Medsurg-Hematology

Front 1

WBC: life span: 4 to 8 hrs,
another 4 to 5 days in tissue.

Back 1

Leukocytosis: WBC > 10, 000
Leukopenic: WBC< 4,000
Neutropenic: Neutrophils < 500

Front 2

erythropoietin ;
the principle stimulator of RBC production
response to low O2 in blood.

Epopoietin Alpha:
manufractured by recombinant DNA technology
(similiar to erythropoietin ), used for pt with
anemia.

Back 2

Hemostasis:
The ability of body to stop bleeding.

Front 3

O2:
1) 97%; combined with Hgb, measured by Sa O2
3) 3%: dissolved in plasma. PaO2 measured O2 carried
in arterial plasma.

Back 3

O2:
1) 97%; combined with Hgb, measured by Sa O2
3) 3%: dissolved in plasma. PaO2 measured O2 carried
in arterial plasma.

Front 4

Lab test: Serum Fibrin split products:
determine if the clot is beginning to break down.

Back 4

Iron---> transerrin ---> ferritin (stored for future use)

(transferrrin: iron + binds with apotransferrin in intestine.
it can transfer iron to different place)

Front 5

Reticuloendothelial system: monocytes, mobile macrophages,
fixed tissue macrophages, specialized endothelial cells
in bone marrow, spleen, and lymph nodes (like Kuppfer liver
cells.)

Back 5

Transfusion;
if pt. has known reactions to transfusion, pt can
be premedicated with diphenhydramine (Benadryl) and
acetaminophen (Tylenol)

Front 6

Hgb < 8 usually the indicator for transfusion with PRBC.

Back 6

If multiple units are required for transfusion in a short
period of time, FFP should be administered to prevent dilutional
coagulopathies.

Front 7

PRBC transfusion & Hypocalcemia ( Low Ca2+)
PRBCs are preserved in citrate.
serum Ca2+ comnnined with citrate---> low Ca2+

Back 7

FFP: includes clotting factors.
indication:
1) pt with clotting factor deficiency (hemophilia etc)
2) elevated bleeding time due to warfarin
3) liver disease.

Front 8

Cryoprecipitate: includes 2 factors not included in FFP
(Factor I and Factor VIII)
* can be used for hemophilia

Back 8

Thrombocytopenia: ( platelets< 50K)
* transfusion of packed platelets may be prequired.

Front 9

Albumin: used for
1) edema (pulmary edema, cerebral edema etc.)
2) shock (used to increase BP)

* unfortunately, albumine has SHORT half-life
due to the body's enzymatic digestion of exogenously
administered albumin.

Back 9

IVIG (Intravenous immunoglobulin ):
1) Doesn't need to be typed with pt;s blood.
2) administered with D5W (nor NS used for other blood
products)

Front 10

IVIG (Intravenous Immunoglobulin )
used for:
1) idiopathic thrombocytopenic purpura (ITP)
2) acquired immunodeficiency syndrome (AIDS)
3) Bone marrow transplant
4) Severe combined immunodeficiency dis. (SCID)
5) autoimmune dis...

Back 10

4 types of blood transfusion reactions:

1) hemolytic
2) anaphylactic
3) febrile
4) circulatory (volume) overload.

Front 11

Blood transfusion reaction: hemolytic;

shortly after transfusion started
caused by ABO-incompatible blood.
S/S: fever, SOB, chest/back pain, hypotension.
Intervention: stop the transfusion immediately, notify MD.

Back 11

Blood transfusion reaction:
hypersensitivity/ anaphylactic )
1) reaction a little bit delayed after blood
transfusion started.
2) S/S: hives, wheezing, SOB, hypotension
3) Stop transfusion STAT, call MD,
preprare meds like: epinephrine or steroid.

Front 12

Circulatory (volume) overload caused by blood transfusion:

usually caused by multiple units blood transfusion.
Lasix can be given between units of transfusion.

Back 12

ITP (idiopathic thrombocytopnia):
treatment:

1) whole blood transfusion.
2) corticosteroids.
3) spleenectomy
4) other agents used: chemo, intranvenous IGG or inferon

Front 13

thrombotic thrombocytopenic purpura (TTP)

Treatment: plasmapheresis, infusion of FFP.

Back 13

sickle cell anemia: happens more in African people.
Abnormal hemoglobin ( Hgb S)
* During hypoxia, Hemoglobin S form crystals.
------> RBC change shapes--> hemolysis.

** S/S: generalized PAIN !! (usually sudden onset)
tachypea & tachycardia


* Tx: blood transfusion and supportive care
( O2, fluid, analgesics)

Front 14

Hemophilia : ( X-linked )

3 types of hemophilia:
Type A; Classic --- factor VIII deficiency
Type B: --- Factor IX deficiency
Type C: Ashkenasic Jews -Factor XI deficiency

Back 14

iron deficiency Anemia:

Interesting Symtom: craving for usual foods/substances.
(eat ice, dirt, plaster, chalk etc.)

Front 15

DIC: Hypercoagulation ---> bleeding.

Back 15

DIC: Treatments:
1) Treat the cause of coagulopathy.
2) Platelet transfusion
( if Platelets < 50 k + evidence of bleeding.)
3) Transfusion of FFP if cause of bleeding is unknown.
4) crypoprecipitate ( with low fibrinogen level)
5) IV acivated protein C.
IV. drotencogin alfa ( Xigris)
** Very EXPENSIVE meds !!

Front 16

in der, wo (Relativpronomen)

Back 16

donde

Front 17

Neutropenic precaution when pt has:
WBC < 4000 & absolute neurtrophil count < 500

if pt has neutropenic fever--> clinical emergency.

Back 17

Tumor lysis syndrome:
occurs often after pt with cancer after chemotherapy.
Chemo kill the tumor cells and cell contents released
to bloodstream. byproducts may cause renal failure.
( byproducts: uric acid, K+, phos, Ca2+)
(renal failure: caused by obstruction of distal tubules and
collecting ducts)

Front 18

Lymphoma
Type 1) Hodgkin's disease
Type 2) Non-Hodgekin's lymphoma.

Back 18

Lymphoma:

usually treated with chemotherapy.
most pt with lymphoma in ICu units has very bad infection.

Front 19

HIT: Heparin induced thyombocytopenia

Pt may be treated with direct thrombin inhibitors
(e.g. argatroban and lepirudin)

Back 19

Pt with organ transplantation will have medicatioin to suppress
immune system.

treatment includes: glucocorticoid hormones, azathioprine, cyclosporine
and other agents (Cyclophosphamide)

Front 20

Pt with organ transplantation will have medicatioin to suppress
immune system.

treatment includes: glucocorticoid hormones, azathioprine, cyclosporine
and other agents (Cyclophosphamide)

Back 20

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