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Step Up - Hematologic > Anemia > Flashcards

Anemia Flashcards

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1
Q

What is pseudoanemia and what causes it?

A

Decrease in Hb or Hct secondary to dilution

Acute volume infusion or overload

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2
Q

What is not contained in packed red blood cells?

A

Clotting factors or platelets

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3
Q

What should packed red blood cells be infused along with? Why?

A

Normal saline

In order to increase infusion rate

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4
Q

Each unit of PRBC’s increased Hct by how much?

A

3 to 4 points

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5
Q

Over what time period should PRBC’s be infused?

A

1.5 to 2 hours

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6
Q

What is contained within fresh frozen plasma? What is not contained in fresh frozen plasma?

A

Contains all clotting factors

No RBC/s, WBC’s, platelets

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7
Q

After all PRBC transfusions, what test needs to be ordered?

A

CBC

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8
Q

For massive blood loss, what must be transfused?

A

Whole blood

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9
Q

What is contained in cryoprecipitate?

A

Factor VIII and fibrinogen

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10
Q

What three conditions is cryoprecipitate used for?

A

Hemophilia A
vWB disease
Disease

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11
Q

1 unit of platelets increases the platelet count by how much?

A

10,000

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12
Q

What are the two types of hemolytic transfusion reaction?

A

Intravascular & Extravascular

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13
Q

Which of the two types of hemolytic transfusion reactions is most deadly?

A

Intravascular

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14
Q

What causes intravascular hemolytic transfusion reaction?

A

ABO mismatched blood transfusion

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15
Q

What are five symptoms seen in intravascular hemolytic transfusion reaction?

A

fever/chills, nausea/vomitting, pain in the flanks/back, chest pain, dyspnea

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16
Q

What are three complications seen in intravascular hemolytic transfusion reaction?

A

hypovolemic shock, DIC, renal failure

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17
Q

Management of intravascular hemolytic transfusion reaction involves what four actions/treatments?

A
  1. Stop the transfusion reaction
  2. Aggressive fluid replacement to avoid renal failure and shock
  3. epinephrine for anaphylaxis
  4. dopamine/norepinephrine to maintain blood pressure
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18
Q

Extravascular hemolytic transfusion reaction typically occurs within what time period?

A

1 month

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19
Q

What two symptoms are seen in extravascular hemolytic transfusion reaction?

A

Fever, jaundice

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20
Q

What is the management of extravascular hemolytic transfusion reaction?

A

None, it is self limited

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21
Q

Why is it called extravascular hemolytic anemia?

A

Hemolysis occurs in the spleen

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22
Q

What is considered elevated reticulocyte index?

A

> 2%

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23
Q

What is considered decreased reticulocyte index?

A

<2%

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24
Q

A reticulocyte index >2% points to what two possible causes?

A

Blood loss or Hemolytic anemia

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25
If Reticulocyte index is <2%, what is the next test to order?
Blood smear to discover MCV
26
If microcytic anemia is diagnosed on blood smear, what are the top four differential diagnoses?
Iron deficiency Anemia of chronic disease Thalassemias Ringed sideroblastic anemia
27
What causes anemia of chronic disease?
Iron is at normal levels in the body, but is not available for Hgb synthesis due to iron trapping in macrophages
28
If macrocytic anemia is diagnosed on blood smear, what are the top four differential diagnoses?
B12 deficiency Folate deficiency Liver disease Stimulated erythropoiesis
29
Why does stimulated erythropoiesis cause macrocytic anemia?
Reticulocytes are larger than mature RBC's
30
If normocytic anemia is diagnosed on blood smear, what are the top five differential diagnoses?
``` Aplastic anemia Bone marrow fibrosis Tumor Anemia of chronic (inflammatory) disease Renal failure ```
31
In microcytic anemia, if both Fe and TIBC are decreased, what is the cause of anemia?
Chronic (inflammatory) disease
32
In microcytic anemia, if Fe is decreased and TIBC is increased, what is the cause of anemia?
Iron deficiency anemia
33
In microcytic anemia, if Fe is normal and TIBC is normal or slightly decreased, what is the cause of anemia?
Lead poisoning | Thallesemia
34
What is the most common cause of iron deficiency anemia in adults?
Menstrual bleeding
35
In the absence of menstrual bleeding, what is the most probable cause of iron-deficiency anemia?
GI bleeding
36
Iron deficiency anemia due to dietary deficiency or increased dietary demand is most commonly seen in what three age groups?
Infants and toddlers Adolescents Pregnant women
37
Why is iron deficiency anemia seen in infants and toddlers?
Maternal milk is low in iron | Increased requirement due to accelerated growth
38
What are the six clinical features of iron deficiency anemia?
``` Pallor Fatigue Dyspnea on exertion Orthostatic lightheadedness Hypotension Tachycardia ```
39
What two labs should be run on a patient who is suspected to have Beta-thalassemia major?
Hemoglobin electrophoresis | Peripheral blood smear
40
What are the six clinical findings that may be seen in a patient with beta-thalassemia major?
Severe anemia Massive hepatosplenomegaly Distortion of bones d/tExpansion of marrow space Growth retardation and failure to thrive Death in first years of life d/t CHF if left untreated Skull X-ray shows "crew cut" appearance
41
A patient with beta thalassemia major will have what hemoglobin electrophoresis results?
Hb F and Hb A2 are elevated
42
A patient with beta thalassemia major will have what results on peripheral blood smear?
Microcytic hypochromic RBC's | Target cells
43
What is seen on Hgb electrophoresis in patients with alpha-thalassemia major?
Hgb H
44
What is the treatment for a patient with Hgb H disease?
Frequent PRBC transfusions and sometimes splenectomy
45
What should be ordered to check for B12 and folate deficiency?
Serum homocysteine level | Serum methylmalonic acid
46
Serum homocysteine level is increased in what?
B12 and Folate deficiency
47
Methylmalonic acid level is increased in what?
B12 deficiency
48
How is haptoglobin level affected in hemolytic anemia? Why?
Haptoglobin decreases - binds to Hgb and Hgb is decreased because of hemolysis
49
How is LDH level affected in hemolytic anemia? Why?
Increases - released by lysed RBC's
50
What does the Direct Coombs test actually test for?
Detects antibody or complement on the surface of RBC's
51
Spherocytes can be seen in what five conditions?
``` Hereditary spherocytosis G6PD Deficiency ABO incompatibility Hyperthermia Autoimmune hemolytic anemia ```
52
4 Lab tests for hereditary spherocytosis
Osmotic fragility test Reticulocyte count Peripheral blood smear Direct Coombs test
53
What is the result of a direct Coombs test in hereditary spherocytosis? Why is this a helpful test?
Negative | Distinguish it from autoimmune hemolytic anemia
54
What is the treatment for hereditary spherocytosis?
Splenectomy
55
What is seen on a peripheral blood smear in G6PD deficiency
Bite cells
56
Name 3 precipitants of G6PD anemia
Sulfonamides, fava beans, infection
57
What are Heinz Bodies?
Abnormal hemoglobin precipitates within RBC's
58
What causes Heinz Bodies to form?
Lack of G6PD leads to accumulation of H2O2 in cell which denatures hemoglobin, which then accumulate forming Heinz Bodies
59
What are the three treatments for G6PD deficient hemolytic anemia?
Avoid offending agents Hydration Perform RBC transfusion when necessary
60
What are the two types of autoimmune hemolytic anemia?
Warm and Cold
61
What type of autoantibody is seen in warm autoimmune hemolytic anemia?
IgG
62
Where does hemolysis occur in warm autoimmune hemolytic anemia?
Extravascular - within the spleen
63
What autoantibodies are seen in cold autoimmune hemolytic anemia?
IgM
64
Where does RBC sequestration occur in cold autoimmune hemolytic anemia? Where does hemolysis occur?
Liver | Intravascular hemolysis
65
What is the mainstay of therapy for warm autoimmune hemolytic anemia?
Glucocorticoids

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