HEME Flashcards
Factor V Leiden is in what pathway
Common pathway
The extrinsic pathway consists of what numbers ?
Really just 7 [and 3] that goes down into 10 to 5 to 2 [common pathway]
Main symptom of factor 5 Leiden to consider in pathology
Unexplained DVT
Activated protein C and S inhibit what 2 factors ?
5Lieden > and small amount of 8
2 important things to remember with protein c and s symptoms ; if they are deficient
Neonatal Purpura
Warfarin induced skin necrosis !
VTE is affected how in protein C and S deficiency
In weird places
At a young age
Recurrent
FAM HX
If warfarin is causing necrosis what should you do
Stop Warfarin
Admin Vit K
ITP often follows what ?
Viral infection
What are the two types of bleeding assoicated with ITP
Dry and Wet bleeds
wet is worse= epistaxis ; gingival bleed
Dry = petechia / brushing
When do you give CC for ITP
If the platelets are less than 30,000
Treatment for thrombotic thyrombocytopenia Purpura
Plasma exchange therapy
4 sxs to think VWF disease
Gingival bleeding [wet]
Heavy menses
Mucocutaneous bleeding
Epistaxis
Minor bleeding or procedures treatment in VWF dz
Desmopressin
Major bleeding or procedures manamgenet in VWF dz
VWF concentrate
4 reasons to have iron deficiency anemia
Chronic bleeding = GI, Menses
Dec iron absorption
GI parasites
Inadequate iron intake
3 signs of severe IDA
Angular chelitis
Koilynchia
Atrophic glossitis
IDA has what level of Ferritin
LOW
In thalassemia iron levels are what
Normal or high
2 medications that can cause folate deficiency
Methotrexate
Trimethoprim
What is homocysteine and mma in Folate deficiency
Increased homo normal mma
2 foods high in folate to recommend for supplementation
Leafy greens, fruit
Vitamin B12 deficiency is also called
Cobalamin deficiency
3 things that can cause B12 deficiency
Stomach surgeries = gastrectomy
Pernicious anemia
Chronic alcohol abuse
4 examples of neuro sxs that often accompany B12 deficiency
Peripheral neuropathy
Diminished sensation
Dementia
Reflex changes
Homo and mma for B12 deficiency
Low homo and HIGH MMA
you gotta be 12 to go to the MMA
Route of B12 management perferred
Parenteral preferred
Can do oral
G6PD enzyme is responsible for converting what into what?
NADP+ in to NADPH from glucose
Without this conversion = low glutathione = HIGH FREE RATICALS
Oxidative stress = Hemolytic anemia
3 medications that usually cause G6PD pathology
Nitrofurantoin
Malaria drugs
Dapsone
FAVE BEANS DONT FORGET>
Why might you have dark urine in G6PD deficiency?
Due to acute hemolytic anemia
Positive findings on peripheral smear for RBCs - G6PD
Heinz bodies
Bite or Blister cells
Common mutation found in polycythemia Vera
JAK2
Polycythemia Vera is an over production of what cells
Myeloid
RBCs // WBCs // Platelets
What is the level of EPO assoc with Polycythemia Vera
Decreased!
Mainstay treatment plolycythemia Vera
Phlebotomy
Sickle cell is what type of genetic disorder
Hbss - Autosomal Recessive
What infection can cause a drop in Hb in sickle cell disease
Parvo
Positive peripheral smear in sickle cell shows what
Howell Jolly bodies
Sickle cell often treated with what
Hydroxyurea
When treating with Hydroxyurea make sure to supplement what
Folic acid
Thalassemia think what region is affected
Mediterranean
African
When does B thalassemia occur
6 months after birth at earliest because fetal blood does not contain the beta chain
3 sxs of hemoglobin H disease
Jaundice
Splenomegaly
Hemolytic anemia
Type of electrophoresis positives in thalassemia
Target cells !
ALL has a proliferation of what
Lymphoblasts
ALL effects
All kids
3 sxs to key in on ALL
Beta sxs and age
With LAD , hepatosplenomegaly , Petechia
Defitnive diagnosis ALL
Bone marrow biopsy with greater 20% lymphoblasts
CLL is what
Crushed little lymphocytes - smudge cells
CLL occurs in who and what is happening
Monoclonal proliferation of premature B cells
Painless LAD
_ hepatosplenomegaly
B sxs
MC in adults in nutrient rich countries
Treatment first line CLL
TKIs
AML think what smear
Auer Rods
What syndrome may progress to AML
Mylodysplastic syndrome
Recurrent infections swollen gums; bimodal distribution think what
AML
CML has what two tings
Philly chromosome
TRIPHASIC course = chronic , accelerated , blastic
2 things assoc with non Hodgkin lymphoma
Burkitts lymphoma
Previous EBV infection
Non hodgkins represents what patho
Malignant transformation of lymphoid [Bs and T’s] into the lymphatic system
3 Ps of non Hodgkin’s lymphoma
Painless , persistent , peripheral LAD
W/ B sxs
Standard diagnosis and staging for non Hodgkin lymphoma
Lymph node biopsy
Ann Arbor staging
Peripheral smear most common in Hodgkin’s lymphoma
Reed sternberg cells “looks like owls”
Hodgkins affects what ages?
Bimodal
20 and 50
Multiple Myeloma think what 4 things
Lytic lesions
Plasma cells proliferation
B sxs
Bone PAIN
3 lab findings in multiple myeloma
Rouleaux formations
Bence jones proteinuria
“M spike” IgG serum electrophoresis
Alcoholics generally have what deficiency
Folate
What med can help reverse tumor lysis syndrome
Allopurinol
Bleeding due to heparin deficiency is treated with what medication
Protamine sulfate
Hodgkin lymphoma folks are at increased risk of what
Solid organ malignancy
Cardiovascular disease
Intrinsic pathway is what
Extrinsic pathway is what
I = PTT
E = pt
HEMOPHILLIA is a concern when? Requires what
Minor trauma causing bruising and effusions
COAG studies
Hodgkin’s lymphoma can have what
Retrosternal chest pain
With hemochromatosis think
Bronze skin and diabetes
Mc cause of pediatric stroke
Sickle cell disease
Reversal agent for heparin is ?
Protamine sulfate
Heterotrophile antibody helps diagnose what
Mono
With ALL think what type of cells
Terminal deoxy neutron tidyl transferase! TDT
Mediastinal mass is super commmmonnnn
CLL effects who
Elderly almost exclusively with mature cells
Cause they are OLD
Warfarin effects the ____ pathway
Intrinsic ; Pt time
Vit K pathway = factor 2, 7, 9 , 10
Helmet cells =
Schistocytes
Thinking TTP
Basophilic stipiling occurs in
Thalassemia
Lead or heavy metal
Microcytic anemia think
MCV less than 80
Severe IDA
Thalassemias
Macrocytic anemia think
MCV greater than 100
Folic acid
Vitamin B12 deficiency
Alcohol abuse; Liver Disease ; Myelodysplastic Syndrome
Normocytic anemia think
MCV 80-199
Anemia of chornic disease
Anemia of chronic renal disease
Multifactorial anemia
What type of anemia is associated with bone marrow suppression
Aplastic anemia