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Family Medicine ROTATION: Hematology

Terms in this set (78)

1. Vaso-occlusive Crisis
—Caused by acidic environments, hypoxia; if the lungs are aerated, you reduce the hypoxia and acute chest syndrome.
—Acute occlusion at various points in the circulation (brain, kidneys).
—Intensity of the pain is defined as the necrosis to the organ.
—Any pt that comes in with sickle cell disease and pain, think necrosis and vaso-occlusive crisis.

Tx: Supplemental oxygen, hydration (makes sure they are maintaining a good fluid status), ample pain meds (morphine, which if not given will increase the hypoxia which increases the occlusive crisis), transfusions (if serious).

Clinically significant vaso-occuslive crisis is acute chest syndrome (unique to sickle cell disease)

Acute Chest Syndrome
—Manifestation of a vaso-occulsion crisis
—Sx: fever, cough (production/nonproductive), chest pain, dyspnea — similar to pneumonia
—Get sputum and blood culture, but presumptively b/c that takes a while, treat empirically with antibiotics.
—If the pt is known to have sickle cell, jump right to management. If there status is unknown, make sure to check the peripheral smear.
—The best first step is IV antibiotics (ceftriaxone), pain meds, gentle fluids, and oxygen.
—Transfusion may be indicated. All pts should be admitted.

2. Splenic Sequestration Crisis/Infection
—Acute, painful enlargement of the spleen. There is sickling in the circulation to the spleen and it starts to trap RBCs and it does so many that it causes circulatory failure leading to hypovolemia.
—Sx: Massive spleen

Tx: Supplemental oxygen, hydration (makes sure they are maintaining a good fluid status), transfusions (if serious), antibiotics (there may be an infection, especially if they have a fever; give a third/fourth generation cephalosporin).

3. Acute Aplastic Crisis
—Acute aplastic anemia usually caused by some type of infection, typically by parvovirus b19.
—Sx: pallor, fatigue, tachycardia
—Only affects the red blood cell line.
—Tx: Transfusion (they have a dropped Hb and Hcrit)