Primary Care: Hematologic Conditions

Question 1

What is Anemia (non pregnant)?

Answer 1

Decrease in red blood cell mass or decrease in hemoglobin. Hemoglobin level less than 12

Question 2

Signs of Anemia

Answer 2

pallor, jaundice, Orthostatic hypotension, peripheral edema, pale mucous membranes and nail beds, smooth, sore tongue, splenomegaly, tachypnea, dyspnea on exertion, tachycardia or flow murmur

Question 3

Symptoms of Anemia

Answer 3

Fatigue, drowsiness, weakness, dizziness, headaches, malaise, pica, poor appetite, changes in food preferences, changes in sleep habits, changes in mood

Question 4

Microcytic anemias

Answer 4

iron deficiency, thalassemias, and anemia of inflammation

Question 5

Macrocytic anemias

Answer 5

folate and vit b12 deficiency, anemia associated with liver disease, increased reticulocyte production, and some medication effects

Question 6

Normocytic anemias

Answer 6

acute blood loss or conditions such as sickle cell disease, hemoglobin C disease, or glucose-6-phosphate dehydrogenase (G6PD) deficiency.

Question 7

Aplastic anemia

Answer 7

normocytic but characterized by pancytopenia, reduction in the number of red blood cells (RBCs), white blood cells (WBCs), and platelets.

Question 8

Which Anemia:
RBC: low
Hgb: Low
MCV: Low
MCH: Low
Reticulocytes: Low
ferritin: Low
Iron: Low
TIBC: High

Answer 8

Iron Deficiency

Question 9

Which Anemia:
RBC: Low
Hgb: Low
MCV: High
MCH: High
Reticulocytes: Low
Ferritin: High
Iron: High
TIBC: Normal

Answer 9

Vit B12 Deficiency

Question 10

Which Anemia:
RBC: Low
Hgb: Low
MCV: High
MCH: High
Reticulocytes: Low
Ferritin: High
Iron: High
TIBC: Normal

Answer 10

Folate Deficiency

Question 11

Which Anemia:
RBC: Normal
Hgb: Low
MCV: Low
MCH: Low
Reticulocytes: High
Ferritin: Normal- High
Iron: Normal- Decreased
TIBC: Variable

Answer 11

Thalassemia

Question 12

Which Anemia:
RBC: Low
Hgb: Low
MCV: Normal- Low
MCH: Low
Reticulocytes: Low
Ferritin: Normal- High
Iron: Low
TIBC: Low

Answer 12

Chronic Disease

Question 13

First level of assessment to help differentiate many underlying causes of anemia

Answer 13

CBC

Question 14

Most sensitive and specific predictor of iron stores; true iron defiency

Answer 14

ferritin level

Question 15

Recommended intake of iron for 14 to 18 years

Answer 15

15 mg

Question 16

Recommended iron from 19 to 50

Answer 16

18 mg

Question 17

Most common causes of iron deficiency anemia in adults

Answer 17

occult blood loss, excessive menstrual loss, and inadequate nutritional intake

Question 18

Ferritin level that confirms diagnosis of iron deficiency

Answer 18

less than 100-150

Question 19

Severe anemia

Answer 19

< 9.0

Question 20

First line tx of iron def anemia

Answer 20

dietary intake of iron risk foods, consumption of vit C- enriched products to enhance absorption of the heme iron

Question 21

Iron rich foods

Answer 21

green leafy veggies, collard greens, egg yolks, raisins, prunes, liver, oysters, some fortified cereals

Question 22

Taking iron preparations will..

Answer 22

decrease absorption but will improve GI effects

Question 23

Antacids will do what to iron supplement absorption

Answer 23

decrease it, should not be taken at the same time

Question 24

Sickle cell disease

Answer 24

Hb SS, severe illness, sickle cell crisis

Question 25

Sickle cell trait

Answer 25

Hb SA; mild anemia, increased risk of UTI, may have sickle cell crisis at high altitudes, if dehydrated, or during extreme physical activity

Question 26

Sickle cell hemoglobin C Disease

Answer 26

Hb SC; mild to moderate anemia and sickle cell crisis; risk for infection, retinopathy, and blindness

Question 27

Hemoglobin C disease

Answer 27

Hb CC; usually asymptomatic, symptoms may be with splenomegaly

Question 28

Hemoglobin C trait

Answer 28

HB CA; usually asymptomatic

Question 29

Beta- thalassemia

Answer 29

Cooley's anemia, severe anemia- frequent blood transfusions, classic facial features

Question 30

Thalassemia intermedia

Answer 30

significant anemia but does not need blood transfusions

Question 31

Thalassemia minor

Answer 31

mild microcytic anemia, individual asymptomatic

Question 32

Alpha- thalassemia trait

Answer 32

mild microcytic anemia, individual is aymptomatic

Question 33

Hemoglobin H disease

Answer 33

(alpha- thal) enlarged spleen, bone abnormalities, severe illness

Question 34

Hemoglobin Bart's hydrops fetalis

Answer 34

incompatible with life; causes hydrops fetalis

Question 35

Thalassemias more prevalent in..

Answer 35

Southeast Asia, the Mediterranean, Africa, Middle East, and the Indian sub continent

Question 36

Alpha- thalassemia most common among..

Answer 36

Chinese and Southeast Asian descent

Question 37

Beta thalassemia most common among...

Answer 37

Mediterranean, Chinese, Asian, and African women

Question 38

Diagnosis of Thalassemia, what should be given and not given

Answer 38

YES: Folic acid supplementation may be used NO IRON PLEASE, INAPPROPRIATE

Question 39

Common complication for nonpregnant women with sickle cell trait

Answer 39

increase in UTI, lessen the accuracy of hemoglobin A 1c testing ( makes testing for diabetes more difficult)

Question 40

Glucose 6 Phosphate Dehydrogenase Deficiency

Answer 40

-X linked -Found in Mediterranean descent and African Americans -Rarely symptomatic in women -Can go from being symptomatic to presenting with severe acute or chronic hemolytic anemia -Hemolysis occurs when the individual has an infection or receives oxidative drugs -Cannot get sulfa drugs or sulfa derivatives, Macrobid, NSAIDS, toluidine blue, and methylene blue - No fava beans and some other legumes -Prompt dx and tx important

Question 41

Von Willebrand's Disease

Answer 41

- Autosomal dominant - Causes defects in protein necessary for plate;et adhesion and affects clotting factor VII -Heavy menses, prolonged bleeding, and fam hx of bleeding problems - Assess: plaetelet count, ferritin level, bleeding time, and coagulation studies -Labs: platelets normal; ferritin low; bleeding time prolonged -Avoid : meds that can make you bleed more, like NSAIDS