Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CPD > Hematology 1 > Flashcards

Hematology 1 Flashcards

(69 cards)

Start Studying
1
Q

What are 4 possible mechanisms of developing anemia?

A

Blood loss (acute or chronic)
Decreased absorption
Deficient erythropoesis
Excessive Hemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some risk factors of anemia?

A

dietary deficiencies, menstruation, gastric ulcer, blood in stool, pregnancy, lactation, hemoglobinopathies, alcoholism, prescription drugs, cancer, rheumatic disorders, chronic inflammatory disease, COPD, CHF, heart disease heart valve, marathon running

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are symptoms of anemia?

A

most occur only if anemia is severe
Weakness, fatigue, seeing spots, drowsiness, syncope, angina, SOB, DOE. May also see vertigo, HA, tinnitus, pica, restless leg syndrome, amenorrhea or menorrhagia, loss of libido, and GI complaints.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are important signs in PE to assess for anemia?

A

Blood pressure - supine, seated and standing (orthostatic)
Inspect conjunctiva, lines of palms, mucus membranes, skin color - pallor
Inspect nails for blueness, ridges, spooning, poor nutrition
Cardiovascular exam - increased heart rate, murmurs,
Splenomegaly
peripheral neuropathy
abdominal distention
petechiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some tests that could be done to assess anemia?

A

Stool occult blood test
CBC with peripheral smear to help differentiate deficient RBC production from excessive RBC destruction
Iron, ferritin, TIBC if CBC or sxs warrant
TSH, free T4 (fatigue, menstrual complaints)
Serum bilirubin, LDH (elevated in hemolysis); if anemia is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is microcytic anemia? Some causes?

A

MCV <80 fL
Altered heme or globin synthesis from:
Iron deficiency, thalassemia, and Hb-synthesis defects, copper deficiency, zinc poisoning, lead poisoning, alcohol.
MB seen in anemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is macrocytic anemia? Causes?

A

MCV > 95 fL
Impaired DNA synthesis from:
B12, folate deficiencies, chemotherapeutic agents, alcoholism, HIV anti-retroviral agents, myelodysplastic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What could cause normocytic anemia?

A

deficient EPO, hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do elevated reticulocytes indicate? What about decreased reticulocytes?

A 
elevated = excessive RBC destruction
decreased = low RBC production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why would you see RBC fragments, ovalocytes, or schistocytes in smear?

A

RBC injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is meant by anisocytosis? Poikilocytosis?

A

Anisocytosis: RBCs of excessive variation in size are present

Poikilocytosis: RBCs of excessive variation in shape are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would be some indications for ordering bone marrow aspiration and biopsy?

A 
Unexplained anemias
Other cytopenias
Unexplained leukocytosis
Thrombocytosis
Suspected leukemia, multiple myeloma, or myelophthisis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What lab result would indicate deficient erythropoesis? What are examples of anemias caused by deficient erythropoesis?

A

Seen by decreased reticulocytes (Reticulocytopenia)

Microcytic
- iron deficiency anemias
- iron-transport deficiency anemias
- iron-utilization anemias
- thalassemias
Normocytic
- bone marrow failure
Macrocytic
- B12, folate deficiencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common anemia?

A

Iron deficient anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some symptoms of severe iron deficient anemia?

A

pica, glossitis, cheilosis, concave nails, increased heart rate, dyspnea, restless leg syndrome, glossal pain, reduced salivary flow leading to dry mouth, atrophy of tongue papillae, cheilosis, and occasionally, alopecia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where is the GI is iron absorbed?
What percentage of iron is absorbed?
What is the daily requirement of iron?
How is non-heme iron absorbed?

A

Absorbed in stomach, duodenum and upper jejunum
about 1mg of every 15mg is absorbed
daily requirement - 25 mg/day
Absorbed best as heme iron (meat products)
Non-heme iron must be reduced and unbound from other food molecules (gastric secretions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What helps iron absorption? What hinders iron absorption?

A

Ascorbic acid increases non-heme iron absorption
Reduced absorption by antacids, plant phytates (wheat, cereals), tannins (black tea), lead and malabsorption disorders such as achlohydria, atrophic gastritis, Helicobacter pylori gastritis, SIBO, gastric bypass, and celiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is iron stored in the body?

A

Ferritin – liver, bone marrow, spleen, RBCs, and serum

Hemosiderin – Liver, marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the causes of iron deficient anemia in men? in women? and in children?

A

MEN - chronic bleed (colon cancer, colitis, PUD, ASA use)
WOMEN - menstruation, repeated pregnancy
CHILDREN - growth spurts
Also due to chronic vascular hemolysis, post gastrectomy, malabsorption, under nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some labs that would help diagnose iron deficient anemia?

A
  • Stool Occult blood (Men, post-menopausal women, women with normal menses)
  • Iron absorption test (fasting serum iron level is compared to a second serum iron level obtained one to four hours following oral ingestion of one 325 mg tablet of iron sulfate - Should increase at least 100 microg/dL if absorption is normal
  • CBC with peripheral smear - LOW Hb, Hct, RBC, MCV, and HIGH RDW
  • serum iron - LOW
  • iron-binding capacity - HIGH
  • serum ferritin - LOW
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is sideroblastic anemia?

A
  • Inadequate or abnormal utilization of marrow iron, in spite of adequate stores
  • Usu part of myelodysplastic syndrome, hereditary or secondary to drugs or other toxins. Reversibly if dt alcoholism, copper deficiency (zinc excess), drugs or hypothermia
  • Also may occur in hemoglobinopathies (thalassemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is sideroblastic anemia diagnosed (lab results)?

A
  • CBC - microcytic, high RDW
  • serum iron - HIGH
  • transferrin - HIGH
  • ferritin - HIGH
  • peripheral smear - anisocytosis,
  • BM biopsy - erythroid hyperplasia

*Check serum lead concentration if cause is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some causes of anemia of chronic disease?

A 
infectious
inflammatory
neoplastic disease
severe trauma
heart failure
diabetes mellitus
anemia of the elderly
acute/chronic immune activation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are labs done to diagnose anemia of chronic disease?

A

CBC - (Hb usually 10-11, normo/microcytic, normo/hypochromic, RDW normal early)
peripheral smear
Iron values are normal unless underlying deficiency
ESR and CRP if underlying cause is unknown
EPO maybe depressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is hypoproliferative anemia?
Low marrow activity due to lack of EPO or inability of marrow to respond to it Associated with renal disease Also associated with hypo metabolic/endocrine deficiency states: hypothyroidism, hyperthyroidism, panhypopituitarism, and primary or secondary hyperparathyroidism
26
What are some causes of aplastic anemia?
genetic or acquired - Chemical exposure: drugs, pesticides, industrial chemicals, benzenes, anti-cancer agents (unknown mechanisms) - Infections such as Parvo-B19, HIV, hepatitis, EBV - Genetic inability to clear toxicity via glutathione S-transferase - Fanconi’s anemia – rare type of inherited aplastic anemia - Pure red cell aplasia due to infections, thymomas, immune system injury, fertilizer exposure, B2 deficiency, CLL
27
What would be some SSxs of aplastic anemia?
- Anemia: pallor, tachycardia, fatigue, dizziness - Thrombocytopenia: petechiae, ecchymosis, bleeding from gums, ocular fundi, other tissues - Agranulocytosis: life-threatening infections * Suspect in (particularly young) pts with pancytopenia (WBCs <50,000/µL)
28
What lab values are associated with aplastic anemia?
``` Low RBCs Low WBCs Low platelets Low reticulocytes High iron Acellular bone marrow ```
29
What is myelophthisic anemia?
Marrow is replaced by a tumor, granuloma, lipid storage diseases, or fibrosis Causes fatigue, night sweats and bone pain, and possible spenomegaly
30
What lab values would you see with myelophthisic anemia?
marked anisocytosis and poikilocytosis nucleated red cells in the blood Immature myeloid cells in the blood Bone marrow biopsy is definitive (refer)
31
What are some causes of macrocytic anemia?
High MCV due to defective DNA synthesis | Caused by alcoholism, B12 deficiency, folate deficiency, cytotoxic drugs, hypothyroid, liver disease
32
What is megaloblastic anemia?
Term given to anemia due to B12 or folate deficiency - Folate deficiency is much more common than B12 deficiency
33
What are causes of B12 deficiency?
Gastric abnormalities - pernicious anemia, gastrectomy/bypass surgery, gastritis, autoimmune SI disease - malabsorption, ileal resection/bypass, Chrohn's Pancreatitis - pancreatic insufficiency Diet - strict vegans, vegetarian during pregnancy Agents that block absorption - neomycin, biguanides, PPIs, N2O anesthesia
34
What are some causes of folate deficiency?
Nutritional deficiency - substance abuse, alcohol, poor diet, overcooked foods, depression Malabsorption - Celiac, IBD, infiltrative bowel disease, short bowel syndrome Drugs - methotrexate, trimethoprim, EtOH, phenytoin Increased requirement - pregnancy, chronic hemolysis, exfoliative dermatitis
35
What are SSxs of macrocytic anemia?
``` Usually none until severe Neuro signs - neuropathy, dementia Glossitis Diarrhea Muscle wasting ```
36
What are labs associated with macrocytic anemia diagnosis?
``` MCV > 95-100 Anisocytosis (high RDW) Poikilocytosis Howell Jolly bodies Hypersegmented PMNs Neutropenia (late) Vitamin B12 and folate levels to determine cause - inaccurate ```
37
What are different causes of intrinsic hemolytic anemia?
Abnormal RBC membranes RBC metabolic disorders Hemoglobinopathies
38
What are extrinsic causes of hemolytic anemia?
``` Hypersplenism (traps RBCs) Toxic exposures (oxidants) Autoimmune Mechanical injury (prosthetic valves, DIC, TTP) Infections (malaria, C. perferingens) ```
39
What are typical SSxs associated with hemolytic anemia?
acute hemolytic crisis presents with fever chills, back/abdominal pain, prostration, shock severe hemolysis presents with jaundice and splenomegaly, and maybe cholelithiasis
40
What labs/PE findings would make you suspect hemolytic anemia in a patient?
``` Anemia Splenomegaly Jaundice Elevated reticulocytes Spherocytosis Elevated Bilirubin Elevated LDH ```
41
What is autoimmune hemolytic anemia? What are the different types?
Body makes antibodies to its own RBCs | Can be 'warm' or 'cold' based on temperature of body that induces Ab formation
42
What are the difference causes of warm and cold AIHA?
``` WARM - most common - Abs react at temperatures > 37C - viral infections - immune deficiency - drugs - SLE - lymphoma - CLL - spontaneous/idiopathic COLD - Abs react at temps < 37C - infections (M. pneumonia) - lymphoproliferative states - 50% are idiopathic/chronic **May see acrocyanosis, Raynoaud;s levido reticularis, scleral icterus, splenomegaly ```
43
What test is done to diagnosis AIHA?
Coombs - dierect antiglobulin test - Ab patterns determine warm vs cold
44
What is hereditary spherocytosis?
Intrinsic hemolytic anemia | Autosomal dominant congenital red cell membrane defect leading to hemolysis of spherical RBCs causing anemia
45
What is hereditary elliptocytosis?
Intrinsic hemolytic anemia | RARE autosomal dominant congenital red cell membrane defect causing oval or elliptical RBCs leading to anemia
46
What are the SSxs associated with spherocytosis/elliptocytosis?
``` Anemia Jaundice Hepatomegaly Splenomegaly Cholelithiasis ```
47
What labs are associated with the diagnosis of spherocytosis/elliptocytosis?
``` PB smear - spheroidal or oval RBCs Anisocytosis Normal/low MCV Elevated MCHC (hyperchromic) Elevated reticulocytes Elevated leukocytes Elevated LDH Elevated bilirubin Decreased haptoglobin ```
48
What is stomatocytosis?
Rare congenital or acquired (excessive EtOH) RBC membrane disorder causing increased fragility and anemia (splenomegaly/jaundice)
49
What is hypophosphatiemia?
Low phosphate depletes RBC ATP causing membranes to become rigid and more susceptible to injury resulting in small spherical RBCs
50
How does G6P deficiency result in hemolytic anemia?
X-linked disorder causes reduction in energy available to maintain RBC membrane Hemolysis occurs when cells are exposed to oxidants (peroxide, primaquine, salicylates, sulfonamides, nitrofuran, vit K, fava beans)
51
What populations are at higher risk of carrying this genetic trait of G6P defect?
African American males and mediterraneans
52
What are the labs associated with G6P deficiency diagnoses?
anemia increased reticulocytes Heinz bodies
53
What is the cause of sickle cell anemia?
Homozygous hemoglobin S gene (or heterozygous sickle cell trait) occurring in Africans
54
What are the SSxs associated with sickle cell anemia?
``` Painful bony crisis Renal damage "punched out" leg ulcers Splenic infarcts aplastic crisis severe anemia developmental delays avascular necrosis of bones (femoral head) Abdominal pain/vomiting Neuro disturbances splenomegaly ```
55
What are the SSxs associated with sickle cell trait?
Myalgias, hematuria
56
How is sickle cell anemia diagnosed?
Normocytic anemia Elevated bilirubin Sickle cells on PB smear Electrophoresis shows hetero (Hb A and Hb S) or homozygotic (only Hb S)
57
What is hemoglobin C disease?
Genetic hemoglobinopathy, more commin in Africans, maybe associated with sickle cell - highly variable
58
What SSxs, PE, and labs are associated with hemoglobin C disease?
``` bone pain splenomegaly jaundice normochromic anemia target cells, spherocytes, or nucleated RBCs Heterozygous may show no symptoms ```
59
What is thalassemia? What are the different types? Who is primarily effected?
Inherited defects in rate of synthesis of one or more globin chains causing ineffective erythropoesis/low RBC production Major (homozygous) or minor (heterozygous) Most commonly effecting mediterraneans, africans, SE asians, (where malaria is present)
60
What are the SSxs associated with thalassemia?
heart failure, failure to thrive, splenomegaly, jaundice, leg ulcers, gallstones Thick malar eminences and cranial bones (in Major) Rare to live long with thalassemia major, normal life with minor
61
What do labs show in thalassemia?
``` Microcytic normochromic anemia target cells basophilic stippling nucleated RBCs Anisocytosis Poikocytosis Elevated iron/ferritn Elevated bilirubin ```
62
What levels neutrophils are associated with neutropenia?
>1200 in blacks and >1500 in whites is normal 1000 - 1500 = mild risk of infection 500 - 1000 = moderate risk <200 = rapidly fatal infection
63
What type on infections do neutrophils protect against? What else is involved in defense against infection?
Bacterial and fungal infection | skin, mucosal/vascular integrity and nutritional status also influence immunity
64
What causes intrinsic neutropenia?
Defects in myeloid cells or precursors - rare Congenital causes Chronic idiopathic
65
What are some causes of secondary neutropenia?
``` Drugs Bone marrow infiltration (cancer/myelofibrosis) Hypersplenism Infections/sepsis (HIV) Alcoholism Autoimmune (SLE) Folate/B12 deficiency Leukemias Transfusions ```
66
What are some important things to consider in pt with neutropenia?
PE of mucosal surfaces, lungs, abdomen, urinary, skin/nails for infection Bacterial/fungal blood cultures if acute and febrile Chest xray for pts with neutrophils <500 Radiography sinuses Determine mechanism of cause (meds, toxins, maybe bone marrow biopsy)
67
What is lymphocytopenia? What number of lymphocytes is diagnostic?
Reduction in lymphocytes Either Tcells (75%) or Bcells (50%) - together make up 20-40% of WBCs <1000 in adults, less than 3000 in children
68
What are causes of lymphocytopenia?
``` Congenital or acquired Infections (Viral - TB, HIV, SARS, Hep) Dietary deficiency Iatrogenic immunosuppression (chemo/rad) Autoimmune (SLE, RA, sarcoid) Cushing's EtOH ```
69
What are SSxs associated with lymphocytopenia?
``` Signs of primary illness Absent/diminished tonsils/lymph nodes LAD with tumors Jaundice, splenomegaly, pallor, petechiae if hematologic disease is cause Recurrent viral/parasitic infections ```

CPD (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions