Anemia - Pathophysiology I - Lecture 2 (1)

With broken ribs and a broken arm and is noted to

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with broken ribs and a broken arm and is noted to have blood all over her forehead and clothing. PMH : Asthma and seasonal allergies Current meds: Albuterol inhaler 2 puffs QID, Diphenhydramine 50mg daily as needed Vitals : BP 70/52 mmHg, HR 125 bpm, RR 13 bpm
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CLINICAL SCENARIO #1 ROS : Positive for facial & upper extremity bruises / open wounds CBC : WBC - 12.3X 10 6 /mm 3 Hemoglobin (Hgb) – 5.1 g/dL Hematocrit (Hct) – 15.2% Platelets – 298,000 Laboratory blood work : RBC 4.5 X 10 6 /mm 3 Reticulocyte count 1.2% MCV 90 fL MCH 3 pg MCHC 31 g/dL
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CLINICAL SCENARIO #1 Is BD anemic? What is the likely cause of BD’s abnormal laboratory findings? If a peripheral smear was performed, what would be the likely morphology of BD’s RBCs? What is the preferred treatment for BD’s anemia?
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CLINICAL SCENARIO #1 FYI…. 1 unit of blood is expected to cause a 1 gm/dL increase in hemoglobin . How many units do you think BD will require? Has anyone ever donated blood before?
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TREATMENT GOALS – Anemia of critical illness Goals of therapy RBC transfusions as needed for acute/severe blood loss Maintain adequate tissue oxygenation and perfusion with improvement in signs/symptoms Establish improvement in laboratory findings Complete blood count (i.e. Hgb, Hct)
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Anemia – Part II Blood Loss / critical illness Hemolytic anemia / G6PD deficiency Sickle cell anemia
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HEMOLYTIC ANEMIA (HA) Background HA results from decreased survival time of RBCs secondary to destruction in the spleen or peripheral circulation Hemolysis may be mild, chronic, lifelong versus severe, acute, life-threatening Pathophysiology Hemolysis, as defined by a RBC lifespan of less than 120 days, results from one of three defects: RBC membrane defects Alterations in Hgb stability Changes in intracellular metabolic processes
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Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency Epidemiology ~ 400 million people worldwide U.S. ~ 10-15% of AA males Recessive hereditary disease Inherited enzyme defect Located on the X chromosome Characterized by abnormally low levels of G6PD G6PD is a metabolic enzyme involved in RBC metabolism Causes red blood cells to break down prematurely (hemolysis) The hemolysis in G6PD deficiency is generally triggered by illness or infection, certain foods or medicines
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