thrombocytopenia: platelets < 150,000/mm3
  • Try to determine cause and current treatmentIdiopathic thrombocytopenic purpura (ITP)
    • Steroids
  • Platelet count: only number, not function
    • > 100,000/mm3: neuroaxial anesthesia/major sx considered safe
    • < 50,000/mm3: increases surgical bleeding risk
      • Discuss with surgical team if want preop plts (example neuro cases may require >100,000)
    • < 20,000/mm3 increases spontaneous bleeding risk
      • Transfuse
  • Each unit of Platelet transfusions generally increase count by 10,000/mm3 for every unit

Health Assessment Oral (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions