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First AId 2CK > Hematology > Flashcards

Hematology Flashcards

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1
Q

Hct 25 - 30%

A

Dyspnea (worse on exertion ), fatigue

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2
Q

Hct 20 - 25%

A

Lightheadedness, angina

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3
Q

Hct < 20%

A

Syncope, chest pain

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4
Q

Causes of cardiac ischemia

A
  • anemia
  • hypoxia
  • coronary artery disease
  • carbon monoxide poisoning
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5
Q

Causes of microcytosis

A

LITS

  • Lead poisoning
  • Iron deficiency
  • Thalassemia
  • Sideroblastic anemia
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6
Q

Microcytosis

A
  • low MCV

- low reticulocyte count

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7
Q

Causes of macrocytic anemia

A
  • B12 and folate deficiency
  • Sideroblastic anemia
  • Alcoholism
  • Liver disease or hypothyroidism
  • Medications (e.g. zidovudine or phenytoin)
  • Myelodysplastic syndrome
  • Antimetabolite rx: azathioprine, 6-MP, or hydroxyurea
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8
Q

Under normal circumstances, situations that raise reticulocyte count

A
  • Blood loss

- Hemolysis

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9
Q

Normocytic anemia

A
  • acute blood loss

- hemolysis

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10
Q

Treatment of severe anemia

A
  • Packed red blood cells
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11
Q

When do you transfuse a patient:

A
  1. If patient is symptomatic

2. Low hct in an elderly pr or one w/ heart disease.

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12
Q

Symptomatic from anemia

A
  • SOB
  • Lighthead, confused, and sometimes syncope
  • Hypotension and tachycardia
  • Chest pain
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13
Q

Packed Red Blood Cells

A
  • concentrated form of bloos
  • whole blood w/ 150ml plasma removed
  • Hct is 70 - 80%
  • 1 unit of PBRCs raise Hct by about 3 points per unit
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14
Q

Fresh Frozen Plasma

A
  • replaces clotting factors in pts with elevated PTT, aPTT, or INR
  • used as replacement w/ plasmapheresis
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15
Q

Blood products for IgA deficient donor

A

IgA deficient donor FFP

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16
Q

Cryoprecicipate

A
  • used to replace fibrinogen
  • some utility in DIC
  • provides high amts of clotting factors in smaller plasma volume
  • High factor VIII and VWF
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17
Q

Microcytosis

A
  • MCV lower than noral

- usually below 80fL

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18
Q

Iron deficiency

A
  • caused by blood loss
  • Fe needs for 1 - 2mg /day
  • menstruating women need 2 - 3 mg /day
  • pregnant women need 5 - 6 mg/day
  • Fe absorbed in duodenum
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19
Q

Chronic disease

A
  • caused by cancer or chronic infxn
  • Fe is locked in storage or trapped in macrophages or in ferritin
  • hemoglobin synthesis can’t move forward
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20
Q

Anemia in renal failure

A

Deficiency of erythropoiestin

- MCV is initially normal then decreases

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21
Q

Sideroblastic anemia

A
  • can be macrocytic as well associated w/ myelodysplasia, preleukemic syndomre
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22
Q

Common causes of sideroblastic anemia

A
  • Alcohol suppressive effect on marrow (MCC)
  • Lead poisoning
  • Isoniazid
  • Vit B6 deficiency
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23
Q

Thalassemia

A
  • extremely common cause of microcytosis

- most patients are assymptomatic

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24
Q

Pt with anemia and c/o blood loss (GI Bleeding). Likely dx?

A

Iron deficiency

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25
Mensturating woman c/o anemia. Likely dx?
Iron deficiency
26
Pt with cancer or chronic infxn is anemic. Likely dx?
Anemia of Chronic dix
27
Anemic Pt with rheumatoid arthritis. Likely dx?
Anemia of chronic disease
28
Alcoholic pt has anemia. Likely dx?
Sideroblastic anemia
29
Asymptomatic pt with anemia. Likely dx?
Thalassemia
30
Most common way to diagnosis microcytic anemia.
Peripheral smea | - target cells are most common w/ thalassemia
31
Pt has low ferritin. Likely dx?
Iron deficiency
32
Pt has high iron. Likely dx?
Sideroblastic anemia
33
Pt has normal iron studies. Likely dx?
Thalassemia
34
Iron deficiency
- low ferritin is extremely specific for Fe deficiency | - increased TIBC b/c of lots of unbound sites on receptors
35
Chronic disease
- serum is low in circulation b/c Fe is trapped in storage - Stored Fe (ferritin) elevated or normal - Circulating Fe is decreased - Low TIBC
36
Sideroblastic anemia
- only microcytic anemia with elevated Fe level
37
Thalassemia
- genetic disease w/ normal Fe
38
Unique lab features of Fe deficiency
- increased RDW b/c new cells are more FE deficient and smaller - as body runs out of Fe, newer cells have less hemoglobin - elevated platelet count
39
Unique lab fx of sideroblastic anemia
Prussian blue staining for ringed sideroblastic anemia is msot accutate test - basophilic stippling can occur in any cause of sideroblastic anemia
40
Unique lab features: thalassemia
Hemoglobin electrophoresis is most accurate diagnostic test
41
Alpha thalassemia
3 genes deleted shows moderate anemia with hemoglobin H, whihc are beta-4 tetrads - increased reticulocytes
42
Hemoglobin Bart
- four genes deleted - gamma 4 tetrads = CHF causes death in utero
43
Beta thalassemia
- increased hemoglobin F and A2
44
Beta thalassemia intermedia
- normal hemoglobin F | - no transfusion dependence
45
Iron deficiency tx
- replace Fe with oral ferrous sulfate | - occasionally pts w/ IM Fe
46
Tx of anemia of chronic disease
- correct underlying disease | - onlt anemia associated w/ ESRD responds to erythropoietin
47
Tx of sideroblastic anemia
Correct underlying cause | - respond to Vitamin B6 or pyroxidine replacement
48
Tx of thalassemia
- Trait can't be treated - Beta thalassemia major managed w/ lifelong chronic transfusion - Iron overload is managed by deferasirox or deferipone
49
Megaloblastic anemia
- presence of hypersegmented neutrophils | - B12 and folate deficiency and antimetabolite medications cause hypersegmeneted neutrophils
50
Vitamin B12 deficiency: Causes
- Pernicious anemia - PANCREATIC INSUFFICIENCY - Dietary deficiency - Crohn dx or any disease damaging terminal ileum - Blind loop syndrome (gastrectomy or gastric bypass) - Diphyllobothrium or HIV
51
Folate deficiency: causes
- Dietary dfeficiency (goat's milk has no folate and provides limited Fe) - Psoriasis and skin loss or turnover - Drugs: phenytoin and sulfa
52
Celiac disease causes what nutritional deficiencies?
Vitamin B12 Folate Iron deficiency
53
Clinical findings which differentiate folate and Vit B12 deficiencies
B12 have neurological abnormalities - peripheral neuropathy is most common - dementia is least common - posterior column damage to vir
54
Causes of neurological findings in Vit B12 deficiency
Posterior column damage to position and vibratory sensation or "subacute combined degeneration of cord - look for ataxia
55
Dx tests associated with folate and Vit B12 deficiency
- megaloblastic anemia - increased LDH and increased indirect bilirubin leveles - decreased reticulocyte count - hypercellular bone marrow - macroovalocytes - increased homocysteine levels
56
Lab test differences btwn folate and vitamin B12 deficiencies
Both folate and Vit B12 deficiencies have increased homocysteine ONLY B12 have increased methylmanonic acid (MMA)
57
Confirmation of parietal anemia
- cause of macrocytic anemia | Confirmed with anti-instrinsic factor and anti-parietal cell antibodies
58
Why are reticulocyte counts so low in setting of macrocytic anemia
Red cells are destroyed as they leave the marrow, so the reticulocyte is low
59
Why does pancreatic insufficiency important for B12 deficiency
Pancreatic enzymes needed for absorption of Vitamin B12
60
What is a complication of B12 and folate replacement?
Hypokalemia | - Reintroduction of B12 and folate causes cells to be produced so rapidly so that marrow packages serum K quickly
61
Obstructive Sleep Aonea
- recurrent transient obstruction of upper airwy dur to pharyngeal collapse during sleep - usually patients are overweight
62
Obstructive Sleep Apnea: Sx
- excessive daytime sleepiness - snoring - morning headaches - impotence - arterial hypertension
63
Discuss OSA and erythropoeitin
- OSA causes short term hypoxemia which is sensed by kidneys and stimulaes increased erythropoetin production - increased epo can cause polycythemia
64
TTP
- patients with hemolytic anemia and thrombocytpenia - altered mental status, renal failure and fever are common - defect in ADAMTS13
65
Best test for TTP
** peripheral blood smear ( can see
66
TTP: Hx and PE
- low platelet count - microangiopathic hemolytic anemia - neuro changes (delirium, seizure, stroke) - impaired renal fxn (incr. BUN:Cr) - fever * * be suspicious if 3/5 are present
67
3 causes of microangiopathic hemolytic anemia
- HUS - TTP - DIC
68
Management of severe hypercalcemia (Ca > 14)
Short term - normal salne hydraton plus calctionin - avoid loop diuretics unless volume overload Long term - Bisphosophates (zoledronic acid)
69
Management of asymptomatic or mild hypercalcemia (ca < 12)
- No immediate treatment required | - avoid thiazide diuretic and lithium use
70
B-thalassemia
- usually of Med descent - asymptomatic w/ mild anemia - disproportionately high RBC count - low MCV - target cells on smear
71
B-thalaseemia on electrophoresis
- elevated hemoglobin A2 on electrophoresis
72
Tx of B-thalaseemia
- Reassurance w/ no specific therapy required
73
A-thalassemis
- pts missing 2/4 alpha globin chains - asymptomatic w/ mild anemia - MCV < 75 - target cells on peripheral semar - normal hemoglobin electrophoresis
74
Heparin Induced Thrombocytopenia
- heparin induced released of PF4 from platelets form heparin-PF4 complexes - IgG antibodies against heparin-PF4 complexes causes platelet activation, endothelial cell activation - increased PTT due to thrombin consumpton
75
Pt has thrombocytopenia and hypercoagulation w/in days of initiating anticoagulation therapy. Likely dx?
HIT due to unfractionated heparin or low weight molecular heparin
76
Hairy cell leukemia
- B-lymphocyte derived chronic leukemia - lymphocytes have fine, hair-like irregular projections - bone marrow may become fibrotic thus may lead to dry tap - TRAP (tartrate resistant acid phosphotase) stain
77
Tx of hairy cell leukemia
- Cladribine (purine analog) | can be toxic to bone marrow and adverse effect include neurological and kidney damage
78
Hereditary spherocytosis
- usally autosomal dominant - triad: hemolytic anemia, jaundice, and splenomegaly - increased risk for bilrubin gallstones & infxn from parvovirus B19
79
Hereditary spherocytosis: Lab findings
- reticulocytye count from 5- 20% - normal to low MCV - increased MCHC indicating membrane loss & dehyrdration - spherocytes on peripheral smear - Negative Coombs test
80
Heme manifestations of SLE
Pancytopenia - Anemia: due to chronic dx, renal insuffuciency, and AHA - Leukopenia: autoimmune destruction thrombocytopenia: immune mediated
81
Acute hemolytic transfusion reaction
Rxn from transfusion of mismatched blood (ABO) - starts WITHIN HOUR of transfusion - pts: have fever, chills, hemoglobinuria, FLANK PAIN and discomfort and site
82
Dx of acute hemolytic transfusion rxn
- positive direct Coombs test - pink plasma (plasma free hemoglobin > 25) - Hemoglobinuria - Repeat type and cross-match shows missmatch
83
Management of acute hemolytic transfusion reaction
- Immediate cessation of transfusion while mantainig IV access and supportive care
84
Delayed hemolytic transfusion
- from anamanestic antibody response to a red blood antigen to which pt was previously sensitized - causes low-grade hemolysis WITHIN 2-10 days
85
IgA deficiency
rapid onset of shock, angioedema/urticaria & respiratory distress - occurs WITHIN SECONDS-MINUTES of tranfusion - caused by recipient of anti-A IgG antibodies
86
Mgmt of anaphylaxis due to IgA deficiency
- Epinepherine with circulatory and respiratory support
87
Giant cell tumor of bone
- benign and locally aggressive skeletal tumor that presents w/ pain, swelling, and decreased range of motion - "Soap-bubble" appearance on X-rays - usually in epiphyseal regions of long bones and involves distal femur and proximal tibia around knee joint
88
Osgood Schlatter disease
- overuse injury caused by repetitive strain - seen in young children and teens who have undergone rapid growth spurt - X-ray shows avulsion apophysis of tibial tubercle
89
Esophageal cancer
- squamous cell most common worldwide | - adenocarcinoma most popular in US, Europe and Australa
90
Risk factors for esophageal squamous cell carcinoma
Alcohol and tobacc
91
Risk factors for adenocarcinoma
- Barrett's esophagus (columnar metaplasia distal esophagus)
92
Hx/PE: for esophageal cancer
- progressive dysphagia initially to solid then liquids | - weight loss, odynophagia, GERD, GI bleeding and vomiting
93
Dx of esophageal cancer
Barrium swallow followed by EGD w/ biopsy
94
Tx of esophageal cancer
Chemoradiation and surgical resection is first line treatment - has poor prognosis
95
Location of SCC of esophagus
in upper and middle 1/3 of esophagus
96
Location of adenocarcinoma of esophagus
in lower 3rd
97
Lynch Syndrome / HNPCC
1. > 3 relatives w/ colorectal (1 must be 1st deg relative) 2. involvement in > 2 generations 3. at least one case diagnosed before 50 4. Exclusion of FAP
98
Lynch Syndrome I vs Lynch Syndrome II
Lynch Syndrome I - hereditary site specific colon cancer | Lynch Syndrome II - incr risk for extracoloni
99
Vitamin B 12
-Macrocytic, megaloblastic anemia) Neuro sx (optic neuropathy, subacute combined degenearation, parasthesias) - Glossitis
100
Leading cause of B12 deficiency
Pernicious anemia - antibodies to IF needed for b12 absorption - chronic gastritis for decr. production of IF
101
Long term complications of pernicious anemia
Gatric cancer
102
ITP
IgG are formed against patient's platelets | - most common immunologic disorder in women of childbearing age
103
Hx/PE: ITP
pts generally feel well but present w/ | - easy bruising, petechiae, hematuria, hematemesis or melena
104
ITP associated w/ which conditions
- Lymphoma - Leukemia - SLE - HIV - HCV
105
Acute ITP
abrupt onset of hemorrhagic complications following viral ilness - usually in children 2-6 y.o
106
Chronic ITP
insiduous onset unrelated to infext - often affects adults 20 - 40 - females 3x more likely affected than males
107
Dx of ITP
- DIAGNOSIS OF EXCLUSION | - can be confirmed w/ hx and pe, CBC, and peripheral blood smear

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