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Chapter 3 Hematologic MDT Flashcards

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1
Q

Hematocrit in adult males less than 41% (hmg < 13.5g/dL)

Hematocrit in adult females less than 37% (hmg <12 g/dL)

A

Anema

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2
Q

Commonly the cause of iron deficiency in adults

A

Bleeding

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3
Q

Two anemia classifications

A

Pathophysiologic basis (increase or decrease production of RBCs)

Cell size

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4
Q

Signs and symptoms:

Lymphadenopathy, hepatosplenomegaly, or bone tenderness

Mucosal changes such as a smooth tongue

A

Anemia (megaloblastic)

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5
Q

Anemia labs:

Iron with total iron binding capacity (TIBC)
-Less than what ferritin value indicates Fe deficiency anemia?

A

12 mcg/L

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6
Q

Anemia labs:

Why would you get hemoglobin electrophoresis?

A

To evaluate for alpha or beta thalassemia

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7
Q

Treatment for:

Anemia

A

Identification of blood loss

Treatment specific to the specific cause of anemia

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8
Q

Most common cause of anemia

A

Iron deficiency

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9
Q

Increases the chances of iron deficiency anemia

A

Menstruation

Pregnancy

Frequent blood donors

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10
Q

Most important cause of iron deficiency anemia

A

Blood loss, especially GI blood loss

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11
Q

Physical findings:

Fatigability, tachycardia, palpitations, and tachypnea on exertion

Severe: Skin/mucosa changes. Smooth tongue, brittle nails, cheilosis

A

Iron deficient anemia

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12
Q

Cause of dysphagic in iron deficient anemia patients

A

Formation of esophageal webs (Plummer-Vinson syndrome)

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13
Q

Many iron-deficient patients develop this, crave specific foods often not rich in iron

A

Pica

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14
Q

Labs for iron deficient anemia

A

CBC - decreased mean corpuscular volume (MCV)

Iron - Ferritin value <12 mcg/L

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15
Q

Treatment for iron deficient anemic patients

A

Ferrous sulfate 325mg TID for 3-6 months

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16
Q

Vitamin B12 deficiency can cause

A

Macrocytic anemia

-B12 level <100 pg/ml

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17
Q

All vitamin B12 comes from:

A

Diet, all foods of animal origin

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18
Q

The daily absorption of vitamin B12

A

5 mcg

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19
Q

Liver contains ____-____ mcg of stored vitamin B12.

Daily losses are ___ mcg/dL.

The body has enough B12 stores for __ years.

A

2000-5000mcg

3-5 mcg/dL

3 years

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20
Q

Surgical resection of the ileum will eliminate the site of:

A

B12 absorption

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21
Q

Rare causes of B12 deficiency

A

Fish tapeworm infection

Pancreatic insufficiency

Severe Crohn’s disease (destroys the ileum)

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22
Q

Physical findings:

  • Glossitis
  • Anorexia
  • Diarrhea
  • Late stages: Pale skin, paresthesia and difficulty with balance
A

B12 deficiency

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23
Q

Hallmark lab findings in B12 deficiency

A

CBC w/ Diff: Megaloblastic Anemia (Large RBCs)

-Macro-ovalocyte with hyper-segmented neutrophils

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24
Q

B12 deficiency:

Mean corpuscular volume (MCV) will be:

A

Strikingly elevated (MCV = RBC volume from CBC)

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25
Treatment for B12 deficiency
IM Injection of B12 - Daily first week - Weekly first month - Monthly for life
26
Three mechanisms that reduce loss of blood from blood vessels
Vascular spasm Platelet plug formation Blood clotting
27
Vascular spasm is caused by damage to smooth muscle and reflexes initiated by _____ receptors
Pain
28
Three stages of blood clotting
Formation of prothrombinase Conversion of prothrombin into thrombin Thrombin converts soluble fibrinogen into insoluble fibrin threads
29
Factors that are vitamin K dependent
II VII IX X
30
Laboratory measurement of the function of intrinsic and extrinsic coagulation pathways
PTT (intrinsic) PT (extrinsic)
31
Congenital deficiency of coagulation factor VIII
Hemophilia A
32
Congenital deficiency of coagulation factor IX
Hemophilia B
33
In many older patients, what viruses from receipt of contaminated blood products can cause coagulopathy?
HIV Hep C
34
Life threatening emergency. Causes thrombosis and hemorrhage. Coagulation and fibrinolysis become abnormally activated, leading to ongoing coagulation and fibrinolysis.
Disseminated intravascular coagulation (DIC)
35
Common bleeding manifestations of DIC
Petechiae Ecchymoses Blood oozing from wound sites, IV lines, catheters, mucosal surfaces
36
Common thromboembolic manfestations of DIC
Venous thromboembolism (VTE) and arterial thrombosis with tissue or organ ischemia
37
Common causes of DIC
Sepsis Malignancy Trauma OB complications Hemolysis (malaria or ABO incompatible transfusion)
38
Less common causes of DIC
Heat stroke Crush injuries Rattlesnake/Viper Bite
39
Treatment for DIC
Treat the underlying cause
40
Symptoms/physical findings: - Bruising without trauma - Bleeding into joint spaces - Epistaxis - Bleeding from eyes - Very heavy vaginal bleeding for prolong times in females
DIC
41
Labs: DIC
PT, PTT
42
X-linked recessive disorder commonly seen in American black men, affecting 10-15% Episodic hemolysis in response to oxidant drugs or infection
G6PD
43
G6PD
Glucose-6-phosphate dehydrogenase
44
G6PD: Oxidized hemoglobin denatures and forms precipitants called:
Heinz bodies
45
G6PD patients to avoid oxidant drugs like:
Dapsone Primaquine Quinidine Quinine Sulfonamides Nitrofurantoin Aspirin Ciprofloxacin
46
Labs for G6PD: Red blood cell smear is not diagnostic but may reveal a small number of "____" cells
"bite"
47
G6PD: Support by monitoring with what lab test?
CBC
48
Autosomal recessive disorder in which an abnormal hemoglobin leads to chronic hemolytic anemia with numerous clinical consequences
Sickle Cell
49
The rate of sickling is influenced by the concentration of _______ and by the presence of other hemoglobin within the cell
Hemoglobin S
50
Hemoglobin S gene is carried in __% of American black people
8%
51
_ of 400 American black children will be born with sickle cell anemia
1 out of 400
52
Symptoms/Physical findings: Chronically produces jaundice, pigment gallstones, hepatosplenomegaly, poorly healing ulcers over the lower tibia. Life-threatening anemia can occur during hemolytic/aplastic crises, usually associated with viral or other infection or by folate deficiency Acute painful episodes include the bones and chest, last hours to days and may produce a fever Cardiomegaly Chronic pain
Sickle Cell Anemia
53
Lab studies: Sickle Cell
CBC w/ Diff -Hematocrit is usually 20-30%
54
Sickel Cell: Blood smear will show what percentage of irreversibly sickled cells
5-50%
55
SCA: Hallmarks of hypersplenism
Howell-Jolly bodies and target cells
56
Sickle cell hemoglobin is confirmed by hemoglobin electrophoresis with hemoglobin S accounting for __% of hemoglobin.
86-98%
57
Disease where no hemoglobin A is present
Homozygous S disease
58
Allogeneic hematopoietic stem cell transplantation before end organ damage, it can cure __% of children with SCA.
80%
59
Treatment for SCA:
Folic acid supplements (1mg PO daily) Transfusions for aplastic/hemolytic crises Keep hydrated Search for underlying infection
60
Average life expectancy for SCA is:
40-50 years old
61
Sickle cell trait
Heterozygous genotype (AS)
62
Sickle cell trait: Screening for sickle hemoglobin will be positive. What percentage will be hemoglobin S?
40%
63
Malignancy of the hematopoietic progenitor cell. These cells proliferate in an uncontrolled fashion and replace normal bone marrow.
Leukemia
64
Leukemia is linked to:
Radiation and some toxins (benzene)
65
Compromised 80% if the acute leukemias of childhood. It is seen in adults, causing approximately 20% of adult acute leukemias.
Acute lymphoblastic leukemia (ALL)
66
Primarily an adult disease with a median age at 60 years and an increasing incidence with advanced age.
Acute myeloid leukemia (AML)
67
Leukemia: Blasts in peripheral blood in __% of patients
90%
68
Symptoms/Physical findings: - Fatigue - Bleeding (gums, mucosa, skin) - Infection - Gum hypertrophy, bone and joint pain - Pale skin and have purpura and petechiae - Enlargement of liver, spleen, and lymph nodes - Bone tenderness, particularly in the sternum, tibia, and femur
Leukemia
69
Hallmark of acute leukemia is:
Combination of pancytopenia with circulating blasts
70
Aleukemic leukemia
No presence of blasts (10% of cases)
71
What percentage of blasts require to make a diagnosis of acute leukemia??
20%
72
Patients with Acute Lymphoblastic Leukemia may show what on chest radiograph?
Mediastinal mass
73
Treatment for leukemia
Referral to hematologist MEDEVAC Chemo and radiation therapy is the mainstay
74
Approximately ___% of adults with AML under age 60 y/o achieve complete remission
70-80%
75
Chemotherapy leads to the cure in __% of patients
35-40%
76
Bone marrow transplants is curative in ___% of cases
50-60%
77
High WBC count
Leukocytosis
78
Low WBCs (<4400 cells/mL)
Leukopenia
79
WBC: - Bacterial infection - Inflammation - Metabolic disease - Stress
Neutrophils
80
WBC: - Viral infection - Immune disease - Stress - Leukemia
Lymphocytes
81
WBC: - Skin diseases - Drug reaction - Parasite infection - Asthma
Eosinophils
82
WBC: -Chronic myeloid leukemia
Basophils
83
WBC: - Infection - Autoimmune disease
Monocytes
84
Benign ethnic neutropenia Infections (Hepatitis, HIV, Epstein-Barr, Parasitic, rickettsia infections) Medications Nutrition: vitamin deficiencies (B12, folate, copper) Hematologic malignancies (leukemia, lymphoproliferative disorders, myelodysplastic syndromes) Rheumatic disorders (RA, SLE)
Etiologies of leukopenia
85
Signs and symptoms of leukopenia or leukocytosis
Fever Skin erythema, ulcerations, fissures, or tenderness Gingivitis, swelling, oral ulceration, dental pain Abnormal respiratory exam
86
Neuro or psychiatric abnormalities may suggest what?
Nutritional deficiency (B12, copper)
87
Abnormally low amount of circulating platelets
Thrombocytopenia
88
The risk of spontaneous bleeding does not typically increase until the platelet count falls below ____/mcL
10,000-20,000
89
Potential causes of thrombocytopenia:
Bone marrow failure or malignancy Disseminated intravascular coagulation (DIC) Chemo or radiation therapy Nutritional deficiencies (folate or iron) Medications
90
Potential causes of thrombocytopenia:
Bone marrow failure or malignancy Disseminated intravascular coagulation (DIC) Chemo or radiation therapy Nutritional deficiencies (folate or iron) Medications
91
Signs and symptoms of thrombocytopenia
PETECHIA (coagulopathy would cause bruising) Mucocutaneous bleeding (gingival, nosebleeds)
92
Abnormally high amount of circulating thrombocytes (>450,000)
Thrombocytosis
93
Two different categories of thrombocytosis
Reactive - Anemia/blood loss - Infection - Non-infectious inflammation - Post splenectomy Autonomous -Primarily cancer of bone marrow
94
Signs/Physical findings: - First sign is elevated platelets - 50-60 y/o - Erythromelalgia - painful burning of the hands w/ erythema - Splenomegaly in 25%
Thrombocytosis
95
Labs/Studies: Thrombocytosis
CBC w/ diff Blood smear Iron studies Inflammatory markers (based on history)
96
Treatment: Thrombocytosis
Refer to hematology if there is no infectious cause or it does not resolve on its own in 2-4 weeks

Hematology (5 decks)

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