Hematologic Notes

8/10/2019 Hematologic Notes

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Hematologic NotesEasy bruising/bleeding

DIC Disseminated intravascular coagulationo Overview

Can be acute or chronico Etiology

Usually occurs when shock causes widespread activation of clotting cascade uses them all up Sepsis Trauma and tissue destruction Massive large vessel coagulation Malignancy

o S&S Bleeding diathesis: petechiae, ecchymosis, oozing from wounds and IVs

Diffuse bleeding from all sites IV, wound, catheter, mucous membranes Thromboembolism Renal dysfunction AKI Hepatic dysfunction- jaundice Resp dysfunction hemoptysis, dyspnea Shock CNS involvement: coma, delirium, TIAs

o Workup Peripheral smear shows microangiopathic hemolytic anemia Low plts and clotting factors (may be near normal in chronic DIC)

o Management Treat underlying cause!! Hemodynamic support Most coagulopathies are short lived but some pts with severe bleeding may need platelets or FFP transfusions

Thrombocytopeniao Low platelet count (


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o Prophylactic platelet transfusion


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response and diminished iron availability, resulting in anemia.

Causes of Preoperative Anemia

Acute or chronic blood loss Poor nutrition Renal insufficiency Malignancy Chronic disease

Consequences of AnemiaAnemia should be viewed as a significant clinical condition, rather than simply an abnormal laboratory value. 6 In surgical patients, anemia has

been linked to increased postoperative morbidity and mortality. 7 Several studies have shown that patients with preoperative anemia have ahigher incidence of allogeneic blood transfusion compounding the problems from anemia which may include a longer hospital stay and anincreased likelihood of dealth after surgery. 2,7,8 Patients who are transfused after surgery as a result of anemia are more likely to develop

postoperative infection, require longer periods of mechanical ventilation, and have a greater risk of mortality. 9,10

Strategies for Managing Anemia

Blood Transfusions In some circumstances, blood transfusion may be a necessary procedure, but concerns about their risk have restrictedtheir use. Blood transfusion has many known adverse effects including potential transmission of infectious diseases, allergic and hemolytictransfusion reactions, and immunomodulation. 10,11 Allogeneic blood transfusion should be avoided whenever possible because of theseassociated risks and also because transfusion has not been proven to improve postoperative outcomes. 12

Blood Conservation Techniques In surgeries with expected high blood loss, strategies to reduce operative blood loss may help prevent postoperative anemia and may decrease or eliminate the need for allogeneic blood transfusions. These strategies include meticulous surgicaltechnique, the use of autologous blood, acute normovolemic hemodilution and cell salvage, to name a few.

Erythropoiesis-Stimulating Agents (ESAs) and Iron ESA plus iron therapy can be used to correct preoperative anemia and has been shown toreduce the need for blood transfusions. In addition to reducing the need for transfusion, management of anemia with erythropoietin and ironhas been shown to accelerate erythropoiesis, Hb recovery, and enhance quality of life and function in surgery patients. 13-15

Recognition and treatment of anemia during the preoperative period gives surgeons more options for dealing with the blood lost duringsurgery. Comprehensive anemia management can reduce or eliminate the need for perioperative allogeneic transfusions, and provide betteroutcomes. According to Dr. Shander, Recognizing and treating anemia before any elective surgery is extremely important, and could be a lifesaving intervention. Fatigue

Systemic responses to surgery


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Sympathetic nervous system activationEndocrine stress response

The classical stress responses (catecholamines, cortisol and glucose) to abdominal surgery such as cholecystectomy pituitary hormone secretioninsulin resistance

Immunological and haematological changescytokine production

The cytokines have a major role in the inflammatory response to surgery and trauma. They have local effects of mediating and maintaining theinflammatory response to tissue injury, and also initiate some of the systemic changes which occu

acute phase reactionneutrophil leucocytosislymphocyte proliferation

Don't be surprised if you feel very tired when you get home, especially if you've had a major operation or a general anaesthetic.

It's important to move around as soon as possible after surgery and follow your doctor's advice on getting active again. This will encourageyour blood to flow and your wounds to heal, and will build up strength in your muscles. Read about walking for health .
http://www.nhs.uk/Livewell/getting-started-guides/Pages/getting-started-walking.aspxhttp://www.nhs.uk/Livewell/getting-started-guides/Pages/getting-started-walking.aspxhttp://www.nhs.uk/Livewell/getting-started-guides/Pages/getting-started-walking.aspxhttp://www.nhs.uk/Livewell/getting-started-guides/Pages/getting-started-walking.aspx

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Hematologic Notes