hematologic Flashcards
anemia
- is a sign, not a dz
- correct us of tests is paramount
- dx of iron deficiency anemia –> locate the etiology
morphologic approach to anemia
micro- MCV 100
folic acid, ETOHic, liver disease
normocytic- MCV 80-100
- anemia of chronic dz
- anemia of chronic renal failure
- multifactorial anemia
RBC destroy after 120 days- hemolysis in the spleen
retic count: baby RBC cells, increase to erythropoeitein
- help evaluate bone marrow function
kinetic approach:
low retic count- problem in marrow, lack of nutrients
bone marrow suppression
high retic count- blood loss, hemolytic anemias, sick cell, autoimmune, drug-induced , thallassemias
check WBC and plts
if low retic- acute blood loss
renal dz, drug effects
low plts and low WBC- sign bone marrow failing
leukemia, myelosuppresion, TB in marrow
iron metabolism
serum iron is free
TIBC- how hungry is our blood for iron.
ferritin- stores iron in liver and RES.
signs of iron deficiency-most common cause of anemia
- spoon nails
- glossitis
- esophageal web- Plummer-Vinson syndrome
- restless legs , check ferritin
- pica- chewing ice
- hair loss
etiology: bleeding, GI bleed, cancer, menses, blood donation, growth periods, pregnancy, lactation, gastric surgery, malabsorption, calcium inhibits GI
tx: oral iron : ferrous sulfate 325 mg bid -constipaion -6-8 weeks to recheck level -vitamin C helps -IV iron -check ferritin in 3-4 weeks
sickle cell
substitution of AA valine from glutamic to form beta s globin. Hbs
-8-10% AA carry gene
-use hemoglobin electrophoresis to dx
( presence of Hbs, higher levels of HbF)
- autosomal recessive
pathophys: deoxygenated hb s polymers causes sickling and damage to membrane
disease: functional splenic ( trivalent vaccine to prevent infections)
sickle cell trait
- no symptoms
- high O2 demand/ dehydration states can develop crisis
- over years can have microinfarts causing kidney damage/cardiac damage
sickle cell anemia
chronic hemolysis -moderate anemia -reticulocytosis - elevated t.billi -incr endothelial RF: if hgb > 8.5- more crisis pregnant pt cold weather high altitude
CHF/cardiac problems.
acute sickle cell crisis
-caused by stress syndrome
-last 1-2 weeks
fever, elevated WBC, acute chest syndrome ( infants, wheezing)
exchange transfusion
- splenic sequestration (LUQ–> hypovolemia, emergecny splenctomy)
-bone infarcts
-asvascular necrosis
-oxgyen, hydrate, and pain meds.
-get strep pneumo/ H.fu
-leg ulcers
-parvoviru 19-fatal
hand/ foot syndrome
maintenance: chronicle followed with CBC, given folic acid,
screening transcranial dopplers, retinal exams, multivalent vaccine
Beta-thalassemia trait
mild-mod anemia
- hgb: 9-11
- mishapen cells
- no sxs
- don’t give erythropotein
beta thalassemia major
- sever anemia
- infants: develop anemia in first weeks
- cardiac stress, hepatosplenomegaly, chipmunk facies ( bone deformity)
tx: allogenic bone marrow transplant
alpha thalassemia syndromes
alpha thalassemia 2 trait- loss of 1/4 alpha globin genes
- no abn MCV
alpha thalassemia-1 trait (minor)- loss of 2/4 alpha globin genes
- mild anemia, MCV is often
Anemia of chronic dz
- reduction is RBC production in bone marrow
- ferritin increased
- iron not available to make new hemoglobin
- low serum iron, TIBC is low, low iron saturation, normal or elevated ferritin
causes: chronic UTI, BC
met cancer, chronic leukemia, RA, UC, thyroid , DM
dx: hgb 8-10
retic count-low
reduced iron and and low TIBC, elevated ferritin
exclude renal failure
tx: manage underlying dz
- EPO
- only given iron if iron deficiency
- transfusion for acute issue
acute variant anemia
- infection, MI
after surgery, major trauma
low serum iron
-high ferritin
hemolytic anemia
caused by premature breakdown of RBC
-severity of anemia related to rate of RBC destruction and ability of bone marrow produce reticulocytes
s/s: acute pallor splenomegaly jaundice -incr LDH -low haptoglobin -incr. retic
hereditary spherocytosis
forms spheroctic cells are destroyed on spleen.
s/s: splenomegaly and jaundice
dx: on blood smear
tx: splenectomy but vaccinate
