ANEMIA
The HbA1C level (3% is normal) is a measure of glucose control over a long period of time, specifically this number of days.
What is 100 days, the RBC lifespan
Overproduction of this hormone is the reason anabolic steroids & chronic hypoxia cause secondary polycythemia.
What is EPO?
In this disease, excess of α chains, which denature developing erythrocytes, thereby leading to their premature death in marrow or to shortened survival in the circulation.
beta thalassemia
This class of drugs is unsafe in porphyria.
BARBITURATES (do we even use them anymore?!)
This type of transfusion may precipitate an extravascular hemolytic reaction if the recipient has unexpected IgG antibodies that target erythrocyte antigens like D, E, Kell, and Duffy.
Uncrossedmatched RBC Transfusion (O or ABO Compatible)
(About 2% of patients have these antibodies and the risk of hemolysis is 0.1%)
A wager in which a sportsbook will predict a number for a statistic in a given game (usually the combined score of the two teams), and bettors wager that the actual number in the game will be either higher or lower than that number.
What is OVER / UNDER?
UNDER production or OVER destruction can describe the kinetics of non- acute blood loss anemia.
The goal hematocrit after therapeutic phlebotomy prior to surgery
What is 45%
The number of globing polypeptide chains in Hemoglobin A
2 (One alpha, one non alpha)
HBA= alpha2/beta2 (95-98%)
HBA2 = alpha2/delta2 (2-3%)
•NEURO-VISCERAL SYMPTOMS (INDUCIBLE)
•NON INDUCIBLE (VERY SENSITIVE SKIN)
Amount of blood loss over 4 hours for which MTP should be triggered
50% BLOOD VOLUME
Etymology: rom the Greek, {Gr} “without blood”
"ANEMIA"
The gene mutation that is most associated with polycythemia vera
What is JAK 2 Mutation
This transfusion trigger is appropriate for a sickle cell patient undergoing Myringotomy
NO TRANSFUSION for low risk surgery
Hemoglobin 10 is best for moderate to high risk surgery.
•CONSERVATIVE: HBS <60%, HBG > 10 G/DL
•TRADITIONAL: HBS<30%, HBG >10G/DL
The reverse fick equation for oxygen uptake (VO2)
VO2 = Q × 13.4 × hemoglobin concentration × (SaO2 – SvO2)
Increased cardiac output, redistribution (brain and heart, for example), Increased oxygen extraction and increased 2,3 DPG, are examples of this.
Increased cardiac output: SVR related to vascular tone and viscosity of blood, need increased SV to get CO up to 180% of normal for HCT 20%
Redistribution of cardiac output: coronary circulation can increase up to 600% of baseline
Increased oxygen extraction @ HCT < 25%,The brain and heart already have a high extraction ratio and are unable to increase oxygen delivery by this mechanism, but tissues such as the kidney, skeletal muscle, and skin compensate in this manner.
Changes in oxygen-hemoglobin affinity: after increased 2,3 DPG, hemoglobin has a decreased affinity for the oxygen molecule and releases oxygen to the tissues at higher partial pressures
THIS TRIAL SHOWED A RESTRICTIVE (7.5) VS. LIBERAL (9.5), NON INFERIOR AMONG MOD TO HIGH RISK CARDIAC SURGERY PATIENTS.
WHAT IS TRICSIII (2017)
The major peri-operative risks you'll counsel the PV patient on during the pre operative evaluation
What are Bleeding & Thrombosis.
Over-expansion of bone marrow causes a “squirrel-like” face, large cheekbones, a depressed nasal bridge, and a protruding maxilla in this hemoglobinopathy.
Thalassemia Major
(a microcytic anemia, named because it was thought to be caused by living close to the sea)
This event can be caused by dehydration, fasting, infection, emotional stress, hormonal changes (menstruation/pregnancy), alcohol
Porphyria Crisis
PRODUCTS SHOULD BE TRANSFUSED IN THE RATIO OF UNITS OF RBC,FFP AND PLATELTS (1 DOSE = 6 UNITS)
1:1:1 RBC:FFP:PLTS
1:2:1 RBC:FFP:PLTS
DON'T FORGET REPLETE CALCIUM!
This index indicates a normal marrow response to anemia is >3 , while a value < 2 is inadequate
RETICULOCYTE PRODUCTION INDEX (RPI)
RPI = (Hematocrit / 45) * Reticulocytes * Correction Factor for maturation
Reticulocytes (% nl is 5-2), Corrected retic (% x hbg/15), RPI takes into account that RBC released prematurely and take longer to mature (@ Hbg of 8, RBC takes double time to mature)
This platelet factor can be abnormal in patients with PV
What is Platelet Factor 3, Acquired Von Willebrands?
This enzyme protects against oxidative stress. Deficiency in it causes a non spherocytic hemolytic anemia under conditions of oxidative stress.
Glucose 6 Dehydrogenase
•ALL ANESTHETICS ARE SAFE (FAVA BEANS ARE NOT)
•INHALATIONAL CAUSE DISEASE IN VITRO ONLY- NOT SUFFICIENT IN VIVO EVIDENCE
•AVOID DRUGS THAT TRIGGER - METHEMOGLOBINEMIA (METHYELNE BLUE INEFFECTIVE)
•AVOID SULFONAMIDES, ACIDOSIS, HYPERGLYCEMIA
Treatment with this reduces the overproduction of δ-aminolevulinic acid in porphyria crisis
Hemin or Heme Arginate
IV: 3 to 4 mg/kg once daily for 4 days
Target level of fibrinogen.
100 mg/dL
Also trials in trauma show TXA is associated with decreased mortality