Diagnosis and Management of Hematologic and Oncologic Disorders Flashcards
(109 cards)
1
Q
Reduction below normal of erythrocytes, hemoglobin, or volume of red blood cells (RBCs) caused by a variety of factors, including blood loss, bone marrow failure/impaired production, or hemolysis/destruction of RBCs
A
Anemias
2
Q
The main component of RBCs and the essential protein that combines with and transports 02 to the body
A
Hgb:
3
Q
Measures tile % of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC mass (RBC concentration)
A
Hct
4
Q
Total iron-binding capacity
A
TIBC:
5
Q
Expression of the average volume and size of individual erythrocytes
A
Mean Corpuscular Volume (MCV)
6
Q
Normal: 14 to 18g/100 ml (males)
12 to 16g/100 ml (females)
A
Hgb
7
Q
Normal: 250 to 450 ug/dl
A
TIBC
8
Q
Normal: 50 to 150 gg/dl
A
Serum Iron
9
Q
Normal: 40 to 54% (males)
37 to 47% (females)
A
Hct
10
Q
Normal: 80 to 100 u3
A
Mean Corpuscular Volume (MCV)
11
Q
microcytic =
A
< 80
12
Q
Expression of the average amount and weight of Hgb contained in a single erythrocyte
A
Mean Corpuscular Hemoglobin (MCH):
13
Q
normocytic =
A
80-100
14
Q
Expression of the average Hgb concentration or proportion of each RBC occupied by Hgb as a percentage: more accurate measure than MCH
A
Mean Corpuscular Hemoglobin Concentration (MCHC):
15
Q
macrocytic =
A
> 100
16
Q
Normal: 32 to 36%
A
Mean Corpuscular Hemoglobin Concentration (MCHC):
17
Q
Hypochromic %?
A
<32%
18
Q
Normochromic %?
A
32%-36%
19
Q
Hyperchromic ____%
A
> 36%
20
Q
Iron deficiency anemia and thalassemia
A
Low MCV:
21
Q
B 12 or folate deficiency, alcoholism, liver failure, and drug effects
A
High MCV:
22
Q
Anemia of chronic disease, sickle cell disease, renal failure, blood loss, and hemolysis
A
Normocytic:
23
Q
Microcytic, hypochromic anemia due to an overall deficiency of iron
A
Iron Deficiency Anemia
24
Q
- The most common cause of anemia
A
Iron Deficiency Anemia
25
2. ____ loss exceeds intake so that storage is depleted
| - -> decrease in iron available for RBC formation
Iron
26
3. Caused by: Blood loss, inadequate iron intake, impaired absorption of ____
iron
27
Signs/Symptoms
1. Usually slow in onset, few symptoms with Hct > 30
2. As the Hct falls, see:
a. Pica: Unusual food cravings such as ice, clay, etc.
b. Dyspnea and mild fatigue with exercise
c. Headache
d. Palpitations
e. Weakness
f. Tachycardia
g. Postural hypotension
h. Pallor
Iron deficiency anemia
28
Laboratory/Diagnostics: Iron deficiency anemia
1. ____ Hgb
2. ___ Hct
3. _____ MCV (microcytic)
4. _____ MCHC (hypochromic)
5. _____ RBC
6. ____ serum iron
7. _____ serum ferritin
8. _____ TIBC
9. _____ RDW (red cell distribution width)
1. Low Hgb
2. Low Hct
3. Low MCV (microcytic)
4. Low MCHC (hypochromic)
5. Low RBC
6. Low serum iron
7. Low serum ferritin
8. High TIBC
9. High RDW (red cell distribution width)
29
Management
| 1. Oral ferrous sulfate _______ mg one to two hours after meals
300-325 mg
30
Iron should not be taken with ______, as they interfere with absorption.
antacids
31
Taking iron with juice that has _____ ___increases absorption
vitamin C
32
Foods high in iron: Raisins, green leafy vegetables, ____ ___, citrus products, and iron-fortified bread and cereals
red meats
33
_________
| Genetically inherited disorders resulting in abnormal Hgb production and microcytic, hypochromic anemia
Thalassemia
34
Incidence
| 1. Found mainly in the Mediterranean, _____, Middle Eastern, Indian, and Asian populations
African
35
Signs/Symptoms
| 1. General physical findings are unremarkable unless the form of ______ is severe
thalassemia
36
Laboratory/Diagnostics: Thalassemia
1. _____ Hgb
2. ___ MCV (microcytic)
3. ____ MCHC (hypochromic)
4. ____ TIBC
5. _____ ferritin
6. ________ a or B Hgb chains
1. Decreased Hgb
2. Low MCV (microcytic)
3. Low MCHC (hypochromic)
4. Normal TIBC
5. Normal ferritin
6. Decreased a or B Hgb chains
37
Management: Thalassemia
1. No _____ for mild to moderate forms
2. RBC transfusion/splenectomy for more severe forms
3. Iron is contraindicated as iron overload can result
treatment
38
Macrocytic, normochromic anemia due to folic acid deficiency
Folic Acid Deficiency
39
Cause: Folic Acid Deficiency
| Inadequate intake/malabsorption of ___ ____ (needed for RBC production)
folic acid
40
Signs/Symptoms: _____ _____ _____
1. Fatigue
2. Dyspnea on exertion
3. Pallor
4. Headache
5. Tachycardia
6. Anorexia
7. Glossitis
8. Aphthous ulcers
Folic Acid Deficiency
41
*____ neurological signs are seen*differentiates B12 from folic acid deficiency*
No
42
Laboratory/Diagnostics: Folic Acid Deficiency
1. Hct and RBC ______
2. MCV _______ (macrocytic)
3. MCHC ______ (normochromic)
4. Serum folate ______
5. Red blood cell folate ____ ng/mL
1. Hct and RBC decreased
2. MCV elevated (macrocytic)
3. MCHC normal (normochromic)
4. Serum folate decreased
5. Red blood cell folate < I00 ng/mL
43
Management: Folic Acid Deficiency
1. Folate ___ mg orally every day
2. Foods high in folic acid: ______, peanut butter, fish, green leafy vegetables' iron-fortified bread and cereals
1. Folate 1 mg orally every day
| 2. Foods high in folic acid: Bananas, peanut butter, fish, green leafy vegetables' iron-fortified bread and cereals
44
____ ______
| Macrocytic, normochromic anemia due to deficiency of intrinsic factor, which results in malabsorption of B 12
Pernicious Anemia
45
Signs/Symptoms:
1. Weakness
2. Glossitis
3. Palpitations
4. Dizziness
5. Anorexia
6. Paresthesia
7. Loss of vibratory sense
8. Loss off'me motor control
9. Positive Romberg
10. Positive Babinski
Pernicious Anemia
46
Laboratory/Diagnostics: Pernicious Anemia
1. Hgb, Hct, and RBCs _______
2. MCV ______ (macrocytic)
3. Serum B12 _______ (< 0.1 ug/ml)
4. Anti-IF (intrinsic factor) and anti parietal cell antibody
tests affirm a ________.
5. Schilling test may help to determine the cause.
1. Hgb, Hct, and RBCs decreased
2. MCV increased (macrocytic)
3. Serum B12 decreased (< 0.1 ug/ml)
4. Anti-IF (intrinsic factor) and anti parietal cell antibody
tests affirm a deficiency.
5. Schilling test may help to determine the cause.
47
Management: Pernicious Anemia
1. B12 (cyanocobalamin) ____ ug IM daily x 1 week
2. Maintenance treatment requires continuous lifelong monthly administration.
100 ug
48
Chronic normocytic, normochromic anemia associated with chronic inflammation, infection, renal failure, and malignancy
Anemia of Chronic Disease
49
Cause: Anemia of Chronic Disease
1. Etiology unclear: Involves decreased erythrocyte life
span
2. The ______ most common cause of anemia
second
50
Signs/ Symptoms: Anemia of Chronic Disease
1. Fatigue
2. Weakness
3. ______ on exertion
4. Anorexia
3. Dyspnea
51
Laboratory/Diagnostics: Anemia of Chronic Disease
1. Hgb and Hct ___
2. MCV ______
3. MCHC _____
4. Serum iron and TIBC ____
5. Serum ferritin is _____ (> 100 ng/mL)
1. Hgb and Hct low
2. MCV normal (normocytic)
3. MCHC normal (normochromic)
4. Serum iron and TIBC low
5. Serum ferritin is high (> 100 ng/mL)
52
Management: Anemia of Chronic Disease
1. Treat associated ______
2. Provide nutritional support
3. Dyspnea on exertion
4. Anorexia
disease
53
Chronic hemolytic anemia that is genetically transmitted characterized by sickle-shaped RBC
Sickle Cell Anemia
54
Signs/Symptoms: Sickle Cell Anemia
1. Signs of the disease develop in infancy or childhood
2. Delayed growth and development, increased
susceptibility to infections is common
3. In a crisis, patients experience:
a. Sudden onset of severe ____ in extremities, back,
chest, and abdomen
b. Aching joint pain
c. Weakness
d. Dyspnea
pain
55
General Concepts: Sickle Cell Anemia
1. An acute, periodic exacerbation in which RBCs become
____-shaped and cause vessel obstruction
2. Cellular hypoxia results in acidosis and tissue ischemia.
3. Pain occurs from tissue ischemia and blood hyperviscosity.
4. Factors which precipitate sickling include hypoxia,
infections, high altitudes, dehydration, physical or
emotional stress, surgery, blood loss, acidosis
sickle
56
Laboratory/Diagnostics: Sickle Cell Anemia
1. Hgb ______
2. Peripheral smear shows classic distorted sickle-shaped
RBCs
3. Cellulose acetate and citrate agar gel electrophoresis
to confirm Hgb genotype
1. Hgb decreased
2. Peripheral smear shows classic distorted sickle-shaped
RBCs
3. Cellulose acetate and citrate agar gel electrophoresis to
confirm Hgb genotype
57
Management: Sickle Cell Anemia
1. Treat both acute and chronic complications of the
disease
2. Acute:____ for dehydration, analgesics for pain, and
___ for hypoxemia
2. Fluids
| oxygen
58
____________-
| Idiopathic and chronic marrow disorder, due to genetic mutation, resulting in increased RBCs and increased hematocrit
Polycythemia
59
Signs/Symptoms: Polycythemia
1. Fatigue
2. Weakness
3. _____ disturbances
4. Headache
Visual
60
Laboratory/Diagnostics: Polycythemia
1. Hemoglobin > 18.5 g/dL in men; > 16.5 g/dL in women
2. Presence of _______ or similar genetic mutation
JAK2617V F
61
Management: Polycythemia
1. Phlebotomy
2. _______
3. Referral
Aspirin
62
The disorder that results in excessive levels of iron; untreated iron overload increases the risk of a variety of conditions
Hemochromatosis
63
```
Signs/Symptoms: Hemochromatosis
1. Fatigue
2. ____ pain
3. Pain in knuckles of the pointer and middle
fingers
```
Joint
64
Laboratory/Diagnostics: Hemochromatosis
| 1.____ panel test
Iron
65
Management: Hemochromatosis
1. ___ chelation
2. Surgery, if needed
3. Do not consume foods that contain large amounts of iron (i.e., red meat)
Iron
66
A genetic disorder that results in results in reduced ability to create blood clots; caused by mutation or deficiency in ____ ______ factor and clotting factor VIII
von Willebrand disease
67
Signs/Symptoms: von Willebrand disease
1. Frequent, prolonged, or severe episodes of bleeding
2. Easy _____
bruising
68
Management: von Willebrand disease
| 1. _________, recombinant vWF, vWf/factor VIII concentrate
Desmopressin
69
Neoplasms arising from hemat0Poietic cells in the bone marrow
Leukemias
70
Cause/Incidence: Leukemias
1. Often, ____ ___ cause can be found.
2. More frequent in males
no direct
71
________ Leukemia:
a. Constitutes 80% of acute leukemia in adults
b. Remission rates from 50 to 85%
c. Long term survival: ruffly 40%
Acute Nonlymphocvtic Leukemia (ANL)/Acute Myelogenous Leukemia (AML)
72
______ Leukemia:
a. More difficult to cure in adults than children (90% remission rate in children)
b. Pancytopenia with circulating blasts (the hallmark of the disease)
Acute Lymphocytic Leukemia (ALL)
73
______ _____ leukemia:
a. Most common leukemia in adults
b. This occurs in both middle and old age
c. Median survival is 10 years
d. Lymphocytosis (the hallmark of the disease)
Chronic Lymphocytic Leukemia (CLL)
74
___ _____
a. Occurs most often in persons aged 40 and older
b. Median survival is three to four years
c. Philadelphia chromosome seen in leukemic cells (the hallmark of the disease)
Chronic Myelogenous (CML)
75
Simas/Symptoms: Leukemia
1. May be asymptomatic
2. Fatigue
3. Weakness
4. Anorexia
5. Generalized __________
6. Weight loss
lymphadenopathy
76
Management: Leukemia
1. __________
2. Bone marrow transplantation
3. Control of symptoms
Chemotherapy
77
Lymphomas: Lymphocytic Malignancy
Diagnosis/Staging
1. Diagnosed by biopsy of enlarged ____ ___
lymph nodes
78
Stage ___: Liver or bone marrow involvement
4
79
Stage ___: Lymph nodes or the spleen involved; occurs on both sides of the diaphragm
3
80
Stage ___: Disease localized to a single lymph node or group
1
81
Stage __: More than one lymph node group involved; confined to one side of the diaphragm
2
82
Stage __: More than one lymph node group involved; confined to one side of the diaphragm
2
83
Non-Hodgkin's Lymphoma
| e. In the _____stage, the disease is usually apparent.
advanced
84
Non-Hodgkin's Lymphoma
| b. Often presents with ________
lymphadenopathy
85
Non-Hodgkin's Lymphoma
d. A ____ predictable pattern of a spread than Hodgkin's
disease
less
86
Non-Hodgkin's Lymphoma
| a. The cause is ____; may have viral etiology
unknown
87
Non-Hodgkin's Lymphoma
c. Most common neoplasm between ages ____ and ___
years
20 and 40 years
88
Non-Hodgkin's Lymphoma:
| In the ______ stage, the disease is usually apparent
advanced
89
Hodgkin's Disease:
| b. More common in males; the average age is ____ years.
32
90
Hodgkin's Disease:
c. Usually presents with cervical _____ and spreads
in a predictable fashion along with lymph node groups
adenopathy
91
Hodgkin's Disease:
d. Characteristic ____ ___ cells differentiate from
non-Hodgkin's disease
Reed-Sternberg
92
Hodgkin's Disease:
| The cause is _______.
unknown
93
Laboratory/Diagnostics: Lymphomas: Lymphocytic Malignancy
| 1. CT, x-rays, ultrasonography, and/or MRI used to locate and ____ disease
stage
94
Are Non- Hodgkins Lymphoma and Hodgkin's Disease both Lymphomas: Lymphocytic Malignancy?
Yes
95
Laboratory/Diagnostics: Lymphomas: Lymphocytic Malignancy
| 2. ______ and histopathologic examination confirm the diagnosis.
Biopsy
96
Management: Lymphomas: Lymphocytic Malignancy
1. _______
2. Chemotherapy
a. Initiate allopurinol to reduce tumor lysis syndrome in
high-risk patients
3. Bone marrow transplantation
Radiation
97
Cancer staging system developed and maintained by the Union for International Cancer Control (UICC); not all tumors have TNM classifications (e.g., brain tumors)
TNM Classification of Malignant Tumors (TNM)
98
TNM Classification of Malignant Tumors (TNM)
Mandatory Parameters ('T', 'N', and 'M')
T (a, is, 0, 1 to 4): Size or direct extent of the ____
tumor
primary
99
TNM Classification of Malignant Tumors (TNM)
| M (0/1): ____ metastasis
Distant
100
TNM Classification of Malignant Tumors (TNM)
| N (0 to 3): Spread to ___ lymph nodes
regional
101
The use of an "X" instead of a number or other suffix means that the parameter was ____ _____.
not assessed
102
TNM Classification of Malignant Tumors (TNM)
| M (0/1): ______ metastasis
Distant
103
The immune system's diminished function with age leads to a decline in the response to infection.
"Immunosenescence":
104
Innate immunity functions (_______, natural killer cells, neutrophils) decline
macrophages
105
Adaptive immune responses ______ with geriatric patients.
diminishes
106
In geriatrics decreased thymic hormone production resulting in a decreased number of functioning ______ in geriatrics
T-cells
107
In geriatrics, there is a decreased ______ production and response
antibody
108
In geriatrics, there is a ______ response to antigens
diminished
109
Possible findings/results: Geriatrics
a. Overall increased susceptibility to ______
b. Poor wound healing
c. Exacerbation of chronic diseases
d. Waning vaccine-induced antibody response
infection
