EXAM #3: COMMON HEMATOLOGIC PRESENTATIONS Flashcards Preview

Hematology and Oncology > EXAM #3: COMMON HEMATOLOGIC PRESENTATIONS > Flashcards

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

What is the full differential for a patient with macrocytic anemia not attributable to folate or B12 deficiency?

1) Hypothyroidism
2) Liver Disease
3) Alcoholism
4) Myelodysplastic Syndrome