Pregnancy & Renal Transplantation

Pregnancy & Renal Transplantation
Presentation by:Alicia Notkin

Case Study:

A 30 year old female w/ ESRD, s/p LDRT from her mother 3 years prior, comes to clinic for f/u. She is fully compliant with her regimen of prednisone 5mg daily, tacro 3mg q12h, and MMF 1g q12h. Her renal function has been stable, with a Cr ~ 1.2 mg/dl and a negative UA. She wishes to become pregnant. How should she be advised & managed?


Outline

* Pregnancy in patients with chronic kidney disease
* Pregnancy in patients on dialysis
* Pregnancy in renal transplant patients
* Transplantation medications in pregnancy
* Recommendations
* Other issues: graft dysfunction in pregnancy, donor & pregnancy, male fertility

Pregnancy in patients with chronic kidney disease: patient considerations
Pregnancy in patients with chronic kidney disease: other patient considerations
Pregnancy in patients with chronic kidney disease: fetal outcomes
Pregnancy in patients on dialysis
Pregnancy in renal transplant patients: outcomes
Transplant medications: steroids
Transplant medications: cyclosporine
Transplant medications: tacrolimus
Transplant medications: sirolimus
Transplant medications: mycophenolate mofetil
Transplant medications: azathioprine
AST Consensus Conference on Reproductive Issues & Transplantation 2005
Recommendations: key points
Graft dysfunction in pregnancy
OK to biopsy??
Issues for donor & male recipient

References

Pregnancy & Renal Transplantation.ppt

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RBC Disorders

RBC Disorders
Presentation by: Joyce Smith RN, BSN

* Decreased Production of RBC
* Iron Deficiency Anemia
* Vitamin B12 Deficiency Anemia
* Folic Acid Deficiency Anemia
* Aplastic Anemia

Fe Deficiency Anemia
* Common world wide
* Affects 10-30% of population in US
* Common in premenapausal woman, infants, children, adolescents, & elderly
* Develops slowly

A&P

* Occurs when supply of Fe is too low for optimal RBC formation
* Iron RDA
* 10mg/d M,
* F 12-49 15 mg
* Typical American diet provides 10 to 20 mg/d
* Many woman consume only 12.4mg/d

Cause of Development

* Inadequate absorption or excess Fe loss
* Inadequate dietary intake of foods high in Fe
* Principal cause in adults acute or chronic bleeding
* Secondary to trauma
* Excessive menses
* GI bleeding
* Blood donation

Diagnostics

* Hgb Panic value < 5g/dl
* Hgb level can drop to 3.6g/dl
* Total RBC count rarely below 3 million/dl
* MCH < 27 pg
* MCHC 20 to 30 g/dl
* Serum Fe as low as 10mcg./dl
* HCT < 47 ml/dl M
* HCT < 42 ml/dl F
* Fe binding capacity 
* Serum ferritin level 
* Bone marrow may also be indicated

Symptoms

* Pallor, glossitis
* Dizziness, irritability, numbness & tingling in limbs, fatigue, decreased concentrated & HA
* Tachycardia & dyspnea on exertion
* Sensitivity to cold, brittle hair & nails
* Atrophic glossitis, stomatitis, dysphagia

Treatment
Nursing Care
Folic Acid Deficiency
Food Sources
Clinical Manifestations
Treatment
Aplastic Anemia
Clinical manifestations
Treatment of Aplastic Anemia
Treatment
RBC Disorders
Polycythemia
Clinical Manifestations
Diagnostic Tests
Management

Hematology.ppt

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Hematology

Hematology
By: Joyce Smith RN BSN
Introduction

* Red Blood Cell Disorders
* White Blood Cell Disorders
* Coagulation Disorders
* Clotting Factor Disorders

RBC Destruction
Sickle Cell Disease
Sickle Cell Crisis
Diagnostic Tests
Clinical Manifestations
Health History
Assess
General Management
Drug Therapy
Immunohemolytic Anemia
or Autoimmune Hemolytic Anemia
Immunohemolytic Anemia
or Autoimmune Hemolytic Anemia
Treatment
Vitamin B 12 Deficiency
Diagnostic Tests
Treatment
Folic Acid Deficiency
Food Sources
Clinical Manifestations
Treatment

Hematology.ppt

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