flex case (anemia & thrombocytopenia) Flashcards by IFUNANYA CHRIS-UKAH

causes of anemia

RBC loss
impaired production (hypoproliferative)
increased destruction

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what is the issue with secondary hemostasis?

clotting factors

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what lab to get for primary hemostasis

CBC

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what lab to get for secondary hemostasis

PT/INR
aPTT

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what type of bleeding do you see with primary hemostasis

petechiae, mucosal

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what type of bleeding do you see with secondary hemostasis?

hemarthrosis, hematomas, ICH, GI bleeds

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which type of hemostasis is epistaxis and menorrhagia common?

primary hemostasis

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which 4 factors are involved in the intrinsic pathway

8, 9, 11, 12

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extrinsic pathway factors (1)

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which factors/proteins are vitamin K dependent? (6)

2,7,9,10
protein C & S

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what is the most common bleeding disorder? (hint: autosomal dominant d/o)

vWD

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what kind of bleed do you see with vWD?

primary hemostasis

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why might you see hemarthroses with vWD?

bc factor 8 is involved

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2 things you need to diagnose vWD?

vWF antibodies
factor VIII activity

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with vWB you have prolonged bleeding time but normal platelet count, why?

bc the issue isn’t the platelets itself, the issue is with the factor

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3 sx of hemophilia

hemarthoses
hematomas
ICH

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two labs you need to diagnose hemophilias

aPTT
factor levels

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hemophilia A is a deficiency of which factor?

factor 8

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hemophilia B is a deficiency of which factor?

factor 9

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how do you treat hemophilia?

replace the missing factor

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how do you treat vWD?

DDAVP if its type 1 or 2
Humate P or alphate if unsure (replacement therapy)

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how does DDAVP work?

causes release of immobilized vWF; its an analog of ADH

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4 microcytic anemias (TICS)

thalassemia
iron deficiency
chronic (30%)
sideroblastic

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3 sx of iron deficiency anemia

pica
heavy menses/blood loss
melena

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3 things to diagnose iron deficiency anemia

low iron low ferritin HIGH TIBC

sx of thalassemia (A vs B)

A-- variable sx (mild to fetal death) B-- sx start at 4-6 mo old

5 things to diagnose thalessemia

LOW MCV Dx w/ Hg normal iron stores splenomegaly electrophoresis

how is thalessemia treated?

iron chelation transfusions bone marrow bx is curative

what is thalessemia

diminished or absent synthesis of globin chains

3 lab values for anemia of chronic dz diagnosis

Low iron & TIBC high ferritin high ESR/CRP

what do you give to someone in renal failure with anemia of chronic dz?

EPO

how is sideroblastic anemia diagnosed (3)

sideroblasts basophilic stippling lead level

how is sideroblastic anemia treated?

chelate lead

in all anemias, what do you do when Hg is <7?

TRANSFUSION!!!

what is anemia of chronic dz

RBC survival reduction and increased hepcidin bc of inflammation which blocks iron release and mobilization

what is ferritin

it is an acute phase reactant often elevated in response to inflammation iron storage

why is iron low in anemia of chronic dz?

not being used by bone marrow or marrow isn't responding to erythropoietin

name the two macrocytic anemias

vitamin B12 deficiency folate deficiency

which tends to have a lower MCV-- iron deficiency or thalessemia

thalessemia (60s)

which anemia tends to be seen in vegans, ppl who drink, malabsorption and has neurologic sx?

vitamin B12 deficiency

MMA & homocysteine differences in B12 and folate deficiencies

B12-- HIGH MMA & homocysteine folate-- normal MMA & HIGH homocysteine

why is folate deficiency not seen much with absorption issues?

it is absorbed throughout the entire GI tract

pernicious anemia is a subset of what anemia?

vit B12 deficiency anemia

which anemia is caused by lack of intrinsic factor or anti-intrinsic factor antibodies?

pernicious anemia-- common in older age

if a patient has classic anemic sx + jaundice or splenomegaly, what type of anemia should you suspect?

hemolytic anemia

level of retics in all hemolytic anemias

high (>2%)

LDH and bilirubin levels in all hemolytic anemias

HIGH (markers of hemolysis)

name the 3 hereditary hemolytic anemias

sickle cell hereditary spherocytosis G6PD deficiency

what is sickle cell anemia

splenomegaly-- sequestration and destruction of abnormally shaped cells

how is sickle cell diagnosed?

Hg-S on electrophoresis

how is hereditary spherocytosis diagnosed?

spherocytes on blood smear

how is hereditary spherocytosis treated?

based on severity, supportive to splenectomy (the definitive treatment)

what is G6PD deficiency?

an x-linked recessive (males) enzyme deficiency

how is G6PD diagnosed

heinz bodies on blood smear

how is G6PD treated?

avoid oxidative drugs and fava beans

what is aplastic anemia?

bone marrow damage causing pancytopenia

what would a bone marrow bx show in aplastic anemia?

fat cells!

causes of aplastic anemia

meds chemo/radiation benzene

which two meds did we say causes aplastic anemia

sulfa chloramphenicol

how is aplastic anemia treated?

based on severity- transfusion, transplant

two conditions that have pancytopenia that we talked about

MDS/cancer aplastic anemia

5 conditions with increased risk of thrombosis (prothrombotic) & familial

Factor V Leiden Prothrombin Gene Mutation Protein C,S Deficiencies Antithrombin III Deficiency Antiphospholipid syndrome (APS)

name 4 thrombocytopenias

ITP TTP HUS DIC

what is the most common thrombocytopenia

ITP

which thrombocytopenia is post viral and no systemic illness?

ITP

does ITP have spont. hemarthroses?

Nope

3 sx of ITP

mucosal or skin purpura epistaxis oral bleeding

expected labs with ITP

low platelets with other labs normal

how is ITP treated?

its self limited use steroids if platelets <50k IVIG

which thrombocytopenia would show schistocytes?

TTP

sx of TTP

sick, fever hemolytic anemia/thrombocytopenia/renal insuf mental status changes

expected labs with TTP

high LDH low haptoglobin; normal coags coombs negative

how is TTP tx? (2)

plasma exchange steroids (+/-) its fatal if not treated

causes of DIC

sepsis trauma/burn pregnancy complication cancer liver dz

which thrombocytopenia involves overactivating clotting system that depletes factors?

DIC

3 things you need for DIC diagnosis

prolonged PT, PTT (coag factors impaired) low fibrinogen elevated D-dimer

how is DIC tx?

underlying cause, replace consumed factors, blood products

typical patient with HUS

kid who ate raw meat and likely has an ecoli shigatoxin infection

2 sx of HUS

diarrhea neuro involvement in some

how is HUS diagnosed? (3)

renal failure (high creatinine) hemolytic anemia normal coagulation

how is HUS tx? (2)

steroids FFP

flex case (anemia & thrombocytopenia) Flashcards

(81 cards)