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Blood MDT Flashcards

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1
Q

Congenital anemia is suggested from the patient’s what?

A

Personal and family hx

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2
Q

Poor diet may result in which deficiencies?

A
  • Folic acid
  • Iron
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3
Q

What is a more common cause of iron deficiency in adults?

A

Bleeding

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4
Q

What hematocrit level defines anemia in males and females?

A

Males= <41%(hgb 13.5 g/dL)
Females = <37% (hgb 12g/dL)

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5
Q

Physical sx of anemia

A

Mucosal changes such as smooth tongue

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6
Q

What labs should be drawn for anemia?

A

CBC with diff
Iron
Hgb electrophoresis (to evaluate alpha or beta thalassemia)

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7
Q

What iron value indicates iron deficient anemia?

A

<12mcg/L

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8
Q

When and where should patients with anemia be referred?

A

Referred to internal medicine if cause is not identified

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9
Q

What is the most common type of anemia worldwide?

A

Iron deficient anemia

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10
Q

What can cause iron deficient anemia?

A

Menstruation, pregnancy, frequent blood donations, ASA and long term NSAID use

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11
Q

Why should IDCs be aware of anemia in males?

A

Male do not menstruate so anemia is likely due to a disease process

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12
Q

Physical findings of iron deficient anemia

A

Smooth tongue, brittle nails, cheilosis (cuts on mouth)

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13
Q

What will iron deficient patients crave?

A

Specific foods (such as ice) often not rich in iron, also called pica

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14
Q

Treatment for iron deficient anemia?

A
  • treat cause of blood loss
  • Ferrous sulfate 325mg 3x per day for 3-6 months
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15
Q

When would parenteral iron be used?

A

Intolerance of oral iron due to GI disease and continued blood loss cannot be corrected
Dosage derived from hematologist

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16
Q

Essentials of dx of Vitamin B12 deficiency

A
  • Macrolytic anemia
  • Macro-ovalcytes and hypersegmeneted neutrophils on peripheral blood smear
  • serum B12 level <100pg/ml
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17
Q

Where is in the diet is vitamin b12 present?

A

Animal origin

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18
Q

What is the daily absorption of vitamin B12

A

5mcg

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19
Q

The liver contains how much stored vitamin B12?

A

2000-5000mcg

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20
Q

Which diet is likely to lead to vitamin B12 deficiency

A

Vegan

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21
Q

Late stage vitamin B12 patients will present how?

A

Pale, with paresthesia and difficulty with balance and neuro findings

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22
Q

What will show on a blood smear of a vitamin B12 deficient patient?

A

Megaloblastic anemia (large RBCs) and macro-ovalocyte with hypersegmented neutrophils

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23
Q

What B12 serum level indicates deficiency?

A

Overt deficiency = <170 pg/ml
Symptomatic = <100 pg/ml

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24
Q

Treatment for Vitamin B12 deficiency?

A

IM injection of B12 daily for a week, weekly for a month and then monthly for life

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25
Disposition of late stage vitamin B12 deficiency?
MEDEVAC, refer to hematologist
26
What 3 mechanisms reduce loss of blood from blood vessels?
Vascular Spasm Platelet Plug Formation Coagulation
27
Describe vascular spasm
- Smooth muscle of a blood vessel wall contracts - Caused by damage to smooth muscle and reflexes initiated by pain receptors - Can be maintained for several minutes to hours
28
Describe platelet plug formation
- clumping of platelets around damage - can stop bleeding completely if hole in blood vessel is small enough
29
Describe coagulation
- Formation of prothrombinase - Conversion of promthrombin into thrombin - Thrombin converts soluble fibrinogen into insoluble fibrin threads
30
What are intrinsic pathway key factors
12, 11, 8, 9
31
What are extrinsic pathway key factors
7
32
What factors do the pathways converge?
10, 5, 2
33
Which factors are vitamin K dependent?
2, 7, 9, 10
34
What labs are used to measure intrinsic pathway?
PTT
35
What labs are used to measure extrinsic pathway?
PT
36
Hemophilia A is a congenital deficiency of which coagulation factor?
8
37
Hemophilia B is a congenital deficiency of which coagulation factor?
9
38
Those with congenital deficiencies are at risk of developing antibodies to which factors?
8 and 9
39
Older patients with congenital deficiencies are at risk of what infections from contaminated blood products?
HIV and Hep C
40
What is Disseminated Intravascular Coagulation (DIC)?
Systemic process with potential of causing thrombosis and hemorrhage
41
In DIC, what happens to the processes of coagulation and fibrinolysis within the vasculature?
They become abnormally activated
42
A variety of initiating procoagulants may contribute to DIC including?
Tissue factor (TF)
43
What are common bleeding manifestations of DIC?
Petechiae, ecchymosis, blood oozing from wound sites, intravenous lines, catheters, mucosal surfaces and venous thromboembolism (VTE)
44
Major principal of treating DIC?
Treat underlying cause
45
Labs should be done for DIC?
PT, PTT, INR CBC
46
G6PD is commonly linked to which patient population?
American Black men, 10-15%
47
What are Heinz bodies?
Oxidized hgb denatures and forms precipitants
48
What happens to Heinz bodies?
Heinz bodies cause membrane damage which leads to removal by the spleen
49
Which anti malaria drug should not be given to patients with G6PD?
Primaquine
50
G6PD patients may have what in their RBC smear?
Bite cells
51
What stain can reveal Heinz bodies in a peripheral blood smear?
Cresyl Violet, they are not visible on the usual Wright-Giesma stained blood smear
52
Treatment of G6PD patients?
- no treatment required, avoid oxidants
53
What is the shape of RBCs in patients with sickle cell
Sickle rather than biconcave disc
54
The rate of sickling in patients with sickle cell trait is influenced by what?
Concentration of hemoglobin S
55
What population carries the hemoglobin S gene?
8% of American blacks and 1 of 400 American black children will be born with sickle cell
56
Physical findings/sx of patients with sickle cell
Jaundice, hepatosplenomegaly, poorly healing ulcers over the lower tibia Acute painful episodes of the bones that last hours to days with low grade fever
57
Labs for patients with sickle cell
CBC with dif Blood Smear
58
What is the hematocrit of patients with sickle cell?
20-30%
59
What may the results of a blood smear from a patient with sickle cell show?
Irreversibly sickled cells comprising of 5-50% Nucleated red blood cells and Howell-Joly bodies and target cells
60
What supplement may assist sickle cell patients?
Folic acid 1mg po daily
61
What complications can sickle cell lead?
Chronic multisystem disease leading to organ failure that may result in death
62
With supportive care, what is average life span of those with sickle cell?
40-50years
63
Screening test for sickle cell reveals what percentage of hemoglobin is hemoglobin S?
40%
64
Acute lymphoblastic leukemia (ALL) occurs at what ages and percentages?
- 80% of acute leukemia in children - 20% of adult acute leukemia
65
Acute myeloid leukemia (AML) occurs at what age?
Median age of 60 years old
66
Blasts in peripheral blood is in what percentage of patients?
90%
67
Bone tenderness in patients with leukemia is present particularly where?
Sternum, tibia and femur
68
DDx of acute leukemia
- Viral infection such as Mono - Pertussis - Other 1 myeloproliferative diseases - hairy cell leukemia, lymphomas, chronic Lymphocytic leukemia - Anemia - hypothyroid - SLE
69
What is the hallmark of acute leukemia?
Pancytopenia with circulating blasts
70
What percentage of blasts are required to make a dx of acute leukemia?
20%
71
Patients with ALL may have what on a chest radiograph?
Mediastinal mass
72
Disposition of acute leukemia?
MEDEVAC Referral to Hematologist
73
Chemotherapy cures what percentage of patients with leukemia?
35-40%
74
Bone marrow transplant is curative in what percentage of leukemia patients?
50-60%
75
What is leukocytosis?
High white cell count relative to normal physiologic numbers
76
What is leukopenia?
Low total white cell count (<4400cells/microL)
77
Elevated neutrophils is called?
Neutrophilia
78
What could cause neutrophilia?
Infection Inflammation Metabolic disease Stress
79
What percentage of whites and blacks get benign ethnic neutropenia?
4.5% Blacks 0.7% Whites
80
Leukopenia can be caused by what viruses?
Hepatitis, HIV, Epstein-Barr. Parasitic and rickettsial infections
81
Leukopenia can be caused by which deficiencies?
Vitamin deficiencies (B12, Folate, Copper)
82
What is thrombocytopenia?
Abnormally low amount of circulating platelets
83
Risk of spontaneous bleeding does not typically increase until when?
Platelets fall below 10,000-20,000/mcl unless the patient has abnormal platelets
84
Hallmark sx of thrombocytopenia?
petechia
85
What is thrombocytosis?
Abnormally high amount of circulating thrombocytes (>450,000)
86
What are the 2 categories of thrombocytosis?
Reactive thrombocytosis Autonomous thrombocytosis
87
Autonomous thrombocytosis is primarily what etiology?
Cancer of bone marrow etiologies
88
Median age of thrombocytosis?
50-60years of age

Blood and Lymph (6 decks)

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