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Flashcards in hematologic Deck (33):
1

anemia

-is a sign, not a dz
-correct us of tests is paramount
- dx of iron deficiency anemia --> locate the etiology

2

morphologic approach to anemia

micro- MCV 100
folic acid, ETOHic, liver disease

normocytic- MCV 80-100
- anemia of chronic dz
-anemia of chronic renal failure
-multifactorial anemia

RBC destroy after 120 days- hemolysis in the spleen

retic count: baby RBC cells, increase to erythropoeitein
- help evaluate bone marrow function


kinetic approach:
low retic count- problem in marrow, lack of nutrients
bone marrow suppression

high retic count- blood loss, hemolytic anemias, sick cell, autoimmune, drug-induced , thallassemias

check WBC and plts
if low retic- acute blood loss
renal dz, drug effects

low plts and low WBC- sign bone marrow failing
leukemia, myelosuppresion, TB in marrow

3

iron metabolism

serum iron is free
TIBC- how hungry is our blood for iron.

ferritin- stores iron in liver and RES.

red cells get iron from transferrin and gets incorporated into heme
-

4

signs of iron deficiency-most common cause of anemia

-spoon nails
-glossitis
-esophageal web- Plummer-Vinson syndrome
-restless legs , check ferritin
-pica- chewing ice
-hair loss

etiology: bleeding, GI bleed, cancer, menses, blood donation, growth periods, pregnancy, lactation, gastric surgery, malabsorption, calcium inhibits GI

tx: oral iron :
ferrous sulfate 325 mg bid
-constipaion
-6-8 weeks to recheck level
-vitamin C helps
-IV iron -check ferritin in 3-4 weeks

5

sickle cell

substitution of AA valine from glutamic to form beta s globin. Hbs
-8-10% AA carry gene
-use hemoglobin electrophoresis to dx
( presence of Hbs, higher levels of HbF)
- autosomal recessive

pathophys: deoxygenated hb s polymers causes sickling and damage to membrane

disease: functional splenic ( trivalent vaccine to prevent infections)

6

sickle cell trait

-no symptoms
-high O2 demand/ dehydration states can develop crisis
- over years can have microinfarts causing kidney damage/cardiac damage

7

sickle cell anemia

chronic hemolysis
-moderate anemia
-reticulocytosis
- elevated t.billi
-incr endothelial
RF: if hgb > 8.5- more crisis
pregnant pt
cold weather
high altitude

CHF/cardiac problems.

8

acute sickle cell crisis

-caused by stress syndrome
-last 1-2 weeks
fever, elevated WBC, acute chest syndrome ( infants, wheezing)
exchange transfusion
- splenic sequestration (LUQ--> hypovolemia, emergecny splenctomy)
-bone infarcts
-asvascular necrosis

-oxgyen, hydrate, and pain meds.

-get strep pneumo/ H.fu
-leg ulcers
-parvoviru 19-fatal
hand/ foot syndrome

maintenance: chronicle followed with CBC, given folic acid,
screening transcranial dopplers, retinal exams, multivalent vaccine

9

Beta-thalassemia trait

mild-mod anemia
- hgb: 9-11
-mishapen cells

-no sxs
-don't give erythropotein

10

beta thalassemia major

-sever anemia
-infants: develop anemia in first weeks
-cardiac stress, hepatosplenomegaly, chipmunk facies ( bone deformity)
tx: allogenic bone marrow transplant

11

alpha thalassemia syndromes

alpha thalassemia 2 trait- loss of 1/4 alpha globin genes
- no abn MCV

alpha thalassemia-1 trait (minor)- loss of 2/4 alpha globin genes
- mild anemia, MCV is often

12

Anemia of chronic dz

-reduction is RBC production in bone marrow
-ferritin increased
-iron not available to make new hemoglobin
-low serum iron, TIBC is low, low iron saturation, normal or elevated ferritin

causes: chronic UTI, BC
met cancer, chronic leukemia, RA, UC, thyroid , DM

dx: hgb 8-10
retic count-low
reduced iron and and low TIBC, elevated ferritin

exclude renal failure

tx: manage underlying dz
-EPO
-only given iron if iron deficiency
-transfusion for acute issue

13

acute variant anemia

- infection, MI
after surgery, major trauma

low serum iron
-high ferritin

14

hemolytic anemia

caused by premature breakdown of RBC
-severity of anemia related to rate of RBC destruction and ability of bone marrow produce reticulocytes

s/s: acute pallor
splenomegaly
jaundice
-incr LDH
-low haptoglobin
-incr. retic

15

hereditary spherocytosis

forms spheroctic cells are destroyed on spleen.

s/s: splenomegaly and jaundice
dx: on blood smear

tx: splenectomy but vaccinate

16

G-6-PD deficiency

RBC depend on anaerobic metabolism

10% black have this

bite cells and Heinz bodies

fauvism: -ingestion of Fava beans cause problems in patient

17

aplastic anemia

-pancytopenia
-rx: hematopoietic cell transplant of HLA compatible

-cyclosporine
-supportive
-IVIG- help immune sysmtpe
ATG-immunosuppresan

causes: chemo tx and rad tx

18

megaloblastic anemia

ETOHism elevated MCV
- vitamin b12 low
-folic acid deficiency
-chemo tx

19

b 12 defieicny

-s/s: neuro sxs
-tx with folic acid will improve anemia

elevated MMA

homocysteine elevated in both b12 and folate deficiency

s/s: dementia, depression,

tx; SQ B12 7 days , 7 weeks, and then mostly

orally: 1-2 mg daily

20

pernicious anemia

-autoimmune gastritis
-attack on gastric intrinsic factor
-incr riskigastric cancer
- 25% autoimmune thyroid disorders

Labs: RBC show macrocytosis ( MCV> 100)

21

folic acid deficient

caused by nutritional deficiency, ETOH abuse, malnutrition

s/s: like pernicious anemia

dx: serum folic acid love

tx: 1 gm daily supplement

all child-bearing ladies should take .4 mg

22

ITP

-idiopathic, autoimmune

s/s: petechial hemorrhage, mucosal bleeding and thrombocy
Plt count

23

TTP

-rare, severe infection, HIV, plalvix

FAT RN
F-evere
A- anemia
T-thrombocytopenia
R-renal impairment
N-neurologica

tx: plasmapheresis

24

Von Willebrand

4 types
- most common bleeding disorder

labs : PTT and BP slightly elevated
VWF levels are low

s/s: mucosal bleeding

tx; DDAVP, plt transfusion, factor IX

25

hemophilia

hemophilia A- affect mailes
- defective clotting factor
-PTT prolonged
dx: quant/qual fictive VII test
tx; mild DDVAP

hemophilia B: Christmas tree
- factor IX
dx: quant IX tes
tx: replace IX concentrate

26

factor xi deficiency

ashkenazi jewish
-bleeidng after trauma
-very rare
tx with Factor XI

27

DIC

systemic- thrombosis and hemorrhage

- d/s results from;
tissue damage, burns,
sepsis, severe allergic reaction

-can be seen by pancreatic cancer



tx: blood thinners or tx bleeding ( FFP, plt transfusion)

check fibrinogen level daily

28

Acute leukemia

RF: rad tx, chemo, down syndrome, organic solvents

ALL-
kids 3-5
-20% leukemia, most are kids
- philadelphia chromosome ( incr risk for patients)
TX: induction chemotherapy X 2 years and then trasplan
cure rate high

AML- age 60
-auer rods from myeloid granules
labs: higher WBC ( 100, 000, leukophoresed)
TX: induction chemo, stem cell transplant if failed relapse

sx: bone marrow failure
( infection, bleeding, sepsis)

29

CLL

-most common leukemia
- age 60
-therapy only if recurrent infection, double of WBC,
tx: chemo and rad tx

30

CML

-chromosone 22
-can remain in chronic phase ( wBC 20-100, 00)
- plastic crisis> 20% blasts

tx: Gleevec is new tx
-80-85% go to remission
life long

labs: WBC
elevate basophils and e

31

multiple myeloma

- accumulation of plasma cells in bone marrow or visceral soft tissue
- sxs: CRAB
C-caclium elevation
R-renal insufficiency
A- anemia BM suppression
B-bone lytic lesions

dx: 1 major and 1 minor
major-
tx: incurable (2-7 years) stem cell transplant
decahedron
chemo tx
monitor closely for infections

32

NHL

- incr age and males
- chronic immunosuppression
-chemo /rt
-chronic infections ( EBV, mono, HIV, Hpylor, HHV)
-SLE, RA

s/s: weight loss, painless lymph nodes, night sweats, fever, pruritus, chest/ pain
dx: CT, PET
elevated WBC, LDH
bx nodes

tx: chemo/ rad tx
Rituxan
stem cell transplant

33

hodgkins lymphoma

younger men and older men
-HIV, fix
-head and neck nodes
-weight loss
-prutis

dx: LN bx with Reed Sternberg cells, high LDh
-imaging -bulky LAD, orderly spread

B-sx -night sweats

course: indolent or aggressive

tx: chemo, rt, stem cell for refractory dz

px: good , 75% curable