Flashcards in Hematology Day 2 Deck (39):
1
which anemia is a/w restless leg?
iron deficiency anemia
2
what is the rule of 3 for ferritin?
take ferritin, divide by 3, gives iron level (less than 20 is iron deficiency)
3
what should you tell pt about iron supplements?
take with OJ or vit. C (if DM)
take with stool softener
4
who should get parental iron supplementation?
more severe cases
(carries risk of allergic rxn)
5
what are sxs of B12 deficiency?
dementia
weakness
sensory ataxia
parasthesias
positive rhombergs
loss of vibratory sense
6
who is at risk for B12 deficiency?
older/malnutrition
alcoholics
strict vegans
bariatric surgery
blind loop syndrome
7
which drugs cause B12 deficiency?
methotrexate
bactrim/neomycin
phenytoin
metformin
8
which inactivates B12?
nitrous oxide
9
what labs do you do on B12 suspicious pts?
B12, folate levels
MMA-intermediate metabolite
homocysteine-intermediate metabolite
intrinsic antibodies
10
what test is used to determine if a pt has a hemoglobinopathy?
hgb electrophoresis (specific for sickle cell)
11
what type of hemoglobin might be protective in sickle cell?
F
12
when does B thal major start to become symptomatic?
6 months
13
what is the prognosis for B thal major?
80% die in 1st 5 yrs of life
14
why do you have Fe overload with transfusions?
EPO increases the guts absorption of Fe
15
which virus would cause a B thal major pt to become aplastic?
parvovirus B19
16
what are smear findings of B thal major?
microcytosis
hypochromic
tear drops
targe cells
inclusion bodies
17
what is B thal minor?
asymptomatic b/c of being a trait carrier
-will show target cells on smear
18
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)
19
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
20
what are common triggers of pain crises?
infections
21
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
22
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
23
what is a neurological complication of sickle cell?
stroke
ischemia w/impaired neurocognitive function
24
what can methadone cause?
cardiac arrhthmias
25
what is priapism?
erection lasting more than 4 hours
26
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
27
what is the most common finding of aplastic anemia?
petechiae (oozing from the mouth)
28
what is the DDx for aplastic anemia?
leukemia
MDS (myelodysplastic syndrome)
marrow replacement (small cell lung CA)
PNH (infection)
overwhleming infection
29
what heart correction could cause hemolysis?
mechanical heart valve
30
what kind of genetic disorder is G6PD?
x-linked disorder
31
what is the problem in G6PD?
RBC membrane is fragile and can have complications b/c of foods (fava beans) and medicines
32
what is used to help improved cell membrane synthesis?
folic acid
33
what is warm agglutin AIHA?
IgG related antibodies-need to stay in cool settings
34
what is cold agglutin AIHA?
igM antiboides-need to stay warm
35
where is ferritin stored?
liver
spleen
bone marrow
36
when are ferritin levels increased?
acute phase illness
37
which Hgb is protective
HgF
38
which virus can cause aplastic crises?
parvovirus 19
39