which anemia is a/w restless leg?
iron deficiency anemia
what is the rule of 3 for ferritin?
take ferritin, divide by 3, gives iron level (less than 20 is iron deficiency)
what should you tell pt about iron supplements?
take with OJ or vit. C (if DM)
take with stool softener
who should get parental iron supplementation?
more severe cases
carries risk of allergic rxn
what are sxs of B12 deficiency?
dementia weakness sensory ataxia parasthesias positive rhombergs loss of vibratory sense
who is at risk for B12 deficiency?
older/malnutrition alcoholics strict vegans bariatric surgery blind loop syndrome
which drugs cause B12 deficiency?
methotrexate
bactrim/neomycin
phenytoin
metformin
which inactivates B12?
nitrous oxide
what labs do you do on B12 suspicious pts?
B12, folate levels
MMA-intermediate metabolite
homocysteine-intermediate metabolite
intrinsic antibodies
what test is used to determine if a pt has a hemoglobinopathy?
hgb electrophoresis (specific for sickle cell)
what type of hemoglobin might be protective in sickle cell?
F
when does B thal major start to become symptomatic?
6 months
what is the prognosis for B thal major?
80% die in 1st 5 yrs of life
why do you have Fe overload with transfusions?
EPO increases the guts absorption of Fe
which virus would cause a B thal major pt to become aplastic?
parvovirus B19
what are smear findings of B thal major?
microcytosis hypochromic tear drops targe cells inclusion bodies
what is B thal minor?
asymptomatic b/c of being a trait carrier
-will show target cells on smear
what are the classes of A thal?
minima-silent carrier (lose one chains)
minor- mild anemia, hypochromic (loses two chains)
major-die w/in hours of birth (loses all chains)
what are sxs of sickle cell?
painful vasocclusive pain splenic sequestration acute/chronic multi-organ failure reduced overall survival leading cause of death is acute chest syndrome and multi-organ failure, sepsis
what are common triggers of pain crises?
infections
what is the progression of SC?
1st few decades: infections struggle
2nd couple decades: vasocclusive pain crisis become more common
later decades: deal with multi-organ failure
what are signs of pain crises?
fever swelling (DVT) tenderness on PE tachypnea HTN N/V pain can be anywhere but some may have a typical pattern of pain
what is a neurological complication of sickle cell?
stroke
ischemia w/impaired neurocognitive function
what can methadone cause?
cardiac arrhthmias
what is priapism?
erection lasting more than 4 hours
<p>
| how do you treat a pain crisis?</p>
<p>
careful transfusion O2 IV fluid folic acid chelating therapy (bind up iron) pain mgmt hydroxyurea? (prevents body from creating sickled cells) pt education</p>
what is the most common finding of aplastic anemia?
petechiae (oozing from the mouth)
what is the DDx for aplastic anemia?
leukemia MDS (myelodysplastic syndrome) marrow replacement (small cell lung CA) PNH (infection) overwhleming infection
what heart correction could cause hemolysis?
mechanical heart valve
what kind of genetic disorder is G6PD?
x-linked disorder
what is the problem in G6PD?
RBC membrane is fragile and can have complications b/c of foods (fava beans) and medicines
what is used to help improved cell membrane synthesis?
folic acid
what is warm agglutin AIHA?
IgG related antibodies-need to stay in cool settings
what is cold agglutin AIHA?
igM antiboides-need to stay warm
where is ferritin stored?
liver
spleen
bone marrow
when are ferritin levels increased?
acute phase illness
which Hgb is protective
HgF
which virus can cause aplastic crises?
parvovirus 19
what are common drugs that cause immune hemolysis?
cephs pcn Nsaids Quinine cancer drugs
