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30 Cards in this Set

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1. Anaemia?
a. Defined as a reduction in Hct or Hb concentration.
2. Compensatory mechanisms for when red cell mass (as measured by Hb or less precisely Hct) decreases?
a. ↑’d cardiac output (heart rate and stroke volume)
b. ↑’d extraction ratio
c. Rightward shift of the oxyhemoglobin curve (↑’d 2,3 DPG) Yes D.
d. Expansion of plasma volume.
3. As a general rule, blood transfusion is not recommended unless either of the following is true?
1. The Hb concentration is <7 g/dl, or
2. The pt requires ↑’d oxygen-carrying capacity (e.g., pts w/CAD or some other cardiopulmonary disease.
4. Are symptoms more or less likely to be present if anaemia develops rapidly?
a. More likely to be present, bc there is little time for compensatory mechanisms.
5. Symptoms of anaemia?
a. Nonspecific complaints: HA, fatigue, poor concentration, diarrhea, N/V, vague abdominal discomfort.
b. Pallor- best noted in conjunctiva.
c. Hypotension and tachycardia
d. Signs of underlying cause- jaundice if haemolytic anaemia, blood in stool if GI bleeding.
6. Formula to convert Hb to Hct:
a. Hb x 3 = Hct
7. What should 1 unit of packed RBCs (PRBCs) increase Hb and Hct by?
a. Hb: 1 point
b. Hct: 3 points
8. Note: If pt has good cardiac function and intravascular volume is adequate, low H&H levels are tolerated. Even an Hb of 7 or 8 provides sufficient oxygen-carrying capacity for most pts.
a. However, Anaemia is not tolerated as well in pts w/impaired cardiac function.
9. 4 historical findings to consider in pts w/anaemia?
a. Family hx of Haemophilia, G6PD deficiency, recent trauma/surgery, hematemesis).
b. Chronic illnesses (e.g., renal failure)
c. Alcoholism (folate, B12, iron deficiency).
10. Pseudoanemia?
a. ↓ in haemoglobin and haematocrit 2º to dilution.
11. What is absent in PRBCs?
a. Platelets and clotting factors.
12. PRBC pearls:
12. PRBC pearls:
13. What does Fresh Frozen Plasma contain (FFP)?
a. All clotting factors
b. NO RBCs/WBCs/Platelets
14. When is FFP given?
a. For high PT/PTT, coagulopathy, and deficiency of clotting factors.
b. FFP can be given if you cannot wait for Vit K to take effect, or if pt has liver failure (in which case Vit K will not work).
15. What is contained w/in cryoprecipitate?
a. Contains factors VIII and fibrinogen.
16. For what 3 conditions if Cryoprecipitate used?
a. Haemophilia A
b. ↑’d fibrinogen (DIC)
c. vWD
17. What does 1 unit of platelet transfusion rate the platelet count by?
a. 10,000.
18. When is whole blood transfused?
a. Only for massive blood loss (rarely used).
19. Why is the Reticulocyte index an important initial test in evaluating anaemia?
a. Bc it indicates whether effective erythropoiesis is occurring in the bone marrow.
20. What is effective erythropoiesis dependent upon?
a. Adequate raw materials i.e.
1. Iron
2. B12
3. Folate.
b. Absence of intrinsic bone marrow disease (e.g., aplastic anaemia
c. Adequate erythropoietin from the kidney
d. Survival of reticulocytes (no premature destruction before leaving the bone marrow.
21. What does a retic index >2% imply?
a. Excessive RBC destruction or loss.
b. Bone marrow is responding to ↑’d requirements
22. What does a retic index <2% imply?
a. Inadequate RBC production by the bone marrow.
23. Note: all causes of anaemia are initially normocytic bc it takes some time for the abnormal-sized RBCs to outnumber the normal sized ones.
23. Note: all causes of anaemia are initially normocytic bc it takes some time for the abnormal-sized RBCs to outnumber the normal sized ones.
24. 2 categories of Haemolytic Transfusion Reactions?
1. Intravascular haemolysis (Acute haemolytic reactions)
2. Extravascular haemolysis (Delayed haemolytic transfusion reaction)
25. What is Intravascular haemolysis (Acute haemolytic reactions) caused by?
a. ABO-mismatched blood transfused into pt.
i. Very Serious and life threatening.
b. I.e., if B blood is given to a type A pt, anti-B IgM antibodies attach to all of the infused B RBCs, they activate the complement pathway, and produce a massive intravascular haemolysis as C9 punches holes through RBC membranes.
26. Symptoms of Intravascular haemolysis (Acute haemolytic reactions)
a. Fever/Chills
b. N/V
c. Pain in flanks/back
d. Chest pain
e. Dyspnea
27. Complications of Intravascular haemolysis (Acute haemolytic reactions)?
a. Hypovolemic shock (hypotension, tachycardia)
b. DIC
c. Renal failure w/haemoglobinuria
28. Management of Intravascular haemolysis (Acute haemolytic reactions)?
a. Stopping the transfusion immediately and aggressively replacing the fluid to avoid shock and renal failure.
29. Extravascular haemolysis (Delayed haemolytic transfusion reaction)?
a. Less severe and in most cases is self-limited
b. It may occur w/in 3-4 wks after a transfusion..
30. What is Extravascular haemolysis (Delayed haemolytic transfusion reaction) caused by?
30. What is Extravascular haemolysis (Delayed haemolytic transfusion reaction) caused by?