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Med Surg > 30- Hematologic Problems > Flashcards

30- Hematologic Problems Flashcards

(53 cards)

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1
Q

Anemia- Dx

A
  • CBC
  • reticulocyte count
  • peripheral blood smear
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2
Q

normocytic

A

MCV:80-95
MCH: 27-31pg

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3
Q

normochromic

A

normal color

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4
Q

normocytic, normochromic

A

aplastic anemia, sickle cell anemia

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5
Q

microcytic, hypochromic

A

iron deficiency

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6
Q

macrocytic, normochromic

A

B12 deficiency

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7
Q

anemia is classified by…

A

morphology (size + color)(more accurate) + etiology (cause)

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8
Q

mild, moderate, severe anemia

Hgb range

A

MILD: 10-12g/dL
MOD: 6-10g/dL
SEV: <6g/dL

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9
Q

mild anemia s/s

A

palpitations
mild fatigue
exertional dyspnea
Hgb 10-12g/dL

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10
Q

mod anemia s/s

A 
bounding pulse,
palpitations,
fatigue
dyspnea
roaring in ears
Hgb 6-10g/dL
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11
Q

severe anemia s/s

A

tachycardia, incr pulse, systolic murmur, angina, HF, MI
blurred vision, retinal hemorrhage, sclera,
anorexia, hepatomega, splenomega, dysphagia, sore mouth
sensitivity to cold, pallor, jaundince, pruritus
glossititis, smooth tongue
bone ain
tachypnea, orthopnea, dyspnea at rest
headache, vertigo, LOC

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12
Q

is anemia a normal finding in adults?

A

NO, but it occurs more often

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13
Q

3 main problems that lead to decreased RBC production

A

1 decr hemoglobin synthesis
—-fr iron deficiency, thalassemia, sideroblastic anemia
2 defective DNA synth
—-cobalamin deficiency, folic acid deficiency
3 diminished availability of erythrocyte precursor> aplastic anemia + anemia of chronic disease

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14
Q

anemia due to defective DNA synthesis

A

cobalamin deficiency

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15
Q

anemia due to decreased Hgb production

A

iron-deficiency

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16
Q

hemolytic anemia that is intrinsic/hereditary

A

sick cell (abnormal hemoglobin)

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17
Q

anemia due to decreased number in RBC precursor

A

aplastic anemia

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18
Q

common causes of iron deficiency anemia

A
  • malnutrition
  • duodenal problems
  • GI blood loss (peptic ulcers, esophagitis, diverticula, hemorrhoids, cancer, gastritis)
  • GU blood loss (menstrual bleeding 45mL/22mg of Fe)
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19
Q

S/S of iron deficiency anemia

A

no early manifestations

most common: pallor, glossitis, cheilitis (inflammation of lips)

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20
Q

daily dose should provide ____ elemental iron

A

150-200mg

ex) 325mg ferrous sulfate has 56mg elemental iron

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21
Q

iron is best absorbed in an ___ environment

A

acidic

-citrus has absorbic acid

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22
Q

how to avoid GI side effects from oral iron?

Study These Flashcards
A

sit upright for 30 min

to avoid heartburn, constipation, diarrhea

23
Q

when to take iron

Study These Flashcards
A

1 hr before meals

24
Q

when can patients stop taking iron therapy?

Study These Flashcards
A

2-3 months after Hgb levels return to normal

25
are macrocytic cells more fragile or sturdy
more fragile - easily destroyed cell membrane
26
serums ____ + _____ are high in B12 deficiency
methylmalonic acid MMA | hemocysteine
27
Tx for Intrinsic Factor deficiency or impaired ileum absorption
- parenteral vit B12 (cyanocobalamin, hydrococobalamin) | - intranasal (cyanocobalamin/Nascobal)
28
Tx for pernicious anemia with working GI absorption
-high dose of oral cobalamin or sublingual
29
dosage of parenteral/intranasal B12 meds
1k mcg/day for 2 weeks then weekly until Hgb is normal then monthly for life
30
aplastic anemia
- pancytopenia - hypocellular bone marrow - rare
31
70% of aplastic anemia is due to
autoimmune activity by overreactive T lymphocytes | -cytotoxic T cells target + destroy hematopoietic cells
32
other causes of aplastic anemia
- chemo/radiation - antiseizure, antimetabolites, NSAID, antithyroid - inherited stem cell defect - fanconi anemia - toxic injury to bone marrow stem cells - viral/bacterial infection
33
Dx of aplastic
- low reticulocyte - low WBC - low platelet - low RBC - normochromic, normocytic - bone marrow biopsy reveals incr yellow fat
34
Tx of aplastic
- immunosuppressive therapy like antithymocyte globulin - ----horse serum that has antibodies against human T cells - HSCT hematopoietic stem cell transplant - steroids or cyclosporine
35
sickle cell disease
inherited autosomal recessive disorder - abnormal form of hemoblobin - normochomic, normocytic - most severe of allt he SCD syndromes
36
sickle cell can cause irreversible damage to ____
liungs, kidneys, brain, retina, bones
37
sickle cell morphology
stiff and angular - more easily to becomes tuck in small capilaries - leads to ACUTE/CHRONIC TISSUE INJURY
38
sickling episodes are most often triggered by...
low O2 tension in the blood | -hypoxia/deoxygentation
39
most common cause of low O2 tension that causes sickling episode
bacterial/viral infection -other causes: high altitude, emo/phys stress, surgery, blood loss, dehydration, acidosis
40
cycle of sickling
hypoxia triggers even> causes sickling of cells> sickle cells causes tissue injury/occlusion> more hypoxia> more sickling
41
sickle cells are hemolyzed by the___
spleen | -causes anemia
42
is sickling reverisble?
- at first it is reversible w reoxygenation | - recurrent sickling leads to irreverisble
43
clinical hallmarks of SCD
vaso-occlusive phenomena + hemolysis
44
why is sickle cell anemia the most severe form of SCD
because they have a high percent of Hgb S | -increases the frequency, extent, + severity
45
s/s sickle cell
- pt is anemic but asymptomatic except during sickling episode - pallor in mucus membranes - grayish skin or jaundice - prone to gallstones * **PAIN*** due to ischemia of tissue
46
most common locations ofpain in sickling episode
back, chest, extremities, abdomen
47
common complications of sickle cell anemia
acute chest syndrome -PNA, tissue infarction, fat embolism, fever, chest pain, cough autosplenectomy -shrinking from repeated scarring from tryiing to phagotize foreign substances -gallstones
48
sickle cell Dx
- peripheral blood smear - incr abnormal reticulocytes - Hgb electrophoresis to check amount og Hgb S - hemolysis (jaundice, high serum bilirubin) - sekelatal x ray (flattening + deformed bones) - MRI - stroke
49
pt w sickle cell should use ___
O2 therapy + incentive spirometer
50
any febrile illness with SCD is...
an emergency
51
treatment for acute chest pain in sickle cell
- abx - folic acid supplement - o2/fluid therapy - transfusion
52
hydroxyurea
drug that increases the production of Hgb F + alters adhesion of sickled RBC
53
only treatment that can cure some pt with SCD
HSCT | Hematopoietic stem cell transplant

Med Surg (18 decks)

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