Heme 1 Flashcards
(100 cards)
1
Q
a high WBC can indicate what?
A
infection
leukemia
2
Q
a low WBC can indicate what?
A
acute leukemia
3
Q
first line of defense in a patient
A
neutrophils
4
Q
release histamine
seen in patients w/ allergies
A
eosinophils
basophils
5
Q
what carries the oxygen in the RBCs?
A
hemoglobin
6
Q
normal hemoglobin in men
A
13-18
7
Q
normal hemoglobin in females
A
12-16
8
Q
normal hematocrit in males
A
45-52
9
Q
normal hematocrit in females
A
37-48
10
Q
tells you the size of the red cells
A
MCV
normal is 80-100
11
Q
Average amount of hgb in average red cell
A
MCH
12
Q
Average concentration of hgb in given volume of red blood cells
A
MCHC
13
Q
variability of red cell size and shape
A
RDW-Red Cell Distribution Width-
14
Q
what is the cutoff for low platelet count (start to get concerned)
A
50,000
15
Q
normal platelet count
A
150,000-450,000
16
Q
decrease in one or more of major RBC measurements from a CBC
A
anemia
17
Q
Hct is usually ___X’s the hgb
A
3
18
Q
Erythropoeisis occurs in the____________
A
bone marrow
19
Q
who can you see elevated RBC levels in?
A
higher elevation
athlete
smoker
20
Q
what is the life of a RBC
A
110-120
21
Q
Reticulocyte count __% of total circulating cells.
A
1%
22
Q
with an acute episodes leading to anemia what symptoms will you have?
A
exertional dyspnea dyspnea at rest fatigue boudning pulse palpitations 'roaring in ears' leg pain
23
Q
what are the 3 mechanisms in the kinetic approach?
A
decreased RBC production
increased RBC destruction
blood loss
24
Q
low levels of what hormones can lead to decreased RBC production
A
lack of TSH
lack of testosterone
lack of EPO
25
with aplastic anemia what will be seen?
low level of all counts (RBC, WBC)
26
what cause macrocytic anemias (MCV>100)
Folate, B12 deficiency
Abnormal RBC maturation
Alcohol Abuse, liver disease
27
what can cause microcytic anemia
Decreased iron content within RBC (MCH)
Decreased iron availability
Decreased heme synthesis
Decreased globin production
28
what are the 3 most common causes of anemia?
IDA, thalassemia, anemia of chronic disease.
29
what poisonings can interfere w/ RBC production
lead and copper
30
what other levels are affected with IDA?
Decreased ferritin, increased TIBC, decreased iron concentration
31
what will be normal with anemia of inflammation?
ferritin (or can be increased (artificial)
32
what is seen with bone marrow supression
differences in white count and platelets as well as RBC s
33
Main cause of VIt B12 deficiency?
people who have undergone gastric bypass
34
what OTC products should you ask someone w/ anemias about?
NSAIDs (affects the kidneys and gastric ulcers)
35
a new onset of neuropathy w/ anemia is probably due to what?
B 12 deficiency (can also cause pancytopenia)
36
if you see Schistocytes what is going on?
hemolysis somewhere
| cells are torn apart
37
infection with what can cause chronic hemolysis and blunt erythropoiesis?
parvovirus
38
how do you treat chronic hemolysis?
steroids (need to cover w/ PPI to prevent more anemia)
39
are bone marrow biopsies usually indicated in anemia?
no
40
who is iron deficiency anemia seen more in?
women and children
41
what does absolute iron deficiency mean?
Iron stores absent in BM, liver and spleen
42
what is ferritin used for?
iron deficiency anemia
43
causes of iron deficiency
Blood loss-overt or occult
Decreased iron absorption (celiac, gastritis)
Foods and medications can impair iron absorption
Hemodyalysis
Gastric Bypass
Congenital Iron deficiency
44
what is pica for ice?
pagophagia
45
symptoms of iron deficiency?
Headache, weakness, irritability, fatigue, exercise intolerance, PICA
Many are asymptomatic
Glossal pain, decreased salivation, dry mouth
46
normal ferritin levels
18-200
47
Preverted appetite for substances not fit for food
Pica
48
what is an Excellent picture of iron stores
serum ferritin (but can be falsely elevated)
49
Girls ages 12-18, nonpregnant women of childbearing age, screen for anemia every how many years?
5-10 years
50
pregnant women should be on how much iron each day?
30 mg/day
51
Patients with hgb <__ should be referred onto hematologist
9
52
if a person takes an antacid when can they take their iron?
2 hours before or 4 hours after
53
how much elemental iron do people w/ IDA need?
120-150 mg of elemental iron
54
indications for IV iron
Indicated for excessive blood loss
Inflammatory disease
Chronic Kidney disease
55
what is one of the biggest iron infusions that can cause anaphylaxis
Infed (Iron Dextran)
| pretreat w/ bendaryl
56
what is an IV iron that is magnetic. Can interfere w/ MRI results
Feraheme
57
what will be seen on a peripheral smear w/ B12 and folate deficiencies
hypersegmented neutrophils on smear
58
causes of a folate deficiency?
```
nutritional;
substance abuse;
depressed patients, nursing homes;
celiac disease;
inflammatory bowel disease;
short bowel syndrome;
pregnancy/lactation; medications
```
59
causes of a B12 deficiency?
```
Pernicious anemia;
bariatric surgery;
gastritis; Chrons disease;
tapeworm; pancreatic insufficiency;
vegans;
medications
```
60
what meds can cause a B12 deficiency
neomycin
metforminn
PPI and H2
61
what drugs can cause a folate deficiency?
methotrexate
trimethoprim
ethanol
phenytoin
62
what lab do you need for pernicious anemia
parietal cell antibody test
63
what are metabolic intermediates w/ B12 and folate anemias
MMA and homocysteine
64
tx for folate deficiency
Folate-1-5 mg/day orally for 1 to 4 months
65
tx for B12/ pernicious anemia
1000 mcq SQ daily X 1 week, q week X 4, then monthly
66
when does Hgb rise w/ B12 and folate deficiency?
rises in 10 days, returns to normal in 8 to 10 weeks.
67
when do neuro problems w/ b12 or folate deficiencies resolve?
3 months
68
are blood transfusions usually indicate in Vitamin B 12 and folate def?
no
69
if anemia in the older adult usually severe or mild?
mild, usually sits above 10
70
causes of anemia in older adults
1/3 nutrition
1/3 CKD or chronic disorders
1/3 is unknown
71
median age of anemia of the older adult
>65
72
what do you need to dx myelodysplasia
bone marrow biopsy
73
A hemoglobinopathy which manifests as a chronic hemolytic anemia occuring almost always in people of African origin
sickle cell anemia
74
what is there an increased risk of w/ sickle cell anemia?
```
stroke
intracrnail hemorrhage
neurocognitive decline
cardiac complications
restrictive and obstructive lung dz
renal failure
```
75
what is the RBC of sickled cells?
17 days
76
what level will be elevated w/ sickle cell anemia?
LDH
77
how do you diagnose sickle cell dz?
Hb electrophoresis (HbS is elevated generally)
78
how do you treat sickle cell dz?
analgesics and IV
may need transfusions
Rx- hydroxyurea (fetal Hb), folate
splenectomy
79
what type anemia is often seen with sickle cells?
normocytic hemolytic anemia
80
with hemolytic anemias what is retic count increased to?
Normal retic count increased to 4 to 5 %
81
Anemia due to shortened survival of RBC
hemolytic anemia
82
Intracorpuscular Defects that can lead to hemolytic anemia
membrane injuries
unstable or missing RBC membrane proteins
PNH (paroxysmal nocturnal hemoglobinuria)
83
Extracorpuscular factors causign hemolytic anemia
Antibodies directed against RBC membrane components. Stasis, trapping of RBCs in spleen
84
what other random things can cause hemolytic anemias?
valves, ventricular assist devices, DIC, TTP
malaria
snake bites, insects, thermal burns
certain strain of C Diff
85
why is haptoglobin decreased in a hemolytic anemia?
Release of hgb, binds to haptoglobin, resulting in hgb-haptoglobin complex that is removed by the liver,
86
what will you see w/ someone in hemolytic anemia?
jaundice
splenomegaly
abnormal cells on smear (schistocytes, tear drop)
87
tx for hemolytic anemia
glucocorticoids 1mg/kg
next move to Cytoxan, Rituxan, splenectomy
immunosupressives and cytoxic agents (1 months for effect)
88
Hgb >16.6 in women, >18.5 in men
polycythemia
89
what is the median age for polycythemia?
60
90
Acquired or inherited mutation leading to an abnormality within RBC progenitors
primary polycythemia
91
symptoms of polycythemia
```
Pruritis
Erythromelalgia
Thrombosis
Visual Disturbances
GI complaints
```
92
what do people w/ secondary polycythemia look like a lot
smokers, overweight, sleep apnea
93
how to approach polycythemia
```
Confirm with second test
H & P
Pulse oximetry
CBC, urinalysis
LFTs
CXR
```
94
concern w/ polycythemia
burnout of the bone marrow
can move into myelofibrosis
or a type of leukemia
95
causes of secondary polycythemia
```
Living at high altitudes
Intracardiac or intrapulmonary shunts
Renal transplant
Family history of PC
Medications
Smoking
Volume depletion
Carbon Monoxide
```
96
what mutation causes primary polycythemia?
JAK2 mutation
97
is EPO increased in secondary or primary polycythemia
secondary
98
what can polycythemia transform into?
AML/MDS
99
tx for polycythemia?
phlebotomy to keep hct <42
100
if someone w/ polycythemia has a high risk of thrombosis what do you give them?
hydrea
| ASA
