heme Flashcards
(38 cards)
Lab value indicative of alcohol withdrawal
AST:ALT ratio 2:1 and less than 300
AST and ALT >1000
Tylenol intoxication, ischemia, or viral hepatitis
Normal serum osmolarity
280-300
Normal levels for neutrophils, lymphocytes, myocytes, eosinophils, basophils
60, 30, 6, 3, 1 No one Likes My Educational Background
Ideal LDL
< 100
Near/above optimal: 100-129
Borderline high: 130-159
High: 160-189
Very High: >190
Ideal Total Cholesterol
< 200
Borderline high: 200-239
High: >240
Ideal Triglyceride level
< 150
Ideal HDL
> 40 for women; > 50 for men
Enzyme that suggests alcoholic liver disease
AST
Normal Hgb
12-15 for women
13.5-17 for men
Types of microcytic anemia
Iron deficiency, Anemia of chronic disease, thalassemia, sideroblastic anemia
Iron deficiency anemia
Microcytic anemia. The most common type of anemia overall.
Labs: Ferritin low Serum iron low TIBC elevated RDW elevated
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.
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
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
Folic acid deficiency
A result of dietary folate deficiency.
Some drugs can contribute: Phenytoin, bactrim, INH, oral contraceptives
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.
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)
Idiopathic thrombocytopenia purport (ITP)
autoimmune process of platelet dysfunction
Steroids boost plt count
Only transfuse platelets when pts. are actively bleeding
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
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
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
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
Earliest indicator of success of Heparin therapy in a pt. with DIC
increased fibrinogen
