Brainscape's Knowledge GenomeTM

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


See full index

1a. 675 - Coexisting Diseases > Week 2 - Hematology > Flashcards

Week 2 - Hematology Flashcards

1
Q

What Hct does the literature suggest is appropriate for a transfusion trigger in pts w/ severe CAD?

A

28-30%

Stoelting’s Ch. 23, pg. 466

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

What would you do/avoid in patients with chronic anemia under going anesthesia?

A

Minimize ↓ in DO2
* Avoid ↓ in CO
* Avoid L shifts in O2 dissociation
– HoThermia
– Iatrogenic Resp. alkalosis (hyperventilation)

Stoelting’s Ch. 23, pg. 466

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

What kind of anemia might a female with a heavy menstrual cycle suffer from?

A

IDA

Iron-deficiency Anemia

Stoelting’s Ch. 23, pg. 467

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

What surgical/anesthetic considerations might you have regarding an Adult male with hereditary spherocytosis

5 long ones

A
  • Anemia can be triggered by infection (bacterial/viral)
  • Avoid Mechanical Heart valves -> Excessive hemolysis
  • Extreme caution in CPBP -> hemolysis -> anemia/small vessel occlusion
  • Free Hgb potent Nitric Oxide scavenger -> ↑ SVR/PVR
  • ↑ in VTE/arterial TE w/ hx of splenectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pt w/ methemoglobinemia, what are some treatments/considerations?

4

A
  • Avoid Oxidative agents
  • Remove offending agents
  • Supportive therapy
  • Methylene Blue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Definitive tx and dose for methemoglobinemia?

A

Methylene Blue
1-2 mg/kg over 3-5 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What kind of methemoglobinemia pts might methylene blue be an awful idea, and what might they need instead?

A

G6PD deficiency
* Plasma exchange therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are considered oxidative agents that you might to avoid methemoglobinemia?

5

A
  • Lidocaine
  • Prilocaine
  • Benzocaine
  • Nitrates
  • Nitric Oxide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What treatment is employed and what is the goal % of HgbS in pts w/ SCD for Cardiac/Major Non-Cardiac Surgery?

A

Exchange Transfusion & Hydroxyurea
* Major Non-cardiac surgery: < 30% HgbS
* Cardiac Surgery: < 5% HgbS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What kind of anemia might alchoholics suffer from and why?

A

Macrocytic anemia
* Folate deficiency due to folate malabsorption 2/2 ETOH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some drugs/therapies that can cause aplastic anemia?

6

A
  • Chemotherapy
  • High-energy radiation
  • Chloramphenicol (Abx)
  • TCA
  • Antiepileptics (phenytoin, carbamazepine, depakote, phenobarbital)
  • NSAIDs/Salicylates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some infections that can cause aplastic anemia?

5

A
  • Viral Hepatitis
  • EBV
  • HIV
  • Rubella
  • Parovirus B19
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Amongst the variables in the DO2 equation, which affect the delivery of oxygen the most?

A
  • HR
  • SV
  • Hgb
  • SpO2

DO2 = CO x CaO2 -> CaO2 = (Hgb x SpO2 x 1.34) + (PaO2 x 0.0031)

CO = HR x SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Amongst variables that affect the O2 dissociation curve, which affects the delivery of O2 The Most

A

H+ concentration (kinda CO2 too)
* Bohr effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why do athletes train in high altitudes?

A

hypoxia erythropoiesis -> Polycythemia -> Cheaters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Erythrocytosis also known as?

A

Polycythemia

17
Q

What drug is used to reverse erythrocytosis in renal transplant patients?

A

ACEi

18
Q

What phase of the clotting cascade is affected by hemophilia (A or B idc)?

A

Propagation

19
Q

Your patient has a severe F. V, X, or prothrombin deficiency, what coagulation test(s) would be prolonged and why?

A

Common-pathway
* PT
* aPTT

20
Q

What is a drawback of using FFP to correct coagulopathies?

A

Fluid overload/Cardiovascular strain
* 15-20mL/kg to ↑ factors by 20-30%
* In a 100kg pt that could be 2000mL

21
Q

What platelet disorder would a transfusion of platelets NOT be a treatment option during an emergent bleeding episode?

A

TTP or Hemolytic Uremic Syndrome

Thrombotic Thrombocytopenic Purpura

22
Q

What pt (name the test first) characteristics add risk for a thromboembolic event?

9, it’s a lot but use the acronym

A

CHADS VASc
* CHF
* HTN
* Age >75
* DM
* Hx of Stroke/TIA
* Vascular disease
* Female
* Age 64-75

23
Q

How long should LMWH be held prior to Epidural removal/insertion?

A
  • 12 hrs prophylactic dosing
  • 24 hrs therapeutic dosing
24
Q

How long should direct Xa anticoagulants be held prior to epidural removal/insertion?

A

> 72 hrs

25
Q

Names of some Direct Xa anticoagulants?

4

A
  • Rivaroxaban
  • Apixaban
  • Edoxaban
  • Dabigatran
26
Q

What kind of pts would benefit from the administration of DDAVP, and when would you give it?

3

A
  • F.VIII deficiency
  • Type 1 (and sometimes 2) vWF deficiency
  • 30-90 minutes before surgery
27
Q

Your pt has an INR of 3.2 and requires urgent surgery, what might be given and when?

A
  • FFP: 10-20mL/kg (or 5-8mL/kg for Warfarin)
  • Vit K: 10mg 4-6 hrs before surgery

Nagelnut pg. 903

28
Q

Pts/pt characteristics that put at risk for secondary polycythemia?

6

A
  • Congenital Heart disease (R -> L shunt)
  • Low CO (CHF)
  • Pulmonary disease (COPD)
  • Pickwickian Syndrome
  • Drugs/Defects -> Methemoglobinemia
  • Defects in Hgb
29
Q

Pts w/ polycythemia vera are @ risk for what perioperative complications?

A
  • Thromboembolic events
  • Hemorrhage (Paradoxical/acquired vWF d/o)
30
Q

What is the Oxygen Delivery Equation?

A
  • DO2 = CO x CaO2
  • CaO2 = (Hgb x SaO2 x 1.34) + (PaO2 x 0.0031)
31
Q

What medications can be used for anticoagulation in a patient with immune-mediated heparin-induced thrombocytopenia?

A
  • Direct Thrombin inhibitors (IV Bivalirudin & Argatroban)
  • Anti-Xa inhibitors (Apixaban, Rivaroxaban, edoxaban)

Dabigatran can be given orally too

32
Q

What coagulation pathway does PT/INR evaluate?

A

Extrinsic & Common pathway

33
Q

What coagulation pathway does aPTT evaluate?

A

Intrinsic & Common pathway

34
Q

What states/conditions should be avoided in pts with SCD?

5

A

Avoid:
* Hypoxia
* Pain
* Acidosis
* HoThermia
* Dehydration

35
Q

How much volume does a unit of PRBCs have and how much does it increase Hgb & Hct?

A

300mL
* Hgb: 1 g/dL
* Hct: 2-3%

36
Q

A pt has a Hgb of 8 g/dL, you’ve transfused 700mL of PRBCs. What should their current Hct be? Hgb?

A

Start Hct: ~24%
Hct ↑ by PRBCs: ~7% (3% ea. 300 mL +1% ea 100 mL)
End Hct: 31%
End Hgb: ~10.3 g/dL

37
Q

Which patient would benefit most from a transfusion of PRBCs to assist in their DO2 and why?

Patient A: A 32-year-old female with iron deficiency anemia, presenting with fatigue and pallor. Her hemoglobin level is 6.9 g/dL, SpO2 of 95%, & PaO2 is 75 mmHg, and she reports heavy menstrual bleeding. She is stable, with normal vital signs.

Patient B: A 65-year-old male with chronic kidney disease, presenting with fatigue and shortness of breath. His hemoglobin level is 8.0 g/dL, PaO2 is 78 mmHg, with stable blood pressure and heart rate. He denies chest pain.

Patient C: A 50-year-old male involved in a car accident, presenting with severe blood loss, he is on 100% NRB, His hemoglobin level is 7.1 g/dL, SpO2 of 87%, and PaO2 80 mmHg. His skin is slightly cyanotic.

Patient D: A 25-year-old female with sickle cell disease experiencing a mild pain crisis. Her hemoglobin level is 9.0 g/dL, PaO2 is 90 mmHg, and her vital signs are stable.

Assume their COs are the same because this is a flashcard not Grey’s ana

A

Patient C
* While Pt A’s Hgb is lower, Pt C’s SpO2 and Hgb are Low
* Pt C’s PaO2 is higher than Pt A’s, but PaO2 contributes less to O2 delivery

1a. 675 - Coexisting Diseases (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions