16-3 Flashcards
Anemia
males HCT less than %?
females HCT less than %?
41%
37%
What is the #1 cause for Anemia in adults?
bleeding
Most important treatment is what?
identification of the cause of blood loss, especially a source of occult blood loss.
Menstruation, pregnancy, and frequent blood donors increase chances of what?
Anemia
What considerations should be taken for males with Anemia?
may be due to a disease process and require a further evaluation and a higher level of care.
Severe iron deficiency causes what?
skin and mucosal changes,
smooth tongue,
brittle nails,
cheilosis.
Many iron-deficient patients develop pica, craving what?
ice chips
What lab do you order for someone with suspected iron deficiency?
CBC with differential
Most important treatment for Anemia is?
identification of the cause of blood loss, especially a source of occult blood loss.
What is the tx for Anemia?
oral iron supplement
Ferrous sulfate 325mg TID x 3-6 months
What Ferritin value is considered Anemic?
<12 mcg/L
Vitamin B12 Deficiency is less than
<100 pg/mL
Physical Findings for vitamin B12 deficiency:
- Glossitis
- Anorexia
- Diarrhea
What is the CBC with diff hallmark for vitamin B12 deficiency?
megaloblastic anemia (large RBC’s)
What late stage & and early stage considerations should be taken for vitamin B12 deficiency?
- MEDEVAC for late stage
- Referral to Hematologist for early stage
What is a sequence of responses that stops bleeding when blood vessels are injured?
Hemostasis
Intrinsic pathway, key factors include:
8, 9, 11, 12
Extrinsic pathway key factor:
7
Intrinsic pathway is measured by
PTT
Extrinsic pathway is measured by
PT
What is a systemic process with the potential for causing thrombosis and hemorrhage. It can present as an acute, life threatening emergency?
Disseminated intravascular coagulation (DIC)
What does G6PD stand for?
Glucose-6-phosphate dehydrogenase
What is a hereditary enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red
blood cells to deal with oxidative stresses?
G6PD
What drug can cause hemolysis for a G6PD patient?
Primaquine
What might a red blood cell smear reveal for a G6PD pt?
“bite cells” or Heinz bodies
What condition might have abnormal RBC take the shape of a sickle rather than a biconcave disc?
Sickle Cell Trait
What is a condition that causes acute painful episodes of back and long bones last hours to days and may produce low-grade fever. And Non-healing ulcers of the lower leg and retinopathy may be present.
Sickle Cell Trait
What lab should be done for someone with suspected SCT?
CBC w/ diff
average life expectancy for Sickle cell anemia is?
40 - 50 y/o
SCT can cause acute pain under extreme conditions such as…?
vigorous exertion at high altitudes or unpressurized aircraft
What is a malignancy of the hematopoietic progenitor cell. These cells proliferate in an uncontrolled fashion and replace normal bone marrow elements?
Leukemia
More than what % of blasts in the bone marrow is considered Leukemia?
20%
Acute lymphoblastic leukemia (ALL) comprises % of the acute leukemias of childhood. It is also seen in adults, causing approximately __% of adult acute leukemias.
80%
20%
Which Leukemia is primarily an adult disease with a median age at
presentation of 60 years and an increasing incidence with advanced age?
Acute myeloid leukemia (AML)
What S&S are present with Leukemia?
pale, purpura, petechiae
Bone tenderness in the sternum, tibia, and femur.
Differential Diagnosis for Leukemia could be what?
Viral infection such as Mononucleosis
Patients with ALL may have what visible on a chest radiograph?
mediastinal mass
What is the treatment for Leukemia?
MEDEVAC
Referral to hematologist.
Approximately what % of adults with AML under age 60 years achieve complete remission?
70-80%
Bone marrow transplantation is curative in what % of cases?
50-60%
What is a high white cell count relative to normal physiologic numbers?
Leukocytosis
What is a low total white cell count?
Leukopenia
<4400 cells/microL
What is an abnormally low amount of circulating platelets?
Thrombocytopenia
The risk of clinically relevant spontaneous bleeding does not typically increase until the platelet count falls below what?
10,000 - 20,000/mcL
What helps you determine that the deficiency is platelets rather then a coagulopathy?
Petechia
Should you MEDEVAC someone with Thrombocytopenia
Yes if actively bleeding
What causes skin and mucosal changes, including a smooth
tongue, brittle nails, and cheilosis?
Iron Deficiency Anemia
What are contraindications for Ferrous sulfate?
What should the pt be counseled on about ferrous sulfate?
very constipating and turns stool black
Vit B12 deficiency is seen mostly in?
Vegans
What is considered a Vit B12 deficiency?
<100/pg/mL
How much stored Vit B12 does the liver contain?
2000-5000 mcg
How long does Vit B12 deficiency take to develop?
3 years
Physical findings of:
Glossitis, Anorexia, Diarrhea, pale, paresthesia
indicate what?
Vitamin B12 dificiency
What Dx has a hallmark of megaloblastic anemia on a CBC w/ diff?
Vit B12 deficiency
What is the Tx for Vit B12 deficiency?
Vit B12 inj IM daily for a week, weekly for a month, and monthly for a year
For late stage Vit B12 deficiency what should you do?
MEDEVAC
For early stage Vit B12 deficiency what should you do?
Referral to Hematologist
3 stages of blood clotting?
- Formation of prothrombinase
- Prothrombinase converts prothrombin to thrombin
- Thrombin converts fibrinogen into insoluble fibrin
Intrinsic pathway key factors?
8,9,11,12
Extrinsinc pathway key factor?
7
Intrinsic pathway lab
PTT
Extrinsic pathway lab
PT
Hemophilia A
Deficiency of factor 8
Hemophilia B
Deficiency of factor 9
What is a systemic process with the potential
for causing thrombosis and hemorrhage. It can present as an acute, life-threatening
emergency.
Disseminated intravascular coagulation (DIC)
Common bleeding manifestations include
petechiae; ecchymoses;
and blood oozing from wound sites
Common causes of DIC
- Sepsis
- Malignancy
- Trauma
- Obstetrical complications
- Heat stroke, crush injuries and Rattlesnake or
another viper bite.
What medication should you avoid giving someone with DIC?
Heparin
Sx: Bruising, bleeding, epistaxis, bleeding from eyes, heavy vaginal bleeding
Dx?
DIC
What labs would you do for DIC?
PT, PTT, INR, CBC
What does G6PD stand for?
glucose 6 phosphate dehydrogenase
What may reveal bite cells or Heinz bodies?
G6PD
What is a autosomal recessive disorder with hemoglobin S
Sickle cell anemia
Acute back and bone pain, low grade fever, non-healing ulcers in the legs, lasting hours to days
SCT
What lab is done for SCT?
CBC w/ diff
How is Sickle cell hemoglobin confirmed?
Hemoglobin Electrophoresis
What is the tx for SCT
keep hydrated and oxygenated
Average life expectancy of sickle cell anemia?
40-50 y/o
What conditions can exacerbate SCT?
vigourous exertion, high altitude, unpressurized aircraft
A malignancy were cells proliferate and replace normal bone marrow
Leukemia
What % of blasts in the bone marrow indicates Leukemia?
20%
What are the 2 classifications of Leukemia?
AML and ALL
What % of ALL is children?
What % of ALL is adults?
80%
20%
AML is common in what age group?
adults over 60y/o
Sx: Fatigue, gingival bleeding, epistaxis, menorrhagia,
pale, purapura, and petechiae
Bone tenderness in the sternum, tibia, and femur
Acute Leukemia
What viral infection presents similar to Leukemia?
Mononucleosis
If lab reveals combo of pancytopenia w/ circulating blasts
what Dx?
Leukemia
Mediastinal mass visible on CXR may be what Dx?
ALL
What is the tx for Leukemia?
MEDEVAC
Referral to hematologist
chemo and radiation therapy
What % of adults with AML achieve remission?
70-80%
Bone marrow transplant for Leukemia is curative in what % of cases?
50-60%
High WBC Dx?
Leukocytosis
