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Rezi FC > Hemato > Flashcards

Hemato Flashcards

1
Q

Simptome anemie

A

DispneeFatigabilitateAstenieCefaleePalpitatiiLipotimie

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2
Q

Semne anemie

A

PaloareTahicardieSuflu SISTOLICInsuficienta cardiaca

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3
Q

Semne specifice in diferite tipuri de anemie

A

Koilonichie (unghii concave) - feripriva de lunga durataIcter - hemoliticaDeformari osoase - talasemie majoraUlcere de membre inferioare - siclemie

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4
Q

Cazuri cu dimorfism eritrocitar

A

Deficite duble - fier si folat (boala celiaca)Dupa tratamentul adecvat al anemiei cu preparate hematinicePosttransfuzional

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5
Q

Utilizari lichid de aspiratie medulara

A

Morfologie celule hematopoieticeImunofenotipareInvestigatii citogeneticeMarkeri moleculariCultura microbiologica

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6
Q

Ce se evalueaza la biopsia osteomedulara

A

Celularitatea maduveiCelularitatea liniilor celulareMorfologia liniilor celulareTipul de eritropoiezaInfiltrarea medularaDepozitele de fier

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7
Q

Fe din dieta + procent absorbtie

A

15-20 mg/zi Fe in dieta10% se absoarbe20-30% absorbtie in deficit/sarcina

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8
Q

Cand este hepcidina scazuta?

A

AnemieHipoxieDepozite scazute de Fe

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9
Q

Gene care sufera mutatii in hemocromatoza

A

HFEHJVTfR2

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10
Q

Cazuri in care creste absorbtia fierului

A

Depozite scazuteSarcinaCresterea activitatii eritropoieticeSangerareHemolizaAltitudine mareHemocromatoza ereditara

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11
Q

Sideremie

A

13-32 mcmoli/LMai mare dimineata

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12
Q

Pierderi zilnice de Fe + cai de pierdere

A

0.5-1 mg/ziMaterii fecaleUrinaTranspiratie

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13
Q

Pierderi menstruale de sange si Fe

A

30-40 mL sange/lunaIn medie 0.5-0.7 mg Fe/ziPierdere > 100 mL sange/luna => deficit de Fe

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14
Q

Cand creste necesarul de Fe?

A

In perioada de crestere (0.6 mg/zi)Sarcina (1-2 mg/zi)

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15
Q

Cauze deficit de Fe

A

Pierderi de sangeAport redusCerere crescuta - crestere, sarcinaAbsorbtie redusa - post-gastrectomie

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16
Q

Tablou clinic feripriva

A

Unghii fragileKoilonichiePar fragilAtrofie de papile lingualeStomatita angularaDisfagie + glosita = sindrom Plummer Vinson/Peterson Brown Kelly

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17
Q

Ce cuprinde anamneza pentru feripriva?

A

AlimentatieSange in scaunAutomedicatie cu AINS+ la femei* Durata menstruatiilor* Aparitia cheagurilor* Numarul de absorbante/tampoane

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18
Q

Caracteristici paraclinice feripriva

A

Microcite (VEM < 80 fL)Hipocroma (HEM < 27 pg)PoikilocitozaAnizocitozaSTf < 19%Feritina scazutaNumar de receptori solubili ai Tf crescut

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19
Q

Feritina serica

A

Barbati30-300 mcg/L11.6-144 nmoli/LFemei15-200 mcg/L5.8-96 nmoli/L

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20
Q

Variante Fe parenteral

A

Fier dextran cu greutate moleculara micaFier sucrozaCarboximaltoza fericaIzomaltozida de fier 1000

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21
Q

Anemia din bolile cronice apare in

A

Boala CrohnPARLESPMRCancerTB

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22
Q

Cauze de anemie sideroblastica dobandita

A

Tulburari mieloproliferativeLeucemie mieloidaMedicamente (izoniazida)Consum necorespunzator de alcoolIntoxicatie cu PbPARCarcinoameAnemii megaloblasticeAnemii hemolitice

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23
Q

Medicamente care interfereaza cu sinteza ADN

A

HidroxicarbamidaHidroxiureeAZT

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24
Q

Surse B12

A

CarnePesteOuaLactateNU plante

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25
Q

Cantitate B12 in dieta zilnica + absorbtie + pierderi zilnice

A

5-30 mcg B12 in dietaSe absorb 2-3 mcgSe stocheaza 2-3 mg (ficat)Pierderi zilnice 1-2 mcg

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26
Q

Principalele cobalamine naturale au grupari:

A

DeoxiadenozilMetilHidroxi

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27
Q

In ce cazuri apare malabsorbtie de B12?

A

PancreatitaBoala celiacaTratament cu metformin

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28
Q

Tablou clinic AP

A

Icter + paloare = culoare galben-lamaieGlositaStomatita angularaNeurologic - degenerare combinata subacuta (disociatie tabetica)Polineuropatie periferica + afectare de cordoane medulare P + LParestezii simetrice degeteDementaTulburari psihiatriceHalucinatii, delirAtrofie optica

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29
Q

Cand apar anomaliile neurologice in AP?

A

B12 < 60 ng/L sau < 50 pmoli/LOcazional pot sa apara la pacienti fara semne clinice de anemie

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30
Q

Surse de folat

A

Legume verzi - spanac, brocoliOrgane - ficat, rinichi

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31
Q

Necesar zilnic de folat

A

100 mcg

32
Q

Ce vitamina se pierde prin gatire si cat?

A

Folatul - 60-90%

33
Q

Rezerva folat

A

10 mg

34
Q

Valoare folat seric si din eritrocite in deficit

A

< 3 mcg/L sau < 7 nmoli/L - folat seric< 150 mcg/L sau < 340 nmoli/L - folat in eritrocite

35
Q

Administrare hidroxicobalamina

A

1000 mcg (1 mg) i.m -> maxim 5-6 mg/2 saptApoi 1 mg la 3 luni - toata viata

36
Q

Raspuns la tratament in deficitul de B12

A

Ameliorare clinica - 48hReticulocitoza - 2-3 zile cu maxim in 5-7 zilePolineuropatia - trece in 6-12 luniDaca MS e afectata cronic => ireversibil

37
Q

Profilaxie cu folat la inceput de sarcina (doza)

A

400 mcg zilnic (de la conceptie pana in a 12a sapt inclusiv)5 mg inainte si in timpul urmatoarei sarcini daca au copil cu defect de tub neural

38
Q

Cauze patologice de macrocitoza normoblastica

A

AlcoolismHepatopatiiHipotiroidieReticulocitoza - hemoragii, hemolizaBoli hematologice - MM, anemie aplastica, mielodisplazie, aplazie eritroida puraMedicamente - AZT, hidroxicarbamidaAglutinine la rece

39
Q

Procese fiziopatologice in anemia din bolile cronice

A

Scade durata de viata a hematiilorScade eliberarea Fe din depozite (MO) pentru dezvoltarea eritroblastilorRaspuns inadecvat al eritropoietinei la anemie

40
Q

In ce anemii se poate folosi eritropoietina recombinanta?

A

BCRBoli inflamatorii (ocazional) - PAR, BII

41
Q

Modificarile megaloblastice apar in:

A

Deficit/metabolism anormal de B12Deficit/metabolism anormal de folatMielodisplazie prin diseritropoiezaDefecte de sinteza a ADNDeficite enzimatice congenitale ale enzimelor implicate in sinteza de ADN (acidurie orotica)Medicamente care interfera cu sinteza ADN (vezi flashcard)

42
Q

Cauze de deficit de B12

A

Aport dietetic redus - vegetarieniUtilizare anormala - deficit congenital de TC II, protoxid de azot (N2O) pentru ca inactiveaza B12Absorbtie deficitara* Stomac - anemie pernicioasa, gastrectomie, deficit congenital de FI* IS - patologie/rezectie ileala, suprapopulare bacteriana, sprue tropical, botriocefalozaMalabsorbtie* Pancreatita* Boala celiaca* Tratament cu metformin

43
Q

Cu ce boli se asociaza frecvent AP?

A

Boala tiroidianaBoala AddisonVitiligoIncidenta mai mare de cancer gastric (1-3%)

44
Q

Ce tipuri de Ac prezinta pacientii cu AP?

A

Ac anti-celula parietala prezenti la 90% pacienti (SENSIBILI) dar NESPECIFICI (10% din indivizii sanatosi au acesti Ac)Ac anti-FI prezenti doar la 50% pacienti dar sunt SPECIFICIAc anti-tiroidieni la 50% din pacienti

45
Q

LIN B12

A

160 ng/L

46
Q

Cauze de deficit de folati prin nutritie (cauza majora)

A

Dieta deficitara* Varstnici* Conditii sociale precare* Infometare* Alcoolism (utilizare deficitara de folat)AnorexiePatologie GI (gastrectomie partiala, boala celiaca)Boala CrohnCancerMedicatie antifolat* Anticonvulsivante - fenitoina, primidona* Metotrexat* Pirimetamina* Trimetoprim

47
Q

Cauze de deficit de folati prin utilizare excesiva

A

Fiziologic* Sarcina* Lactatie* PrematuritatePatologic* Boli hematologice cu productie excesiva de eritrocite (hemoliza)* Cancere (creste turnoverul celular)* Boli inflamatorii* Boli metabolice (homocisteinurie)* Hemodializa/dializa peritoneala* Malabsorbtie - boala intestinului subtire (efect minor comparativ cu anorexia)

48
Q

Cauze fiziologice de macrocitoza normoblastica

A

SarcinaNou-nascut

49
Q

RA tratament deficit de B12

A

HipoK -> suplimentare (daca este severa)Deficit de Fe in primele cateva saptamaniHiperuricemie (dar guta e rara)

50
Q

Cauze variate de anemii hemolitice dobandite

A

Toxice - arsenic, toxinele produse de C. perfringens (welchii)MalarieHipersplenismArsuri extinseMedicamente - dapsona, sulfasalazinaChimicale - erbicide (clorat de sodiu)

51
Q

Cauze de distrugere non-imuna a eritrocitelor

A

Defecte membranare dobandite - HPNFactori mecanici - proteze valvulare, anemie hemolitica microangiopaticaSecundar unor patologii sistemice - boli renale, boli hepatice

52
Q

Clasificare AHAI in functie de temperatura la care se ataseaza Ac de eritrocite

A

La cald - 65%La rece - 30%Mixte - 5%

53
Q

Cauze secundare de AHAI la rece

A

MNI (EBV)Infectie cu M. pneumoniaeInfectii virale rare - CMVLimfoameHPR (cu IgG)

54
Q

Cauze secundare de AHAI la cald

A

Boli reumatice - LESLimfoameLimfom HodgkinLLCCarcinoameMedicamente* Penicilina* Cefalosporine* IFN* AINS* Chinina* Metildopa

55
Q

Cand este testul Coombs direct pozitiv?

A

Sensibilizarea eritrocitelor IN VIVOAHAIBHNN (eritroblastoza fetala)Reactii transfuzionaleAH post-medicamentoasa

56
Q

Cand este testul Coombs indirect pozitiv?

A

Sensibilizarea eritrocitelor IN VITRODepistare Ac iregulariProba de compatibilitate intre eritrocitele donatorului si serul primitorului (screening pre-transfuzie)

57
Q

Cauze de anemie hemolitica microangiopatica

A

HT malignaEclampsieVasculitaSHUPTTCID

58
Q

In AHAI la cald Coombs este pozitiv pentru:

A

IgG + C (56%)IgG (35%)C (9%)

59
Q

Cu ce boli se asociaza HPR?

A

OreionVaricelaRujeola

60
Q

Specificitatea anticorpilor din AHAI

A

AHAI la cald - pentru sistemul Rh (ex: antigenul e)CHAD - pentru sistemul grupelor sangvine (antigenul I si ocazional i)HPR - antigenul P

61
Q

Ce conditii pot precipita HPN?

A

InfectiiOperatiiTerapia cu Fe

62
Q

Administrare eculizumab in HPN

A

Primele 5 saptamani - i.v o data la 7 zileApoi o data la 2 saptamani

63
Q

Beneficii eculizumab in HPN

A

Reduce hemoliza intravascularaReduce hemoglobinuriaReduce necesarul transfuzionalCreste calitatea vietiiScade riscul tromboticSe poate utiliza in sarcina

64
Q

Risc eculizumab

A

Blocarea completa a complementului in caz de infectie cu meningococ => se face vaccin anti-meningococ cu 2 saptamani inainte de a incepe terapia

65
Q

Optiuni terapeutice in HPN cu aplazie medulara

A

CiclosporinaImunosupresoare cu globulina antilimfocitaraTransplant medular

66
Q

Simptomele clinice majore in HPN

A

HemoglobinurieHemoliza intravascularaTromboza venoasa

67
Q

Cauza primara de mortalitate in HPN

A

Tromboza venoasa

68
Q

Ce alte antigene mai sunt in sistemul Rh pe langa D?

A

ceEKellyDuffyKidd

69
Q

Cand poate avea loc sensibilizarea mamei (in afara de nastere)?

A

Avort spontanSarcina ectopicaTransfuzii sangvineEpisoade din timpul sarcinii care determina hemoragie transplacentara:* Amniocenteza* BVC* Iminenta de avort

70
Q

Cand apar manifestarile in incompatibilitatea Rh si care sunt?

A

Din saptamana 18Hidrops fetal* HSmegalie* Edem* IC

71
Q

Cand apare icter nuclear?

A

Bi > 250 mcmoli/L postpartum

72
Q

Anticorpii semnificativi din punct de vedere clinic in sarcina

A

Anti-DAnti-cAnti-K

73
Q

Sangele utilizat in EST ar trebui sa fie

A

Compatibil ABO pentru mama si fatFara antigenul impotriva caruia e indreptat Ac maternProaspat (maxim 5 zile)Iradiat (previne GVHD)

74
Q

Doza IgG anti-D postnatal la mame NEimunizate

A

500 UI, i.m, in primele 72h postnatal

75
Q

Profilaxie antenatala mama sensibilizata prin avort/iminenta de avort/SE

A

250 UI inainte de S20 + 500 UI dupa S20 + test Kleihauer dupa S20

76
Q

Profilaxie antenatala la femei NEimunizate

A

Doza dubla = 500 sau 1500 UI - una in S28 si una in S34SAUDoza unica = 1500 UI in S28 sau intre S28 si S30

77
Q

Dupa ce tipuri de transplant poate aparea anemie hemolitica alloimuna?

A

MOFicatRinichiCordIntestin

Rezi FC (29 decks)

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