Flashcards in Hemonc2 Deck (109):
Pt has fatigue and pallor- what lab should be run? What to expect?
suspect anemiaH&H- Hbg and Hct are low
What is the general rule for calculating hbg and hct?
What lab to do next if H&H are low?
What if retic is low/high, what does it mean and what is next step?
retic is high - bone marrow is able to compensate for blood loss --> check for blood loss or hemolytic anemiaretix is low - bone marrow is not making RBC --> MCV
What are the categories for MCV and what is next step?
microcytic check iron studiesnormocytic 100 --> aplastic anemia, tumor, renal failure, G6PDmacrocytic >100 --> check B12 and folate deficiency
What if Fe and TIBC is decreased? What should RDW and Ferritin be?
anemia of chronic dzRDW: normalferritin: normal
What if Fe is low but TIBC is high? What if older age-what to suspect? What should RDW and Ferritin be?
iron def. anemiacolon cancerRDW: high Ferritin: low
What if Fe if normal but TIBC is norm/low? What should RDW and Ferritin be?
lead poisoningthalassemiaRDW: high/norm Ferritin: high/norm
If pt has high TIBC and low Fe and ferritin - what PE to expect?
iron def anemiakoilnychiaglossitisplummer-vinson sx -thin tissue growth to blocks esophageal pipe
How to tx iron def anemia?
iron replacement - ferrous sulfate
Is MCV high or low in iron def. anemia?
How to dx B major thalassemia/Cooley's anemia and what to expect on PE?
electrophoresis: HbF elevatedblood smear: microcytic anemia + target cellsPE: chipmunk face; normal at birth
How many genes are affected in B major thalassemia?
Pt is mediterranean but Fe, Ferritin, TIBC, and RDW is normal and iron supplements don't help - what lab should be done and what to expect?
Beta minorblood smear- howell jolly bodieselctrophoresis- high A2 and F
What Beta thalassemias are entirely blood transfusion dependent?
intermediate and severeintermediate only needs after stressors
Pt has trouble exercising at school - what labs should be done and what to expect?
alpha thalassemiairon studies - low hct and MCV but normal RBCblood smear - Aconthocyteselectrophoresis - LOW HbA, HbA2 and Hb F
What dz have acanthocytes on blood smear - what is next step (what to expect on labs)?
alpha thalassemiahemoglobin Helectrophoresis- hemoglobin H: HbH; alpha thalassemia: low HbA, HbA2, and HbF
What is hydrops fetalis?
still born d/t all thalassemia being goofed up
How to differentiate anemia of chronic dz and iron def anemia via labs?
anemia of chronic dz has high ferritin but iron def has low ferritin
Pt is mediterranean and has chipmunk face - how to tx?
What is the pathophys/cx of anemia of chronic dz? Tx?
anemia is secondary to some sort of underlying dz (TB)tx: self limiting-do not give iron
Pt has fatigue, recurrent infxn, easy bruising and seizures (carbamazepine)?
What can occur in aplastic anemia and what can this lead to eventually?
pancytopenia - anemia, neutropenia, thrombocytopeniaacute leukemia
What age does aplastic anemia affect?
15-30yo or >60yo
How to dx and tx aplastic anemia?
bone bxbone marrow transplant
Pt has Crohn's dz and had colon resected-what are they at risk for?
B12 def b/c it cannot be absorbed- resected out
Where is B12 absorbed and what does vit B12 bind to?
where: terminal ileumwhat: intrinsic factor
Pt has NO intrinsic factors? How should labs look like?
pernicious anemialabs: low MCV, low B12, HIGH methylmalonic acid
How to differentiate between B12 def and folate def? What can be the same in BOTH?
B12 has NEUROPATHY - numbness in extremitiesB12 has HIGH methylmalonic acid both: homocysteine
How to dx pernicious anemia?
How to tx B12 def?
supplemental shots: daily --> wkly --> monthly
Pt has seizures (phenytoin) + alcoholic-what PE should you expect?
folate defNO neurological probs
Which dz have howell-jolly on blood smear?
beta minorfolate def
What are indications for hemolysis (RBC)?
lack of haptoglobin (LOW) - if hbg is destroyed then haptoglobin that is attached to hbg is destroyed too!LDH is high (HIGH)- LDH is released from RBC during destructionDARK urine- suggesting intravascular hemolysis
What are the different blood smears re: hemolytic anemia and what dz could they suggest?
helmet cells/spherocytes - extravascular hemolysisheinz bodies - G6PDsickle cellschistocytes -intravascular
What is an autosomal recessive dz and what to expect on electrophoresis (why)?
sickle cellHb S - Hb S replaces Hb A
What supplement is crucial for pts w/ hemolytic anemia?
Sickle cell have anemia?
Pt has splenomegaly, AA- what to expect on lab results? What to do w/ spleen?
leukocytosisthrombocytosishigh bilirubin sickle-dex testHb Ssplenectomy
Pt with sickle cell got infxd w/ parvovirusb19- tx?
aplastic crisis occurs - blood transfusion to tx
Pt w/ sickle cell - what haps to heart, bone, skin, lung?
heart- cardiomegalybone- pain crisis; avascular necrosisskin - non healing ulcers lung- acute chest syndrome - similar to pneumonia
How to tx sickle cell - acute vs chronic?
acute: O2, hydration, abx - NO TRANSFUSIONchronic: folic acid, vaccinate, bone marrow transplant, HDYROXYUREA
What are the 2 types of extravascular hemolytic dz?
hereditaroy spheroctyosisautoimmune hemolytic anemia
How to differentiate between hereditary spherocytosis and autoimmune hemolytic anemia?
direct coomb's test: hereditary spherocytosis is negative
Pt has splenomegaly, gallstone, jaundice, and high MCHC- what to expect on blood smear and what dx test?
hereditary spherocytosisblood smear: spherocytesosmotic fragility test - dx
How to tx hereditary spherocytosis?
Pathophys of spheroctyosis?
autosomal dominant dz where the RBC size is defected and cannot go through the spleen --> EXPLODES!
Male mediterranean that ate fava beans + dark urine + jaundice- what to expect on blood smear?
G6PD defheinz body + bite cells
Male w/ MD that is recovering from UTI?
G6PD defcx: nitrofuratoin, bactrim, glipizide, NSAIDs
Pt has leukemia and went to Hawaii for summer vacation - fatigue + jaundice + splenomegaly?
warm autoimmune hemolytic anemia - extravascular IgG
What is happening in autoimmune hemolytic anemia?
depending on type of AIHA, antibody attacks RBC --> goes into spleen --> macrophage eat them --> spherocyte (defect on membrane occurs) --> splenomegly --> anemia sx
How to tx IgG vs IgM AIHA?
IgG responds to steroids b/c it is extravascularIgM does NOT respond to steroids b/c it is intravascular; use Riuximab
Pt has polycythemia vera- what to expect on labs?
HIGH:RBC, platelet, B12, uric acids
What is happening in polycythemia vera? Tx?
blood is too thick and getting sludgytx: drain blood out, PREVENT THROMOBSIS , splenectomy
Pt has hard time swallowing cold drinks?
cold autoimmune hemolytic anemia -intravascular IgM
Pt has lead poisoning-what to expect on blood smear?
Pt has recurrent epitaxis - what are cx of this dz?
thrombocytopeniacx: bone marrow fails, invasion, injury; autoimmune destruction; exogenous destruction: HIV, HIT2
Pt is healthy and in for annual exam but labs show thrombocytopenia?
Child had flu and now has petechiae and ecchymoses- what to expect on lab?
immune thrombocytopenic purpuraisolated thromboctyopenia
What to expect in adults w/ immune thrombocytopenic purpura and how to tx?
mucocutaneous bleedingtx: PLASMAPHERESIS +/- steroids +/- splenectomy
Pt has HUS + fever + altered mental status? What is this a def of? What to expect on labs-why?
thrombotic thrombocytopenic purpuramicroangiopathic hemolytic anemia -MAHA --> def of ADAMTS13Labs show NORMAL PT and PTT b/c it is only platelets getting eaten NOT clotting factors!
Child has acute renal failure + thrombocytopenia-what to expect on blood smear?
hemolytic uremic syndrome (HUS)MAHA schistocytes
How to tx HUS?
What is CONTRAINDICIATED IN TTP?
Pt has DVT after heparin-what drug was probably used? How many days does it take to take effect?
heparin induced thrombocytopeniaunfractionated heparin5-14days
Pt has recurrent epitaxis, easy brusing since childhood-what to expect on labs?
von willebran dznormal platelet count and PT, PTT but b/c platelets are useless d/t lack of von wille bran --> bleeding time is LONG
How to tx von willebran dz?
ddAVP to help stimulate vWF from endotheliumavoid NSAIDs
Male pt has hemoarthrosis - what to expect on labs?
hemophilia Anormal bleeding time and normal platelet count but LONG PT
Defect of factor VIII can lead to what dz?
vWD and hemophilia A in males
How to tx hemophilia A?
PT vs PTT vs bleeding time vs thrombin time?
PT: extrinsic pathway - prolonged by warfarinPTT: intrinsic pathway - prolonged by heparinthrombin time: how much fibrinogenbleeding time: fxn of platelet
Pt has coagulopathy, what to think of and how to differentiate the two?
vita K def and liver dzvia K def: PT is LONG but PTT is normalliver dz: PT AND PTT is LONG *both platelet ct is normal
Pt has a blood draw but cannot stop bleeding and has sepsis? What is going on? What are they at risk for?
Disseminated Intravascular Coagulationbody is clotting and bleeding at random placesrisk: organ failure, PE
What labs for DIC-increased and decreased?
increased: PTT, PT, bleeding time, d-dimerdecreased: platelet ct
Tx for DIC?
Pt took abx, on warfarin, and now cannot stop bleeding after cutting hand? What to expect on labs?
vita K def-cx: abx and wafarinlabs: long PT
Tx for vita K? Acute?
What organ is responsible for making clotting factors?
How to reverse heparin?
Pt has rash after taking herbal supplements? What is it?
drug induced thrombocytopenia - type II hypersensitivity
Platelet count for thrombocytosis? Risk for?
>400,000DVT, PE, stroke
What are the sx for multiple myeloma?
CRABCalcium (hypercalecmia)Renal failureAnemiaBone lesions
Pt is in ICU + NPO- at risk for?
vita K def
What dz have M spike on electrophoresis? What is the pathophys?
multiple myelomawaldenstrom macroglobulinemiasmonocolonal gammopathy of undetermined significance pathophys: monoclonal neoplasms of B cell line --> increase neoplastic cells
Pt has fever, night sweats, wt loss, 65yo and M spike on electrophoresis?
Pt is asymptomatic but has monocolonal proteins in urine - may lead to?
monocolonal gammopathy of undetermined significancelead to: multiple myeloma
Pathophys in multiple myeloma?
bone marrow is replaced by malignant plasma cell
Pt has bone pain, anemia, renal failure - what do they die from and what to see in urine?
recurrent infxnfree light chains: bence jones + M-protein in urine
Tx for multiple myeloma?
hematopoietic cell transplantation - usually for the youngchemo/radiation
Pathophys for Waldenstrom macroglobulinemia?
Pt has painless lymphadenopathy w/ fever and wt loss? Labs-diagnostic?
Hodgkinlymph node bx- REED STERNBERG CELL CXR and CT to eval how much lymph nodes bone marrow bx- if bone is invaded
What staging is in Hodgkin lymphoma? What is it?
ann arbor stage I: ONE lymph nodestage II: involving 2+ lymph nodestage III - BOTH sides of diaphragm stage IV - extralymphatic sites A- no sxB - fever, wt loss, night sweats
Hodgkin has a strong association w/what virus?
How to tx Hodgkin?
Stage I, II, and IIIA - radiationStage IIB, IV - chemo
Pt has painless lymph node + abdominal pain/hepatosplenomegaly + anemia? Labs -diagnostic?
non hodgkin lyphoma labs: lymph node bx - 4wks-diagnostic
What is low, inter, and high grade non hodgkin? Which are B cell and T cell origin?
low: elderlyintermediate: middle agedHigh grade: kids B cell origin: low and intermedT cell origin: high
Rapid progressing tumor - non hodgkin? Common in? What to expect on bx?
What is mycosis fungoides?
t cell lymphoma of the skin
Pt has acute renal failure after chemo? What to expect on labs?
tumor lysis syndromeHYPERkalemiaHYPERuricemiaHYPERphosHYPOcalcemia
Tx for acute lymphocytic leukemia?
What are the two types of acute leukemia?
acute myelogenous (AML)acute lymphoblastic (ALL)
Pt is adult (40-60yo) w/ pancytopenia after radiation? What to expect on labs?
acute myelogenous labs: aure rods
Pt is >60yo coming in for annual exam and find isolated increase in WBC? How is this staged?
Chronic lymphocytic leukemia stage 0- lymphocytosisstage I - lymphadenopathystage II - organomegalystage III - anemicstage IV - thrmboctopenic
How to dx chronic lymphocytic leukemia? Tx?
bone marrow bxsupportive
How phases are there in chronic myelogenous leukemia? What would you see on lab? Tx?
crhonic, accelerated, blast crisisphiladelphia chromosomeimatinib
Pt has severe prutitus after a hot bath or shower? What to see on lab?
polycythemia vera lab: high RBC ct, B12; low erythropoietin
Polycythemia vera tx?
Polycythemia vera at risk for-life threatening?
thrmobitc (DVT, CVA, MI)bleeding- GI bleeding