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Flashcards in heme Deck (38)
1

Lab value indicative of alcohol withdrawal

AST:ALT ratio 2:1 and less than 300

2

AST and ALT >1000

Tylenol intoxication, ischemia, or viral hepatitis

3

Normal serum osmolarity

280-300

4

Normal levels for neutrophils, lymphocytes, myocytes, eosinophils, basophils

60, 30, 6, 3, 1
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5

Ideal LDL

< 100

Near/above optimal: 100-129
Borderline high: 130-159
High: 160-189
Very High: >190

6

Ideal Total Cholesterol

< 200

Borderline high: 200-239
High: >240

7

Ideal Triglyceride level

< 150

8

Ideal HDL

> 40 for women; > 50 for men

9

Enzyme that suggests alcoholic liver disease

AST

10

Normal Hgb

12-15 for women
13.5-17 for men

11

Types of microcytic anemia

Iron deficiency, Anemia of chronic disease, thalassemia, sideroblastic anemia

12

Iron deficiency anemia

Microcytic anemia. The most common type of anemia overall.

Labs:
Ferritin low
Serum iron low
TIBC elevated
RDW elevated

13

Thalassemia

Microcytic anemia present since birth. Genetic mutation that does not allow the person to make hgb normally.

Iron indices are usually normal
RDW is WNL

Microcytosis is typically disproportionate to the anemia

Most common in African Americans, Asians, Mediterraneans.

Tx: Do Not give iron! Transfusions in severe forms.

14

Macrocytic Anemia Definition and types

Due to abnormalities of DNA synthesis with resultant problems in RBC division and formation.

MCV >100

Pernicious anemia, folic acid deficiency, B12

15

Pernicious anemia

Occurs as a result of insufficient B12 usually due to deficiency in intrinsic factor.

Only anemia to cause neuropsychotic changes that are irreversible

Elevated MMA is the indicator of pernicious anemia. Antibodies to IF and parietal cells may also be measured.

Treatment: B12 (cyanocobalamin) 100 mcg IM daily for one week, weekly for the next 4-6 weeks and then monthly for life

16

Folic acid deficiency

A result of dietary folate deficiency.

Some drugs can contribute: Phenytoin, bactrim, INH, oral contraceptives

17

Anemia of chronic disease

Second most common form of anemia after IDA

Generally a mild anemia

Causes: thought due to decreased life span of the erythrocyte. Renal failure - due to deficiency of erythropoietin production, also iron and folic acid are lost during dialysis.

18

Sickle cell anemia

When exposed to lower oxygen tension, RBCs assume a sickle shape, resulting in stasis of RBCs in capillaries. Painful crises are caused by ischemic tissue injury resulting from obstruction of blood flow produced by sickled erythrocytes. Microinfarcts occur and predispose the pt. to infections and anoxia.

Treatment: prevention of crisis, O2, IV antbx for infection, aggressive pain management, hydrea only or extreme cases (can cause malignancy)

19

Idiopathic thrombocytopenia purport (ITP)

autoimmune process of platelet dysfunction

Steroids boost plt count

Only transfuse platelets when pts. are actively bleeding

20

CLL

• Major pathophysiologic deficit in CLL is failure of B cells to mature into plasma cells that synthesize immunoglobulins, resulting in hypogammaglobulinemia. This leads to...
• Suppression of humoral immunity caused by reduction in normally functioning B cells is the most significant effect of CLL.
• Individuals are at risk for both infections and development of autoimmune diseases resulting in secondary cancers.
• Median age of presentation is 65 (90% of cases occur after age 50)
• Most common type of leukemia in older adults
• Poorer prognosis with increased age
• Incidental discovery is common as this type of leukemia is often asymptomatic.
• Isolated lymphocytosis is the hallmark of CLL; Minimum level is >5000; usual range is 40,000 to 150,000

21

CML

• A myeloprolifeative disorder characterized by overproduction of myeloid cells.
• CML is characterized by a specific chromosomal abnormality, the Philadelphia chromosome.
• Early CML does not behave like a malignant disease and bone marrow function is retained.
• CML is unstable and without treatment, the disease progresses to an accelerataed and acute blast phase. The acute effects are similar to those of acute leukemia but with more prominent and painful splenomegaly.
• Median age of presentation is 55 years of age

22

ALL

• 80% of all childhood leukemias, with peak onset at ages 3-7.
• 20% of all adult leukemias with second peak at age 60.
• ALL is the most common cancer and the leading cause of death in children younger than 15 years.
• Pancytopenia with circulating blasts is the hallmark of ALL

23

AML

• Comprises 80% of leukemias in adults over 20
• Median age of presentation is 50-60 years of age
• Long-term survival is 40%
• Auer's rods are present

24

Earliest indicator of success of Heparin therapy in a pt. with DIC

increased fibrinogen

25

Felty's Syndrome

Immune neutropenia that can be seen with sero positive rheumatoid arthritis

26

Hodgkins Lymphoma

• A malignant disorder of lymphoreticular origin, characterized histologically by the presence of multinucleated giant cells (Reed-Sternberg cells).
• Bimodal age distribution - 15-34 yrs. and again at >50 yr.
• More common in males, whites, and those from higher socioeconomic classes.

27

Non-Hodgkins Lymphoma

• Heterogeneous group of lymphocytic cancers predominantly of B-cell origin and lacking Reed-Sternberg cells that produce a diverse group of malignancies.
• Average age of patients is early 40s.
• Median survival is 6-10 years; overall prognosis is not favorable.
• Complete remission may occur in 60-65% of all patients.

28

Ann Arbor staging of lymphoma

Stage 1: single lymph node or single extralymphatic origin

Stage 2: 2 or more lymph node regions or sites on the same side of the diaphragm

Stage 3: involvement of lymph node regions or sites on both sides of the diaphragm

Stage 4: diffuse or disseminated involvement of more than one organ with or without associated lymph node involvement. Bone marrow involvement confers stage IV designation.

29

Disseminated Intravascular Coagulation (DIC)

An abnormal stimulus results in the formation of excess thrombin, which in turn, causes:
fibrinogen consumption, irreversible platelet aggregation, activation of the fibrinolytic system

Most sensitive lab is d-dimer; hypofibrinogenemia is also a very important finding.
DIC panel: fibrinogen decreased, fibrinogen monomer positive or elevated, d-dimer, PT INR

Acute DIC due to blood exposure to tissue factor (TF), normally seen with vascular injury
Chronic DIC due to constant/intermittent low amounts of tissue factor exposure
TF: procoagulant (clotting)

30

FFP transfusion

o FFP should be administered only to provide coagulation factors or plasma proteins that cannot be obtained from safer sources.
o FFP may be indicated for emergency removal of the coagulopathy induced by warfarin anticoagulants.
o Should be administered as boluses as rapidly as feasible so that the resulting factor levels allow hemostasis.
o The half-life is only 2-6 hours, so repeat boluses are commonly needed.
o Prophylactic use of FFP for procedures is usually not needed. Pts. do not usually bleed as a result of coagulation factor insufficiency when the INR is < 2.0

31

Platelet transfusion

Usually withheld until the count is <10

Each unit is expected to raise the count by 10; usual dose is 6 units

Recheck count one hour post transfusion

32

Cryoprecipitate transfusion

o Each bag is a concentrated source of factor VIII, vWF, fibrinogen, factor XIII, and fibronectin.
o Commonly used to treat pts. with inherited coagulopathies such as hemophilia A, vWD, or factor XIII deficiency.
o In the ICU, it is more commonly used to replenish fibrinogen.
o Usual dose is 10 bags, then 6-10 bags every 8 hours or as needed to keep fibrinogen level >100.

33

Heparin Induced Thrombocytopenia (HIT) type II

autoimmune, immune system attacks platelets causing clotting and bleeding at the same time.
Order PF4 antigen
If bleeding or clot is present, switch to a thrombin inhibitor: argatroban or lepirudin

34

IgA

X

35

IgG

X

36

IgM

x

37

IgE

x

38

Hemolysis lab workup

x