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PNCB CPNP-PC > Hematology > Flashcards

Hematology Flashcards

1
Q

RBC Indices
-2-: -1-; expression of the average volume and -2- of individual -3-
> Important classification: -4-: -5-

A
  1. Mean corpuscular volume (MCV)
  2. Size
  3. erythrocytes
  4. Microcytic
  5. < 80 fl
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2
Q

RBC Indices - Size
> -1-: -2-
> -3-: -4-

A
  1. Normocytic
  2. 80-100 fL
  3. macrocytic
  4. > 100 fL
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3
Q 
RBC Indices
-1-: expression of the proportion of each RBC occupied by Hgb as a percentage; -2- of the cell; more reliable for measureing RBC pathologies than MCH
> -3-: 32-36% (32-33% for newborns)
> -4-: <32%
> -5-: >36% (>33% for newborns)
A
  1. Mean corpuscular hemoglobin concentration (MCHC)
  2. “color”
  3. Normochromic
  4. Hypochromic (pale, increased central clearing)
  5. Hyperchromic
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4
Q

RBC Indices
-1-: -2- -3-; experssion of the average amount and -1- of hgb contained in a single erythrocyte; not as useful
> Physiologic: -3-

A
  1. Weight
  2. Mean corpuscular (MCH)
  3. hemoglobin
  4. 27 - 33 pg
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5
Q 
RBC Indices
-1-
> IDA: -2-
> -3-: -4- or slightly decreased
> -5-: physiologic -1-
A
  1. Red cell Distribution Width (RDW)
  2. increased
  3. Thalassemia
  4. physiologic
  5. ACD
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6
Q

RBC Indices
-1-
> No. of -2- RBCs in circulation
> Expressed as a -3-

A
  1. Ret count
  2. new/young (i.e., immature)
  3. percentage (physiologic is 0.5-1.5%)
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7
Q

RBC Indices - Ret Count
Index of -1- and -2-
> Also -3-

A
  1. bone marrow health
  2. response to anemia
  3. response to therapy (sign of improving anemia as RBCs are released from the marrow)
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8
Q

Anemias
> Def: Anemia is not a disease itself, but rather a -1- that results in a low number of RBCs
> Classification: Anemias are classified according to RBC -2- and hgb -3-

A
  1. sign of an underlying condition
  2. size (MCV)
  3. concentration (MCHC)
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9
Q

Anemias - Classification

-1-: -2-, -3-, & thalassemia

A
  1. Microcytic/hypochromic
  2. IDA
  3. lead poisoning
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10
Q

Anemias - Classification

Microcytic/hypochromic: -2-, -3-, & -4-

A
  1. IDA
  2. thalassemia
  3. lead poisoning
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11
Q

Anemias - Classification

Normocytic/normochromic: -1-, acute -2-, -3-, -4-, -5-

A
  1. ACD
  2. blood loss
  3. early IDA
  4. infection
  5. medication
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12
Q

Anemias - Classification

-1-: -2-, -3-, early IDA, acute -4-, -5-

A
  1. Normocytic/normochromic
  2. infection
  3. ACD
  4. blood loss
  5. medication
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13
Q

Anemias - Classification

-1-: vitamin -2- deficiency, -3- deficiency, -4- anemia

A
  1. Macrocytic/normochromic
  2. B12
  3. folate
  4. pernicious
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14
Q

IDA
> Caused by -1-, increased needs, or -2-
> In -3-, iron deficiency is due to a(n) -1- (e.g., -4-, -5-) or microhemorrhage from the gut due to an early intake of cow’s milk (<12 months old)

A
  1. decreased iron intake
  2. slow GI blood loss
  3. infancy
  4. low-iron formula
  5. exclusive breast-feeding w/o iron supplementation
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15
Q

IDA
> In -1-, ID is often due to a(n) -2- the expense of iron-rich solid foods
> In -3-, -4- contribute to an inadequate -5-, specifically in girls after menarche

A
  1. toddlers
  2. increased reliance on dairy milk at
  3. Adolescents
  4. dieting practices
  5. intake of iron (green, leafy vegetables for one)
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16
Q

IDA - S/S
Severity depends on -1-
> Easy -2- and -3-
> -4- (-5-)

A
  1. degree of anemia
  2. fatigability
  3. lethargy
  4. Pica
  5. mostly ice
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17
Q

IDA - S/S
> Postural -1- in -2-
> -3-
> Flat, brittle or -4-

A
  1. hypotension
  2. severe anemia
  3. brittle hair
  4. spoon-shaped nails
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18
Q

IDA - Lab/Dx
> Low -1-
> low -2-
> Increased -3-

A
  1. MCV
  2. MCHC
  3. RDW
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19
Q

IDA - Lab/Dx
> Serum -1- < 12 mcg/L (indicates depleted -2-)
> -3-: low incases of inadequate iron intake; elevated in cases of blood loss & resolving anemia

A
  1. ferritin
  2. iron stores
  3. Ret count
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20
Q

IDA - Mgmt
A(n) -1- is required while the cause is being managed and should be contineud until the resolution of the underlying process
> Treat with -2- once daily until -3-, then
> Replace -4-

A
  1. medicinal iron supplement
  2. elemental iron 3-6 mg/kg/day
  3. Hgb returns to physiologic levels
  4. iron stores: 2-3 mg/kg/day for 4 months
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21
Q

IDA - Mgmt
> Take iron supplement with -1-; take at least 1 hour before or 2 hours after eating (empty stomach)
> Consider -2- to prevent -3- iron therapy
> Discuss the importance of -4-

A
  1. Vitamin C to improve absorption
  2. miralax
  3. constipation caused by
  4. adherence to iron regimen
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22
Q

Thalassemia
Def: a group of -1- disorders characterized by a(n) -2- and -3- chains
> -4- of each gene -5-

A
  1. hereditary
  2. abnormal synthesis of alpha (4 genes)
  3. beta (two genes) globin
  4. One or more
  5. can be missing
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23
Q

Thalassemia
> Type is determined by -1-
> Severity depends on -2- affected
> Usually found in individuals -3-

A
  1. which genes are missing (alpha vs. beta thalassemia)
  2. number of genes
  3. of Mediterranean descent
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24
Q

Thalassemia - Causes/Incidence
> Second most common cause of -1-
> Often identifed during perinatal period or -2-
> -3- genetic disorder

A
  1. microcytic anemia
  2. newborn screening
  3. Autosomal Recessive
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25
Q

Thalassemia - S/S
-1- to -2- of anemia
> -3- color to -4-

A
  1. varies from asymptomatic
  2. severe s/s
  3. Pale or bronze
  4. skin
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26
Q 
Thalassemia - S/S
> -1-
> -2-
> -3-
> Frontal -4-
A
  1. tachypnea
  2. tachycardia
  3. hepatosplenomegaly
  4. bossing
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27
Q 
Thalassemia - PE Findings
> -1-
>> -2-
>> -3-
>> -4-/severe anemia
A
  1. Infancy
  2. FTT
  3. irritability
  4. pallor
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28
Q 
Thalassemia - PE Findings
> -1-
>> -2-
>> -3-
>> -4- due to -5-
A
  1. Older child
  2. bony changes (erythropoiesis)
  3. splenomegaly
  4. iron overload
  5. multiple transfusions
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29
Q 
Thalassemia - Lab/Dx
> CBC shows
>> -2-
>> -3-
>> -4-
A
  1. low hgb
  2. low MCV (microcytic anemia)
  3. hypochromic RBCs
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30
Q

Thalassemia - Lab/Dx
> -1-
> -2-
> -3-

A
  1. high ret count
  2. hgb electrophoresis
  3. high ferritin
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31
Q

Thalassemia - Mgmt
> referral to -1-
> obtain a -2- (-3-) of affected relatives for AG

A
  1. hematology
  2. genogram/family history
  3. 3-generations
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32
Q

Sickle Cell Anemia

Def: A -1- in which abnormal hgb leads to the dev of -2-, which have a -3-

A
  1. chronic hemolytic anemia
  2. sickle-shaped RBCs
  3. shorter life-span
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33
Q

Sickle Cell Anemia - Causes/Incidence
> -1- disorder in which HgbS develops instead of HgbA; the pt is -2-
> Most prevalent in -3-; Hgb S gene is carried in 8% of -3-: incidence of sickle cell trait is -4-; incidence of sickle cell disease in -3- is 1 in 365

A
  1. autosomal disorder
  2. homozygous for Hgb S (Hgb SS)
  3. persons of African/-American ancestry
  4. 1 in 13
34
Q

Sickle Cell Anemia - Causes/Incidence
> Patients who have -1- are generally -2- but are -3-
> The peak incidence of infection is -4- of age

A
  1. heterozygous Hgb genotype (AS)
  2. clinically asymptomatic (unless hypoxic)
  3. carriers
  4. 5 months
35
Q

Sickle Cell Anemia - S/S
> Sickle cell -1-
» pts usually have -2-
» May experience acute painful symptoms under extreme conditions such as -3- at -4- and -5-

A
  1. Trait (Hgb AS)
  2. no clinical symptoms
  3. extreme exertion
  4. high altitudes
  5. severe dehydration
36
Q

Sickle Cell Anemia - S/S
> Sickle cell -1-
» -2- due to a -3- (Sickled cells -4-; -5-) usually in the back, chest, abdomen, and long bones

A
  1. anemia (Hgb SS)
  2. sudden, excrutiating pain
  3. vaso-occlusive crisis
  4. adhere to vascular lining
  5. ED visit
37
Q 
Sickle Cell Anemia - S/S
> Sickle cell anemia
>> -1-
>> -2-
>> Tendency toward -3-
A
  1. Low grade fever
  2. delayed puberty
  3. more frequent infections (which also aggravate crisis)
38
Q

Sickle Cell - PE Findings
> -1-
» This sub-population is -2- with -3- findings

A
  1. SCT
  2. clinically physiologic
  3. no pathologic exam
39
Q 
Sickle Cell Anemia - PE Findings
> SCA
>> Chronically ill in appearance
>> -1-
>> -2- (vision changes)
>> -3-
>> -4- with hyperdynamic precordium
>> Systolic murmur
A
  1. jaundice
  2. retinopathy
  3. hepatosplenomegaly
  4. enlarged heart
40
Q 
Sickle Cell Anemia - PE Findings
> SCA
>> -1- in appearance
>> jaundice
>> retinopathy (-2-)
>> hepatosplenomegaly
>> enlarged heart with hyperdynamic precordium
>> Systolic -3-
A
  1. Chronically ill
  2. vision changes
  3. murmur
41
Q

Sickle Cell Anemia - Lab/Dx
> -1-
> Labs show a complex -2- indicative of -3-:
» Pathologic -4-: sickle-shaped RBCs which have a shorter lifespan
» -5-

A
  1. Hemoglobin electrophoresis
  2. constellation of findings
  3. SCA
  4. hemoglobin (SS)
  5. chronic hemolytic anemia
42
Q

Sickle Cell Anemia - Lab/Dx

> Children with SCT may have episodes of -1- and inability to concentrate their -2- due to -3-

A
  1. gross hematura
  2. urine
  3. renal tubular damage
43
Q

Sickle Cell Anemia - Mgmt
> -1-
> Hematopoietic -2-
> -3- chronically on -4- supplementation

A
  1. Collaboration with hematologist
  2. stem-cell transplant
  3. Maintained
  4. folic acid
44
Q

Sickle Cell Anemia - Mgmt
> -1- is to prevent episodes and to provide support during the crisis episode
» Keep client adequately hydrated
» Ensure -2-
» analgesics for pain control
» -3- for assoc. -4-
» Transfusions and/or exchange transfusions for intractable crisi and as a preventative measure for clients undergoing anesthesia

A
  1. Cornerstone of therapy
  2. adequate oxygenation
  3. antibiotics
  4. infection
45
Q

Sickle Cell Anemia - Mgmt
> Cornerstone of therapy is to prevent episodes and to provide support during the crisis episode
» Keep client adequately -1-
» Ensure adequate oxygenation
» -2- control
» antibiotics for assoc. infection
» -3- and/or exchange transfusions for intractable crisises and as a preventative measure for clients undergoing anesthesia

A
  1. hydrated
  2. analgesics for pain
  3. Supplemental
46
Q

Sickle Cell Anemia - Mgmt

> -1- to -2- production of -3-, which -4-

A
  1. hydroxyurea, 15-35 mg/kg/day
  2. stimulate
  3. fetal hemoglobin (hgb F)
  4. does not sickle
47
Q

Sickle Cell Anemia - Mgmt
> Immunize with -1- and confirm -2-
> Provide or refer for -3-

A
  1. pneumovax (PS23)
  2. hep B immunity
  3. genetic counseling
48
Q

Idiopathic/Immune Thrombocytopenic Purpura (ITP) - Gen Concepts/Incidence
> -1-
> Thrombocytopenia: decrased (-2-) number of platelets in the blood
> -3- of the skin, including bruising
> Incidence peaks between -4-

A
  1. idopathic: unknown (could be immune)
  2. < 150k platelets/mcL
  3. Purpura: purple discoloring
  4. 1 & 6 yo
49
Q 
Idiopathic/Immune Thrombocytopenic Purpura (ITP) - S/S
> -1- (petechiae or purpura)
> -2-
> -3-
> -4- minor cuts
A
  1. easy bruising
  2. bleeding from gums
  3. nose bleeds
  4. prolonged bleeding from
50
Q

Idiopathic/Immune Thrombocytopenic Purpura (ITP) - Lab/Dx
> -1-
> additional blood and urine tests to measure -2- and detect possible infections
> Review of the child’s -3-
> -4- may be needed (if -5-)

A
  1. CBC
  2. bleeding time
  3. medications
  4. bone marrow aspiration
  5. ITP is chronic
51
Q

Idiopathic/Immune Thrombocytopenic Purpura (ITP) - Mgmt
> -1-
> Children usually -2-
> A variety of mgmt strategies may be used, including -3- the platelet count, -4-, among others

A
  1. refer to hematology
  2. improve w/o treatment
  3. medications to increase
  4. surgery (splenectomy)
52
Q

Hemophilia A (X-linked recessive)
> Occurs in -1-
> Deficiency of -2-

A
  1. 1:5000 males

2. Factor VIII

53
Q 
Hemophilia A (X-linked recessive)
> Female carriers (Mendelian distribution) have, with each pregnancy, a 25% chance of having a(n):
>> -3- 
>> -4-
>> healthy son
>> -6-
A
  1. affected son
  2. carrier daughter
  3. non-carrier daughter
54
Q 
Hemophilia A (X-linked recessive)
> -1- have--with each pregnancy--a -2- having a(n):
>> affected son 
>> carrier daughter
>> -5-
>> non-carrier daughter
A
  1. Female carriers (Mendelian distribution)
  2. 25% chance of
  3. healthy son
55
Q 
Hemophilia A (X-linked recessive)
> frequency of carrier females is -1-
> Typical findings
>> -2- at birth
>> -3-: ranges from spontaneous bleeding to bleeding after trauma (usually -4-)
A
  1. 1:2500
  2. Phenotypically physiologic
  3. Bleeding tendency
  4. discovered with circumcision
56
Q

Hemophilia A (X-linked recessive) - Mgmt
> Infusions of recombinant -1- or only when -2-
> Possible -3- to surgical procedures
> -4-

A
  1. factor VIII prophylactically
  2. a bleed occurs
  3. desmopressin IV/SQ/nasally prior
  4. NSAID avoidance
57
Q

Lead Poisoning
Def: The CDC definition of lead poisoning is -1-; can occur via ingestion or inhalation
> Common Sources
» Paint and paint dust (houses -2-; mandated laws require -3-!)
» -4-

A
  1. a level over 3.5 mcg/dL
  2. prior to 1978
  3. lead free paint
  4. contaminated soil
58
Q 
Lead Poisoning - S/S
> -1-
> Severe: -2-, difficult walking, neuropathies
> -3- discoloration -4-
> -5-
A
  1. Vague GI symptoms
  2. lethargy
  3. Buronian lines: bluish
  4. of gingival border (another reason oral exam is important in these patients)
59
Q

Lead Poisoning - S/S
» -1-
» -2- in more -3-
» May have a -4-

A
  1. papilledema
  2. cognitive delays
  3. severe cases
  4. history of pica
60
Q

Lead Poisoning - General assessment
> Medical -1-
> -2-
» Family members’ behaviors, -3-

A
  1. and developmental history (mouthing and pica history)
  2. Environmental history
  3. occupations
61
Q

Lead Poisoning - General assessment
> Detailed -1-
> Physical exam
» Pay particular attention to the -2- the child’s -3- development

A
  1. nutritional history
  2. neuro exam
  3. psychosocial & language
62
Q

Lead Poisoning - Lab/Dx/Tx
> -1- blood level concentrations
» level < 3.5 mcg/dL (-3- testing)
» level 3.5-10 mcg/dL (-5-)

A
  1. Venous (after capillary levels are high)
  2. non-toxic; follow-up lead
  3. Class I: 6-mo f/u + AG
63
Q

Lead Poisoning - Lab/Dx/Tx
> lead: 10-14 mcg/dL (Class -2-)
> Lead: 15-19 mcg/dL (Class -4- assessment -5-)

A
  1. IIA - F/u lead level in 3 months, & assess iron levels
  2. IIB - confirm lead level in 20 days and 3 months - environmental/playmate
  3. after confirmation level is high
64
Q

Lead Poisoning - Lab/Dx

> … iron status

A

Ferritin to assess

65
Q

Lead Poisoning - Distal Mgmt
> Observe for -1-, impaired renal function, or vit D deficiencies
> -2- for prevention of sources -3-

A
  1. hgb-opathies
  2. AG needed
  3. of lead ingestion
66
Q

Leukemias
Def: A group of -1- in which physiologic bone marrow elements are replaced by pathologic, poorly differentiated lymphocytes known as blast cells
> -2- accounts for about -3-, with a peak -4- years of age; it occurs more frequently in boys than girls, and is more common among caucasian children

A
  1. malignant hematological diseases
  2. acute lymphocytic leukemia (ALL)
  3. 75% of cases
  4. incidence around 4
67
Q

Leukemias

> -1- accounts for up to 20% of childhood leukemia cases; occurs primarily in -2- children

A
  1. AML

2. infants and older

68
Q 
Leukemias - S/S
> -1-
> -2-
> -3-
> Chronically -4-
A
  1. pale
  2. listless
  3. Irritable
  4. tired
69
Q

Leukemias - S/S
> Hx of -1-
> -2- such as epistaxis, -3-, and hematomas
> -4- and hepatosplenomegaly

A
  1. repeated infections
  2. bleeding
  3. petechia
  4. lymphadenopathy
70
Q

Leukemias - Lab/Dx
> -1- , platelet, and ret counts
> -2- may demonstrate -3-
> -4- will show the poorly differentiated -5- that have been replacing the healthy bone marrow tissue

A
  1. CBC w/ differentiated WBCs - (thrombocytopenia is common and anemia is usally present)
  2. Peripheral Smear
  3. malignant cells (blasts)
  4. bone marrow
  5. blast cells
71
Q

Leukemias - Mgmt
> referral -1-
> -2-

A
  1. to hem/onc

2. familial support

72
Q

Lead Poisoning - Lab/Dx/Tx

> Lead 20-44 mcg/dL: Class -1-, repeat in -2- to confirm; -3- if confirmed; f/u -4- until hazard -5-; refer to -6-

A
  1. III
  2. 5 days
  3. environmental/playmate eval
  4. monthly
  5. abates, then quarterly
  6. CPS
73
Q

Lead Poisoning - Lab/Dx/Tx

> Lead 45-69 mcg/dL: Class -1-, repeat in -2-; -3-; f/u -4-; refer to -5-

A
  1. IV
  2. 3 days to confirm
  3. environmental, playmate evaluation if confirmed
  4. at least monthly until hazard abates, then quarterly
  5. CMS and psych eval
74
Q

Lead Poisoning - Lab/Dx/Tx

> Lead >69 mcg/dL: Class -1-, repeat in -2-; -3-; f/u -4-; refer to -5-

A
  1. V
  2. Immediately to confirm
  3. environmental, playmate evaluation if confirmed
  4. at 1-2 week intervals until hazard abates, then provider discretion
  5. CMS and psych eval
75
Q 
Henoch-Schönlein purpura (HSP)
> most common -1- found in young children
> appears more commonly in the -2-
> most frequently seen in -3-
> -4- is a common trigger
A
  1. small vessel vasculitis
  2. spring and fall
  3. males ages 2-7
  4. Group A streptococcus
76
Q 
Henoch-Schönlein purpura (HSP)
S/S
> skin: -1-
> GI (-2-)
>> Mild: -3-
>> Severe: -4-
> MS: -5-
A
  1. non-thrombocytopenic/non-blanchable palpable purpura
  2. usually follows rash
  3. colicky abdominal pain
  4. profuse bleeding/perforations
  5. arthritis
77
Q

Iron deficiency anemia is a common nutritional disorder and frequently affects children -1- of age who are given -2- and insufficient intake of high-iron foods. Persistent iron deficiency anemia can negatively affect -3-. Severe anemia can contribute to fatigue, -4-, and a change in the -5-.

A
  1. 12-36 months
  2. excessive dairy products
  3. cognitive function/learning
  4. irritability
  5. oxygen dissociation curve
78
Q

The AAP recommends that a child’s hemoglobin level be checked at -1- of age. A low -2- indicate that the child has iron deficiency anemia likely related to an insufficient -3- of iron.

The -4- of iron deficiency anemia is reduced iron stores, which is reflected in the -5-, a protein that estimates the stores of iron.

A
  1. 12 months
  2. H&H and MCV
  3. dietary intake
  4. first laboratory indication
  5. ferritin value
79
Q

As stores of iron decrease, the -1- more increases, which is evaluated through total -2-. With reduced availability of hemoglobin, the -3- and the MCV decreases.

Administration of -4- will increase the hemoglobin by one to two g/dL -5-.

A
  1. capacity to absorb
  2. iron binding capacity
  3. RDW increases
  4. iron supplementation
  5. within one month
80
Q

Supplemental iron is continued for -1- normalization of the hemoglobin to develop -2-. With severe anemia, a -3- can be obtained shortly after iron therapy has begun to -4- of iron deficiency anemia.

A
  1. 2-3 months after
  2. adequate iron reserves
  3. reticulocyte count
  4. confirm the diagnosis
81
Q

Serum iron, ferritin, and total iron binding capacity are -1- to make the diagnosis of iron deficiency anemia and are usually obtained when the -2- are not improving as expected with -3-. Serum ferritin levels may be tested -4- iron supplements are stopped to assure adequate iron stores.

A
  1. not required
  2. hemoglobin and hematocrit
  3. iron supplementation
  4. 6 months after
82
Q

Anemia of chronic disease is categorized as a -1-. Iron deficiency anemia, thalassemia, and lead poisoning are all -2-.

A
  1. normocytic/normochormic anemia

2. microcytic and hypochromic

PNCB CPNP-PC (19 decks)

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