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Hematology/Lymph > MDT's Hematology > Flashcards

MDT's Hematology Flashcards

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1
Q

What is Anemia defined as?

A

A HCT <41% in males or <37% in females

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2
Q

What are symptoms of Anemia?

A
  • Signs of primary Hematologic diseases
    • Lymphadenopathy
    • Hepatosplenomegaly
    • Bone tenderness
  • Mucosal changes (smooth tongue)
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3
Q

What labs do you get with Anemia?

A
  • CBC w/ differential
  • Iron with Total Iron Binding Capacity (TIBC)
  • Microscopic analysis
  • Hemoglobin electrophresis
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4
Q

Treatment of Anemia?

A
  • Identification of cause of blood loss, esp. occult blood loss
  • Specific once cause of anemia established
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5
Q

When to refer for Anemia?

A
  • Refer to Internal Medicine if cause of anemia is unknown
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6
Q

Essentials of Diagnosis of Iron Deficiency Anemia

A
  • Caused by bleeding unless proved otherwise
  • Responds to iron therapy
  • Serum Ferritin <12mcg/L
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7
Q

General considerations for Iron Deficiency Anemia

A
  • Most common cause of anemia is iron deficiency
  • Most important cause of iron deficiency anemia is blood loss
  • Menstruation, pregnancy, and frequent blood donors increase chances
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8
Q

Physical findings of anemia

A
  • Fatigue, Tachycardia, Tachypnea, and palpitations on exertion
  • Dysphagia
  • Pica (food cravings, i.e. ice chips)
  • Severe causes skin/mucosal changes:
    • smooth tongue
    • brittle nails
    • cheilosis
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9
Q

Labs for Iron Deficiency Anemia

A
  • CBC w/ differential (decreased Mean Corpuscular Volume, MCV)
  • Iron with Total Iron Binding Capacity (TIBC)
  • Ferritin value <12mcg/L
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10
Q

Treatment of Iron Deficiency Anemia

A
  • Identification of cause of blood loss
  • Ferrous Sulfate 325 mg
  • Parental Iron (only if intolerance to oral iron, GI disease)
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11
Q

What are the contraindications for Ferrous Sulfate?

A
  • Hemolytic anemia
  • Peptic ulcer disease
  • Ulcerative colitis
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12
Q

Essentials of Dx Vitamin b12 Deficiency

A
  • Microcytic anemia
  • Neutrophils of peripheral blood smear
  • Serum Vitamin b12 level <100pg/mL
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13
Q

General considerations of Vitamin b12 deficiency anemia?

A
  • B12 found in food products from animals
  • Vegans at risk
  • Have for life
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14
Q

Lab findings for Vitamin B12 deficiency?

A
  • *Hallmark: megaloblast anemia (large RBC’s) on CBC**
  • Mean Corpuscular Volume (MCV) strikingly elevated
  • Overt B12 deficiency <170 pg/mL
  • Symptomatic B12 deficiency <100 pg/mL
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15
Q

Physical findings of Vitamin B12 deficiency?

A
  • Glossitis
  • Anorexia
  • Diarrhea
  • Pale, paresthesia, and difficulty balance (neuro Sx’s)
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16
Q

Treatment for Vitamin B12 deficiency?

A
  • B12 injections IM
  • 1st week: Daily
  • 1st month: Weekly
  • Monthly for life
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17
Q

Post diagnostic considerations for Vitamin B12 deficiency?

A
  • MEDEVAC for late stage
  • Hematology referral early stage
  • Lifelong disease
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18
Q

As part of coagulation process, what factors lead to fibrin clot formation?

A

Factor XII to Factor II

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19
Q

The intrinsic pathway of coagulation includes what factors? How is it measured in the lab?

A
  • Factors XII, XI, IX, VIII

- PTT

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20
Q

The extrinsic pathway of coagulation includes what factors? How is it measured in the lab?

A
  • Factors VII- PT
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21
Q

What are the convergence pathways for coagulation?

A

Factors X, V, and II

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22
Q

What factors of coagulation are Vitamin K dependents?

A

Factors II, VII, IX, and X

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23
Q

What are the congenital disorders of coagulation?

A
  • Hemophilia A
  • Hemophilia B
  • Recurrent Hemarthroses and arthropathy
  • Development of inhibitory antibodies to factor VII or IX
  • From infection with HIV or Hep C from contaminated blood in older Pt’s
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24
Q

What is a congenital disorder of coagulation factor VIII?

A

Hemophilia A

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25
What is a congenital deficiency of coagulation factor IX?
Hemophilia B
26
What is Disseminated Intravascular Coagulation (DIC)?
Systemic process with potential for causing thrombosis and hemorrhage
27
What coagulation can present as an acute, life-threatening emergency?
Disseminated Intravascular Coagulation (DIC)
28
Common causes of DIC?
- Sepsis - Malignancy - Trauma - Obstetrical complications - Intravascular hemolysis - Less commonly seen in: Heat stroke, crush injuries, and Rattlesnake/viper bites
29
What is the major principle of management of DIC?
- Treatment of underlying cause | - MEDEVAC
30
Medications for DIC?
- Heparin - Coumadin - Rivaroxaban - Apixaban - Pradaxa
31
Symptoms/Physical findings DIC?
- Ecchymosis (bruising) w/out any known trauma - Bleeding in joint spaces - Epistaxis - Bleeding from eyes - Very heavy vaginal bleeding
32
Labs for DIC?
- PT - PTT - INR - CBC
33
Complications of DIC?
- Anemia - Massive Hemorrhage - Hemoptysis
34
Overview of Glucose-6Phosphate Dehydrogenase?
- Commonly seen in American Black men, affecting 10-15% - Hereditary enzyme - Episodic hemolysis in response to drugs/infections
35
What are Heinz bodies?
- Oxidized hemoglobin denatures and forms a precipitant | - Causes membrane damage and removal of cell by spleen
36
What is Hemolysis?
Process of RBC's rupturing
37
Symptoms/physical findings of G6PD?
Usually healthy without chronic hemolytic anemia or splenomegaly
38
What drugs can cause hemolysis associated with G6PD?
- Dapsone - Primaquine - Quinidine - Quinine - Sulfonamides - Nitrofurantoin - Aspirin - Ciprofloxin
39
Treatment of G6PD
- No Tx necessary except to avoid oxidants - Pt education to avoid oxidants - Supportive monitoring CBC - Severe cases: potential to require blood transfusions - Possession of red dog tag
40
What is Sickle Cell Anemia?
An autosomal recessive disorder in which an abnormal hemoglobin (Hemoglobin S) leads to chronic hemolytic anemia - abnormal RBC is shaped as sickle cell
41
Why is Sickle Cell Anemia painful?
Sickle cells become trapped and cannot pass through capillary system causing lack of blood flow leading to ischemia
42
Symptoms/physical findings of sickle cell anemia?
- Jaundice - Pigment gallstones - Hepatosplenomegaly - Poor healing ulcers over lower tibia - Cardiomegaly - Chronic pain (esp. back and long bones)
43
Treatment of sickle cell anemia?
- Supportive care is mainstay * Maintained on folic acid supplements * Transfusions for aplastic or hemolytic crises - Keep hydrated - Search for underlying infection
44
MEDEVAC if complications for sickle cell anemia?
Yes
45
Pertinent physiology of sickle cell trait?
- Clinically normal, but have acute painful episodes with extreme conditions such as exertion at high altitude
46
Labs and Tx for Sickle Cell Trait?
- Screening for Sickle Cell hemoglobin | - No treatment necessary
47
What is leukemia?
Malignancy of the hematopoietic progenitor cells. These cells proliferate in an uncontrolled fashion and replace normal bone marrow elements
48
What are the two acute types of leukemia and what age are they normally diagnosed?
- Acute lymphoblastic leukemia (ALL): diagnosed in childhood | - Acute myeloid leukemia (AML): diagnosed about 60 yrs
49
Where are blasts located in association with leukemia?
- 20% in the bone marrow | - 90% in peripheral blood
50
Symptoms/Physical findings of Leukemia?
- Most usually only complain of fatigue - Bleeding in skin/mucosal surfaces (gingival bleeding, epistaxis, menorrhagia) - infection due to neutropenia (presentations include pneumonia, cellulitis, perirectal infection) - Gum hypotrophy - Bone/joint pain - Bone tenderness in sternum, tibia, femur - Enlargement of liver, spleen, and lymph nodes
51
Labs/Studies for Leukemia?
* * Hallmark is combination of pancytopenia with circulating blasts** - Hyperuricemia may be seen - Mediastinal mass seen on CXR in Pt's w/ ALL
52
Treatment for Leukemia?
- Refer to hematologist - MEDEVAC - Combo chemo and radiation therapy will be mainstay
53
Initial care and follow up for leukemia?
- Approx 70-80% of adults with AML under 60 achieve complete remission - Chemo leads to cure in 35-40% - Bone marrow transplant is curative in 50-60%
54
What is Leukocytosis?
High white cell count relative to normal physiological numbers
55
What is Leukopenia?
Low total white cell count (<4400 cells/microL)
56
In regards to Leukocytosis, what is high neutrophils (called Neutrophilia) indicative of?
- Bacterial infection - Inflammation - Metabolic disease - Stress
57
In regards to Leukocytosis, what is high lymphocytes (lymphocytosis) indicative of?
- Viral infection - Immune disease - Stress - Leukemia
58
In regards to Leukocytosis, what is high Eosinophils (Eosinophilia) indicative of?
- Skin diseases - Drug interaction - Parasite infection - Asthma
59
In regards to Leukocytosis, what is high Basophils (Basophilia) indicative of?
- Chronic myeloid leukemia
60
In regards to Leukocytosis, what is high Monocytes (Monocytosis) indicative of?
- Infection | - Autoimmune disease
61
What are the different etiologies of leukopenia?
- Infections (can be seen with viral: Hepatitis, HIV) - Medications - Nutritional vitamin deficiencies (B12, Folate, copper) - Hematological malignancies - Rheumatologic disorders
62
Signs/symptoms of Leukocytosis/Leukopenia?
- Evidence of infection: * Fever * Skin ulcerations, erythema, fissures, tenderness * Gingivitis, swelling, oral ulceration * Abnormal respiratory exam - Jaundice - Joint swelling/ bone pain - Rash - Lymphadenopathy - Neuro/psychiatric disorders
63
Labs for Leukocytosis/Leukopenia?
CBC w/ differential
64
Treatment for Leukocytosis/leukopenia?
Based on cause
65
What is thrombocytopenia?
Abnormally low amount of circulating platelets
66
What are potential causes of thrombocytopenia?
- Bone marrow failure/ malignancy - Disseminated intravascular coagulation - Chemo and radiation therapy - Nutritional deficiency (folate or iron) - Medications
67
Symptoms/physical findings for thrombocytopenia?
- Petechia (helps determine that deficiency is platelets rather than coagulopathy) - Mucocutaneous bleeding
68
Labs/Study of thrombocytopenia?
Platelet count below normal reference range
69
Treatment of thrombocytopenia?
- Stop potentially offending assignments - Evaluate for underlying cause - Referral to Hematologist or Internal Medicine - MEDEVAC if actively bleeding
70
What is thrombocytosis?
- Abnormally high amount of circulating thrombocytes (>450,000) - Elevated platelet count with absence of other causes
71
What are the two different categories that thrombocytosis are broken into?
- Reactive thrombocytosis | - Autonomous thrombocytosis
72
Symptoms/physical findings of thrombocytosis?
- Median age 50-60 yrs - 1st sign elevated platelets - Increased risk for thrombosis - Erythromelalgia - Splenomegaly in about 25%
73
Labs/Studies/EKG's thrombocytosis?
- CBC w/ differential - Blood smear - Iron studies - Inflammatory markers
74
Treatment of Thrombocytosis?
- Refer to Hematology if: * No infectious cause * Does not resolve on its own within 2-4 weeks
75
Initial care and follow up for thrombocytosis?
- Good Hx and PE - CBC and blood smear - Refer to Hematologist if you cannot determine etiology

Hematology/Lymph (8 decks)

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