Hematology Flashcards
(166 cards)
What tests should be ordered initially if anemia is suspected?
- Reticulocyte count
- Haptoglobin
- LDH
- Total and direct bilirubin
- TSH with T4
- B12 and folate level
- Iron studies
- Urinalaysis with microscopic analysis
- CBC with peripheral smear
A pt presenting with complaints of craving ice or dirt (Pica) suggest the pt is suffering from …
Anemia
What is the best initial test for suspected anemia?
CBC with peripheral smear (focus on MCV and MCHC)
A pt presenting with fatigue/ loss of energy, pallor, pale conjunctiva, microcytic anemia, elevated platelets and history of blood loss most likely suffers from …
Iron deficiency
What is the best initial diagnostic test and associated findings for iron deficiency?
iron studies
low ferritin, high TIBC, low Fe, low Fe sat, elevated RDW bc new cells are progressively smaller
What is the most accurate test for iron deficiency?
bone marrow biopsy (do not perform on CCS)
What is the treatment for iron deficiency?
ferrous sulfate orally (turns stools dark)
A pt presenting with fatigue/ loss of energy, pallor, pale conjunctiva, microcytic anemia and a history of rheumatoid arthritis/ end stage renal disease/ chronif infection/inflammatory or connective tissue disease most likely suffers from …
Anemia of chronic disease
normal/ increased iron in storage (ferritin/TIBC), but inability to process it into usable cells
What is the best initial diagnostic test and associated findings for anemia of chronic disease?
iron studies
high ferritin, low TIBC, low Fe, normal or low Fe sat
What is the treatment for anemia of chronic disease?
correct the underlying disease
A pt presenting with possible fatigue/ loss of energy, microcytic anemia with very small MCV and the presence of target cells on smear most likely suffers from …
Thalassemia
What is the most accurate diagnostic test for Thalassemia?
Hemoglobin Electrophoresis
(beta thal- elevated Hg2, HgF; alpha thal- normal)
(alpha thal best diagnosed with DNA sequencing)
A pt presenting with fatigue/ loss of energy, pallor, pale, conjunctiva, microcytic anemia and a history of alcoholism/ isoniazid use/ lead exposure most likely suffers from …
Sideroblastic anemia
iron builds up in mitochondria
What is the best initial diagnostic test for sideroblastic anemia?
iron studies
high Fe
What is the most accurate diagnostic test for sideroblastic anemia?
prussian blue stain
detect iron build up in mitochondria
What is the best treatment for sideroblastic anemia?
- major: remove toxin exposure
2. minor: pyridoxine replacement
What is the initial best step in management of a pt > 50 years old who presents with microcytic anemia?
Colonscopy (to rule out colon cancer)
What cause of anemia of chronic disease is the only form that will respond to erythropoietin?
end stage renal disease
A pt presenting with fatigue/ loss of energy, pallor, pale conjunctiva, neuro deficits (peripheral neuropathy), glossitis (smooth tongue), diarrhea and macrocytic anemia most likely suffers from …
Vitamin B12 deficiency
What diabetic medication can result in vitamin B12 deficiency by blocking absorption of B12?
metformin
What is the best initial test for macrocytic anemia (vitamin B12 deficiency and folate deficiency)?
CBC with peripheral smear (look for hypersegmented neutrophils and oval cells)
(also order bilirubin, LDH and reticulocyte count)
A pt presenting with fatigue/ loss of energy, pallor, pale conjunctiva and macrocytic anemia with normal neuro exam most likely suffers from ..
Folate deficiency
What are the lab findings associated with the ineffective erythropoiesis associated with vitamin B12 deficiency? (3)
- high LDL (RBC destruction)
- high bilirubin (RBC destruction)
- low reticulocyte count (RBC destruction)
What is the first sign/symptom to correct after starting B12 replacement therapy for vitamin B12 deficiency?
reticulocyte count ( neuro corrects last)