Anthony Shared "Step 1 FA Hemonc" - 102 Picmonics
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Step 1 FA Hemonc
Hemoglobin
- Hemoglobin Has Four Iron Hemes
- Lots Of Hemoglobin In Red Blood Cells
- High O2 Levels Increase O2 Binding
- High Temperature Reduces O2 Binding
- High CO2 Levels Reduce O2 Binding
- Low pH Reduces O2 Binding
- Myoglobin Binds Oxygen in Muscle
2 mins
Blood Types
- Allele A is Dominant
- Allele B is Dominant
- Allele O is Recessive
- Genotypes AA and AO have Type A Blood
- Genotypes BB and BO have Type B Blood
- Genotype AB is co-dominant and has Type AB Blood
- Genotype OO Results in Type O Blood
2 mins
Blood Types and Compatibilities
- ABO Compatibility
- No Antigens (Type O Blood)
- Universal Donor
- A Antigen (Type A Blood)
- B Antigen (Type B Blood)
- AB Antigen (Type AB Blood)
- Universal Recipient
- Rhesus (Rh) Compatibility
- Rh (Rhesus) Antigen
- Never Rh+ to Rh-
- Considerations
- Blood Transfusion
- Obstetric Patient
2 mins
Whole Blood Composition
- Characteristics
- Plasma
- Electrolytes And Other Solutes
- Proteins
- Albumin
- Fibrinogen
- Globulins
- Water
- Formed Elements
- Buffy Coat
- White Blood Cells (WBC)
- Platelets
- Red Blood Cells (RBC)
2 mins
RhoGam [Rho(D) Immune Globulin]
- Indications
- Antepartum Prevention at 28 weeks
- Suppress Antibody Production
- Mechanism of Action
- Lysis of Fetal RBC in Maternal Bloodstream
- Side Effects
- Myalgia and Lethargy
- Considerations
- Negative Coombs Test
- Standard Dose 300 mcg
- Microdose 50 mcg
- Blood Product
2 mins
WBC Differential Lab Value
- White Blood Cells (WBC)
- 5-10 (5,000-10,000)
- Leukocyte Differential
- Neutrophils (50%-70%)
- Bands (2%-5%)
- Segs (50%-70%)
- Lymphocytes (20%-40%)
- Monocytes (4%-8%)
- Eosinophils (2%-4%)
- Basophils (0.5%-1.5%)
2 mins
Clotting Overview
- Characteristics
- Endothelial Cells are Damaged
- Platelets Respond to Exposed Collagen and Stick
- Platelets Release Recruiting Factors
- More Platelets are Attracted
- Soluble Fibrinogen Turns to Insoluble Fibrin
- Fibrin Seals the Clot
- Clot Dissolves
- Liver Produces Clotting Factors
2 mins
Coagulation Cascade Overview
- Secondary Hemostasis
- Intrinsic Pathway
- Partial Thromboplastin Time (PTT)
- Heparin
- Extrinsic Pathway
- Prothrombin Time (PT)
- Warfarin
- Common Pathway
- Thrombin
- Convert Fibrinogen to Fibrin
- Stabilizes the Platelet Plug
2 mins
Vitamin K
- Sources
- Dark Green Leafy Vegetables
- Synthesized by Intestinal Flora
- Mechanism
- Activated by Epoxide Reductase
- Gamma Carboxylation of Glutamate
- Activation of Clotting Factors II, VII, IX, X, Protein C and S
- Considerations
- Deficiency with Broad Spectrum Antibiotics
- Neonatal Hemorrhage with Increased PT and aPTT
- Warfarin is a Vitamin K Antagonist
4 mins
Vitamin K1 (Phytonadione)
- Mechanism
- Synthesizes Clotting Factors II, VII, IX, X
- Indications
- Hypoprothrombinemia
- Newborn Prophylaxis
- Bleeding from Warfarin Overdose
- Side Effects
- Shock
- Kernicterus
- Cardiac Arrest
- Considerations
- Bile Salts required for Intestinal Absorption
- Increased Risks with IV Administration
2 mins
Heme synthesis Part 1
- Mitochondria
- glycine + succinyl-CoA
- with B6
- E: aminolevulinate synthase
- rate limiting step
- cytoplasm
- aminolevulinic acid
- E: aminolevulinate dehydratase
- Porphobilinogen
- E: porphobilinogen deaminase
- hydroxymethylbilane
- Uroporphyrinogen III synthase
- Uroporphyrinogen
- Note: aminolevulinate = ALA
- Note: glucose and heme inhibit ALA synthase
Heme synthesis Part 2
- cytoplasm
- Uroprophrinogen
- E: uroporphyrinogen decarboxylase
- coproporphyrinogen III
- Mitochondria
- protoporphyrin
- with iron (Fe2+)
- E: ferrochelatase
- Heme synthesis
PT/PTT Lab Values
- Prothrombin Time (PT)
- 10-14 seconds
- Activated Partial Thromboplastin Time (PTT or aPTT)
- 25-35 seconds
1 min
Anemia Lab Values
- Iron Deficiency Anemia
- Serum Iron Decreased
- Transferrin Increased
- Ferritin Decreased
- % Transferrin Saturation Decreased
- Pregnancy and OCP Use
- Serum Iron Normal
- Transferrin Increased
- Ferritin Normal
- % Transferrin Saturation Decreased
- Anemia of Chronic Disease
- Serum Iron Decreased
- Transferrin Decreased
- Ferritin Increased
- % Transferrin Saturation Decreased or Normal
- Hemochromatosis
- Serum Iron Increased
- Transferrin Decreased
- Ferritin Increased
- % Transferrin Saturation Increased
3 mins
Microcytic Anemia Causes
- MCV < 80
- Causes
- Thalassemias
- Chronic Disease or Illness
- Lead Toxicity
- Late Iron Deficiency
- Sideroblastic Anemia
1 min
Iron Deficiency Anemia
- Causes
- Malnutrition/Malabsorption
- Hemorrhage
- Signs
- Microcytic, Hypochromic Anemia
- Decreased Heme Synthesis
- Labs
- Decreased Reticulocytes
- Decreased Ferritin
- Increased Red Cell Distribution Width (RDW)
- Poikilocytosis
- Anisocytosis
- Increased Central Pallor
2 mins
Iron (Ferrous Sulfate)
- Mechanism
- Ferrous Salts
- Indications
- Anemia
- Side Effects
- GI Distress
- Nausea and Vomiting
- Dark Stools
- Considerations
- Take Between Meals
- Liquid can Stain Teeth
- Keep out of Reach from Children
- Caution with GI Disorders
- Avoid Antacids
3 mins
Plummer-Vinson Syndrome
- Triad of Symptoms
- Dysphagia
- Esophageal Webs
- Glossitis
- Iron Deficiency Anemia
- Association
- Squamous Cell Cancer of Esophagus
1 min
Sideroblastic Anemia
- Sideroblastic anemia
- Defect in Heme Synthesis
- X-linked defent in delta-ALA synthase gene
- Decreased TIBC
- Increased ferritin
- Ringed sideroblasts
- Basophilic stippling
- C
- Caused by Vitamin B6 deficiency
- Caused by Copper deficiency
- Isoniazid
- Treat with pyridoxine
Lead Poisoning
- Lead poisoning
- Lead lines (on gingivae and X-ray)
- encephalopathy
- erythrocyte basophilic stippling
- Abdominal Colic
- Sideroblastic anemia
- Peripheral Neuropathy
- Lead inhibits ferrochelatase and ALA-dehydratase in the heme synthesis pathway
- ringed sideroblasts in bone marrow
- Usually from exposure to lead paint (common in homes built before 1978)
- dimercaprol and EDTA for adults, succimer for kids
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