Hematology Day 2 Flashcards
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
| how do you treat a pain crisis?
careful transfusion O2 IV fluid folic acid chelating therapy (bind up iron) pain mgmt hydroxyurea? (prevents body from creating sickled cells) pt education
