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Hem/Onc > anemia pt 2 > Flashcards

anemia pt 2 Flashcards

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1
Q

idiopathic autoimmune suppression of ALL hematopoiesis

A

aplastic anemia

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2
Q

benzene, chemo, hepatitis, radiation exposure, and pregnancy all can cause…

A

aplastic anemia

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3
Q

pallor, purpura, petechiae can be seen in…

A

aplastic anemia

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4
Q

hepatomegaly and splenomegaly is typically not seen in aplastic anemia because…

A

no hemolysis happening

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5
Q

hypocellular aspirate can be seen in

A

aplastic anemia

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6
Q

eltrombopag (promacta) is tx for…

A

mild aplastic anemia
boosts RBC AND WBC production

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7
Q

what is the general tx for mild aplastic anemia

A
  1. bone marrow growth factors
    - multilineage
    - erythropoietic
    - myeloid
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8
Q

tx for severe aplastic anemia (2)

A
  1. bone marrow transplant
  2. immunosuppression - more ppl that cannot undergo bone marrow transplant
    - ATG, cyclosporine
    - steroids used with ATG to reduce SE
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9
Q

anemia due to CKD, chemotherapy, myelodysplasia can be given this medication

A

epoetin/darbepoetin

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10
Q

which has a longer half-life, darbepoetin or epoetin?

A

darbepoetin
3x of epoetin

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11
Q

contraindication for epoetin/darbepoetin

A

HTN
BBW: CV stuff, thrombosis stuff, cancer

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12
Q

common SE of epoetin/darbepoetin

A

HTN, thrombosis

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13
Q

anemia that have abnormalities in heme synthesis and mitochondrial function

A

sideroblastic anemia

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14
Q

inability to incorporate iron into protoporphyrin IX

A

sideroblastic anemia

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15
Q

how is sideroblastic anemia inherited/congenital?

A

X-linked (MC)
autosomal recessive
mitochondrial

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16
Q

cause sideroblastic anemia is more commonly…

A

acquired
- often part of general myelodysplastic snydrome
- chronic alc
- meds - mostly abx

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17
Q

s/s of anemia, pallor of conjunctiva, palmar creases can be seen in

A

sideroblastic

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18
Q

what must be ordered to make sideroblastic dx?

A

bone marrow aspirate

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19
Q

iron deposits in mitochondria encircling the nucleus can be seen in

A

sideroblastic
ringed sideroblasts

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20
Q

what is the MC cause of anemia worldwide?

A

iron deficiency

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21
Q

how much iron is overall absorbed?

A

10% overall normally in acidic environment

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22
Q

name the major iron transporter that releases iron from cells

A

ferroportin

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23
Q

what promotes ferroportin breakdown and inhibits iron release

A

hepcidin

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24
Q

what type of med can decrease iron absorption

A

antiacids

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25
5 causes of iron loss
1. diet 2. increased requirements - pregnancy, lactation, growth spurt 3. chronic blood loss - periods, GI bleeds 4. decreased absorption - gastritis, chronic disease 5. iron sequestration chronic intravascular hemolysis/hemoglobinuria - chronic iron loss
26
heavy periods and GI bleeds (ulcers, IBD, cancer, chronic ASA/NSAID use) can cause what type of anemia
iron deficiency anemia
27
celiac spue or crohn's disease can cause what type of anemia
iron deficiency
28
presentations of: - smooth tongue, brittle nails, koilonychia, cheilosis - Pica - restless leg syndrome is indicative of...
iron deficiency
29
plummer-vinson syndrome can be seen in...
iron deficiency leads to dysphagia
30
what happens to iron levels during iron deficiency
TIBC - increase transferrin saturation - decrease iron - decreased ferritin - decreased
31
what is the common iron replacement therapy
ferrous sulfate 325 mg orally 3x daily on empty stomach
32
what happens to Hct and reticulocytes during iron replacement therapy
Hct - halfway to normal in 3 weeks, baseline in 2 months reticulocytes - rises in 4-7 days, peak in 1-1.5 weeks
33
pt that cannot tolerate or absorb iron orally reside to...
parenteral - generally IV infusion - iron dextran - older form of parenteral iron and has more risk for serious reactions - newer preparations is more safe and faster
34
proinflammatory cytokines that decreases iron absorption and availability is caused by...
inflammation/infection anemia
35
failure to secrete enough EPO is caused by... (disease)
anemia of CKD EPO secreted by kidneys*
36
decreased EPO secretion mainly seen in decreased hormone secretion states (thyroid, testosterone cortisol) is caused by...
anemia of endocrine disorders
37
cholesterol deposits in RBC membrane that shortens RBc survival and inadequate EPO secretion can be seen in...
anemia in chronic liver disease deposits can increase RBC size (macrocytic)
38
decreased protein intake that leads to decreased EPO is caused by...
anemia of starvation
39
3 causes of anemia of the elderly
1. resistance to EPO 2. decreased EPO secretion 3. chronic low-level inflammation
40
what medication can be given for anemias of chronic disease
EPO
41
what converts methylmalonyl-CoA to succinyl-CoA and homocysteine to methionine
B12
42
what helps with absorption of B12
intrinsic factor in stomach secreted by parietal gastric cells
43
what is absorbed in the terminal ileum
B12-intrinsic factor
44
B12 is stored in the...
liver
45
7 causes of B12 deficiency
1. diet - vegan, alc, elderly 2. decreased intrinsic factor 3. pancreatic insufficiency 4. transcobalamin II deficiency 5. meds 6. competition for B12 7. decreased absorption of B12
46
pernicious anemia and gastric surgery can cause...
B12 deficiency
47
metformin, proton pump inhibitors, and colchicine can cause...
B12 deficiency
48
blind loop syndrome can cause...
competition for B12 = B12 deficiency bacterial overgrowth of small bowel
49
surgical small bowel resection and Crohn's disease can cause...
decreased absorption of B12 = B12 deficiency
50
presentation of B12 deficiency
1. anemia 2. GI - anorexia, nausea, glossitis, angular cheilitis 3. fatigue 4. neuro - gradual onset - initial: peripheral paresthesias - later: problems with balance and proprioception - severe: may affect cerebral function can see non-heme symptoms before anemia mainfests
51
lab findings of B12 deficiency
MCV - increased (megablasts) MCH - increased MCHC - normal
52
tests for pernicious anemia
1. anti-intrinsic factor antibodies - antiparietal cell antibodies - gastrin levels 2. gastric biopsy 3. Schilling test
53
5 tx for B12 deficiency
1. B12 injection 2. oral B12 3. folic acid 4. transfusion (rare) 5. dietary counseling
54
what is the response during B12 tx
reticulocytosis in 1 week CBC normal in 2 months
55
cyanocoalamin is used for
B12 deficiency
56
contraindications for ferrous sulfate
1. allergy to rx 2. hemochromatosis 3. hemolytic anemia
57
contraindication for cyanocobalamin
allergy
58
maintenance monitoring for cyanocobalamin
CBC and B12 level every 3-6 months
59
what coenzyme converts homocysteine to methionine
folate
60
5 causes of folate deficiency
1. diet (MC cause) 2. increased folate requirement - pregnancy - chronic hemolytic anemia - exfoliative skin disease 3. inhibition of reduction to active form (methotrexate) 4. excess folate loss (hemodialysis) 5. decreased absorption of folate - tropical sprue - concurrent B12 deficiency - meds
61
phenytoin, sulfasalazine, trimethoprim-sulfamethoxazole can cause...
decreased absorption of folate = folate deficiency
62
what metabolite is absorbed in the duodenum
iron
63
what metabolite is absorbed in the jejunum
folate
64
presentation of folate deficiency
similar to B12 but NO NEUROPATHY
65
response to folate deficiency tx
reticulocytosis in 1 week CBC normalized in 2 months
66
SE of folic acid
malise, nausea allergic rxn - malaise, flushing, erythema, rash, bronchospasms
67
diverse group of disorders categorized by excessive growth of one or more hematopoitic stem cell lines
myeloproliferative disorders
68
myeloproliferative disorders can see an increase in: (4)
1. polycythemia vera - all hematopoietic cells 2. essential thrombocytosis - platelets 3. myelofibrosis - collagen, fibrous tissue in marrow 4. chronic myelogenous leukemia (CML) - granulocytes
69
instead of pallor, ruddy facial features (plethora) can be seen in...
myeloproliferative disorder - polycythemia vera
70
tx for myeloproliferative disorders
usually myelosuppression

Hem/Onc (13 decks)

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