Flashcards in EXAM #3: COMMON HEMATOLOGIC PRESENTATIONS Deck (49):
1
Why is angina a common symptom of anemia in patients with pre-existing CAD?
Decreased oxygen delivery to the heart b/c of decreased oxygen in the blood
2
What is the definition of anemia in males and feamles?
- Males= Hb less than 13.5
- Females= Hb less than 12.5
3
What are the common causes of a microcytic anemia?
1) Fe++ deficiency
2) ACD
3) Sideroblastic anemia
4) Thalassemia
4
How does iron deficiency lead to microcytic anemia?
Hb= heme + globin
- Decreased iron
- Decreased heme
- Decreased Hb
-->Microcytic anemia
5
What is the most common cause of Fe++ deficiency in infants?
Breast-feeding
6
What is the most common cause of Fe++ deficiency in children?
Poor diet
7
What is the most common cause of Fe++ deficiency in Adults?
PUD vs. hookworm
8
What is the most common cause of Fe++ deficiency in Elderly?
Colon polyps/carcinoma
9
What lab values are characteristic of Fe++ deficiency anemia?
- Decreased ferritin
- Increased TBIC
- Decreased serum Fe++
- Decreased %saturation
- Increased FEP
10
How does increased Hepcidin production in ACD lead to microcytic anemia?
1) Hepcidin sequesters Fe++ in storage sites
2) Decreased available Fe++
3) Decreased heme
4) Decreased Hb
-->Microcytic anemia
11
What are the lab findings in ACD?
- Increased Ferretin
- Decreased TIBC
- Decreased serum Fe++
- Decreased %saturation
- Increased FEP
12
Explain the etiology of sideroblastic anemia leading to microcytic anemia.
Sideroblastic anemia= congenital defect in ALA Synthease, the rate limiting step of heme synthesis
1) Decreased protoporphyrin
2) Decreased heme
3) Decreased Hb
-->Microcytic anemia
13
When protoporphyrin is deficient, where is Fe++ trapped? What does this lead to?
Mitochondria --> "Ringer sideroblasts"
14
What are the acquired causes of sideroblastic anemia?
Alcoholism
Pb poisoning
Vitamin B6 deficiency
****B6 is the cofactor for ALA synthase****
15
What are the lab findings in sideroblastic anemia?
- Increased ferretin
- Decreased TBIC
- Increased serum Fe++
- Increased %saturation
16
Outline the etiology of microcytic anemia in Thalassemia.
Decreased synthesis of globin chains=
- Decreased Hb
-->Microcytic anemia
17
What is the hallmark PBS finding of Beta-Thalassemia?
Target cells
18
What is the approach to treating stable Fe++ deficiency anemia in the elderly?
Oral Fe++ therapy with 325 mg of Ferrous Sulfate and 500 units Vitamin C
19
What are the most common causes of macrocytic anemia?
Folate/ B12 deficiency
20
How do Folate and B12 deficiency lead to macrocytic anemia?
Both are necessary for DNA precursors; leads to cell enlargement without division
21
What type of neutrophil is associated with Folate and B12 deficiency?
Hypersegmented i.e. greater than 5 lobes
22
Folate deficiency picmonic.
See picmonic.
23
B12 deficiency picmonic.
See picmonic.
24
What are the lab findings associated with folate deficiency?
1) Decreased folate
2) Increased homocysteine
3) Normal MMA
25
What does increased homocysteine increase the risk for?
Thrombosis
26
What are the lab findings associated with B12 deficiency?
1) Decreased B12
2) Increased serum homocystine
3) Increased MMA
27
How is B12 deficiency treated?
1) Parenteranl injection
2) Oral supplementation
28
How do you correct a RC count?
RC x Hct/45
29
What does a corrected RC count greater than 3 represent?
Good marrow response
30
What does a corrected RC count less than 3 represent?
Poor marrow response
31
What are the clinical findings associated with extravascular hemolysis?
1) Splenomegaly
2) Jaundice
3) Bilirubin gallstones
32
What are the clinical findings associated with intravascular hemolysis?
1) Hemoglobinuria
2) Hemoglobinemia
3) Hemosidinuria
33
What is the inheritance pattern of G6PD?
X-linked recessive
34
Outline the etiology of G6PD.
- Decreased G6PD
- Decreased NADPH
- Decreased reduced glutathione
- Oxidative injury
35
What are the PBS findings associated with G6PD?
Heinz bodies
Bite cells
36
What type of anemia is seen with G6PD?
Normocytic
37
What type of hemolysis is associated with G6PD?
Predominantly intravascular
****Note that this is different from the case presentation from class****
38
What is the most common source of a PE?
DVT
39
What is a "D-dimer?"
Fibrin solubility product
40
Aside from DVTs, what else can cause a PE?
1) Amniotic fluid embolus
2) Fat embolus
3) Hypercoaguable state
4) Cancer
41
What is the etiology of PV?
Polycythemia Vera= neoplastic proliferation of myeloid cells, esp. RBC
42
What mutation is associated with PV?
JAK2
43
What are the symptoms of PV?
Hyperviscosity Syndrome:
1) Itching with bathing
2) Headache
3) Blurred vision
44
What is a serious complication of PV?
Budd Chiari Syndrome
45
What is treatment for PV?
1) Phlebotomy
2) ASA
3) Hydroxyurea
46
How is PV distinguished from reactive polycythemia?
- PV= decreased EPO, SaO2 normal
- Reactive= low SaO2, increased EPO
47
What are the SaO2 and EPO findings associated with RCC?
Normal SaO2 and high EPO
48
What are the lab findings in PV?
1) High WBC
2) ALL myeloid cells are increased, more so of the 1 lineage affected
49