Fatigue DSA + Reading

Question 1

What hemotologic causes of fatigue are specific to dyspnea?

Answer 1

anemia

lymphadenopathy

malignancy

Question 2

What do telangiectasias suggest?

Answer 2

connective tissue dz or hereditary hemorrhagic telangiectasia

Question 3

What is the best test to run to work-up anemia?

Answer 3

reticulocyte count

Question 4

What are the five general defects causing decreased reticulocyte count and anemia?

Answer 4

defects of stem cells (aplastic anemia)

proliferation/distribution defects of erythroid progenitor cells (chronic kidney dz)

disturbances of DNA synthesis (megaloblastic anemia)

disturbance of hemoglobin synthesis

unknown or multiple mechanisms (chronic dz, marrow infiltration)

Question 5

What labs will you see in iron deficiency anemia?

Answer 5

mucrocytic hypochromic anemia

low iron and ferritin

increased TIBC

Question 6

How do you treat anemia of chronic dz?

Answer 6

(iron supplementation is NOT effective)

supportive care if anemia is mild (Hb 10-12)

if severe, transfusions may be helpful

Question 7

What is factitious anemia

Answer 7

autophlebotomy

underlying psych issue

Question 8

What is march hemoglobinuria?

Answer 8

feet striking ground repeatedly damages RBCs in capillaries on soles of feet –> pee blood the next morning

Question 9

What is cardiac anemia?

Answer 9

pts w/ severe aortic stenosis and pts w/ prosthetic valves –> get lysis of RBCs –> mild anemia

Question 10

What do you see on smear of G6PD deficiency?

Answer 10

heinz bodies - denature hb

Bite cells - denatured hb removed by spleen

anemia - normochromic

Question 11

How does lead cause anemia?

Answer 11

interferes w/ cation pump - shortened RBC survival time

inhibits ferochelatase –> buildup of protoporphorin and decr heme synthesis

inhibits ALAD –> buildup of ALA

Question 12

What is the most common cause of hemolytic anemia worldwide?

Answer 12

malaria

Question 13

What types of Immunoglobulins cause cold and warm immune-mediated hemolytic anemia?

Answer 13

(its always warm in Georgia, its cold in minnesota)

IgG –> warm

IgM –> cold

Question 14

What is the main tx for Immune-mediated hemolytic anemia?

Answer 14

high-dose steroids

can use transfusions if needed

cyclophosphamide and azathioprine if refractory

splenectomy if chronic

Question 15

What are the sx of polycythemia vera?

Answer 15

facial rubor

hyperviscosity signs - HA, dizziness, blurred vision, heaviness in arms or legs

pruritis w/ hot shower/bath

splenomegaly (frequently involved in extramedullary hematopoiesis in spent phase)

Question 16

What are the risks of polycythemia vera?

Answer 16

w/out tx –> thrombotic complications (budd-chiary syndrome)

usual cause of death in treated pts is progressive marrow fibrosis w/ pancytopenia (spent phase)

Question 17

What do you have to rule out when evaluating someone with polycythemia vera?

Answer 17

abnormal lung function (smokers often have elevated carboxyhemoglobin)

interstitial lung dz - would see decreased DLCO

Question 18

What mutation is associated w/ polycythemia vera?

Answer 18

JAK-2

w/ normal serum EPO, ID’s 98% of P. vera pts

Question 19

How do you tx p. vera?

Answer 19

phlebotomy of 250-500 cc every 1-2 weeks as long as Hct > 50%

usually keep doing this every 6-12 weeks

can use hydroxyurea

Question 20

What is the risk of using alkylating agents to tx P. vera?

Answer 20

therapy-related leukemia

Question 21

What sleep disorder should be considered w/ cc of fatigue?

Answer 21

obstructive sleep apnea

Question 22

What drugs are commonly associated with fatigue?

Answer 22

antidepressants

antipsychotics

anxiolytics

opiates

antispasticity and antiseizure agents

beta blockers

Question 23

What is chronic multisymptom illness?

Answer 23

gulf-war syndrome

prominent fatigue is noted in presentation

Question 24

Why should you do a formal neuro exam when working up fatigue?

Answer 24

to rule out objective muscle weakness

Question 25

What is performance status grading and what is it used for?

Answer 25

used to establish extent of a pt’s disability, often to see if ppl will be tolerant of cytotoxic chemo