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NP Cert Exam > 2 Hematology > Flashcards

2 Hematology Flashcards

0
Q

Memorize A1C and lipid norms:

A

Hemoglobin A1C

3.5-6% good control is 240 mg/do high risk

HDL 40-60
Elevated levels are cardio protective

Triglycerides
Normal 130

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1
Q

Anemia is a reduction in one or more of these RBC measurements:

A

Hemoglobin
Hematocrit
RBC count

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2
Q

3 reasons people become anemic:

A

Blood loss
Bone marrow not making enough RBC
Increased destruction of RBC

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3
Q

Know that a 30 & 10 is a

And nl H & H. Around

A

Low hematocrit and Hgb!

13 & 37 good - in middle

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4
Q

Anemia through blood loss:

3 ways

A

Melena: “tarry” feces upper GI bleed

Hematemesis: vomiting blood- upper GI bleed- ulcer. Gastritis tumor smoking bacteria

Trauma

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5
Q

3 reasons people get anemic

A

Blood loss
Bone marrow not making enough RBC
Increased destruction of RBCs

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6
Q

Reasons bone marrow not making enough RBCs:

A

Lack of nutrients - Fe. Folate. B12

Bone marrow disorders- aplastic anemia , myelodysplastic syndromes

Bone marrow suppression- chemo. Others

Low levels of erythropoietin(protein made in kidney that leads to formation of RBCs in the bone marrow). chronic renal failure

Anemia of inflammation: malignancy, anemia of chronic disease

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7
Q

Anemia r/t increased destruction of RBCs

A

Inherited disorders: Sickle cell, thalassemias

Maleria

Hemolytic anemia: G6PD deficiency

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8
Q

Polycythemia

Who has it?

A

Poycythemia is opposite of H& H- pt. has increased H&H!

Smokers
COPD
Residents of high altitudes **Denver*. (Exam)

All these have decreased O2 so the body compinsates by making inc RBC

“Smoker’s polycythemia”. …Crit 52

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9
Q

Every anemia is characterized by two things:

A

RBC size. “Cytic”=cell

RBC color. “Chromic”=color
How much Hgb in a RBC determines it’s color

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10
Q

What CBC value tells RBC size:

Small cells
Normal cells
Large cells

And values for each

A

MCV. Mean corpuscular hemoglobin tells size of RBC
MCV=Hct/RBC count

Micro cytic 96

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11
Q

This CBC value tells RBC color

Low in color
Nl color
Too much color

A

MCH mean corpuscular hemoglobin

Tells the color of a RBC(the greater the Hgb content, the redder the cell

Hypochromic(light bc less Hgb content)
Normochromic
Hyperchromic (dark bc tons of Hgb)

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12
Q

What do you glean here?

MCV 106 (80-96)
MCH 27.4 (23.7-28.4)
A

Macrocytic normochromic anemia

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13
Q

RDW indicates.

Imagery to use….

A

RDW. Red cell distribution width

Degree of variation in RBC size (15% something is wrong!

Donut hole image- 11 doughnut holes and and 1 reg size

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14
Q

Normal values

Hemoglobin

Hematocrit

A

Hgb. 12-15

Hct 37-51

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15
Q

TIBC

If iron count is high, TIBC is

If iron count is low, TIBC is

A

Total iron binding capacity

Reciprocal relationship

If iron count is high, TIBC is low bc not much room left for it to bind
If iron count is low, TIBC is high bc lots of empty space to bind

Egg carton idea

IDA- TIBC is high bc CAN bind lots of iron

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16
Q

Serum iron

Serum ferritin

A

Serum iron. Total iron in circulation. ACD and IDA both have

Serum ferritin measure of iron in storage. ferritin is a protein that stores iron (Like a ferrat storing iron in a tree)

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17
Q

What are immature/baby RBCs?

A

Reticulocyte count. Retics are immature RBCs- it takes 24 hrs for them to grow

Retic count Indicates ability of bone marrow to reproduce RBCs

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18
Q

Why would Retic count be high or low. What does it mean about bone marrow

A

If Pt. Is anemic and Retic count is high it means bone marrow is increasing production of retics

If Pt. Is anemic and Retic count is low it means bone marrow is sick

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19
Q

What is peripheral smear

A

A visual description of RBCs

At bottom of lab report when lab tech says “hypochromic microcytic RBCs”

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20
Q

Microcytic hypochromic anemias

<80 fl

A

IDA. Iron defic anemia. -needs iron
and
Thalassemia- don’t give iron-will kill them!
-beta: Refer!
-alpha: common, just always a little bit anemic

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21
Q

Normocytic, normochromic anemia

A

Anemia of chronic disease! ACD

30% of time it is microcytic hypochromic

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22
Q

Macrocytic anemias. Also called_____

What deficiencies cause?

Other etiologies:

A

Macrocytic=megaloblastic anemia

Vitamin B12, Folate deficiency leads to problems with RBC synthesis

Other causes: Medication most common cause (methotrexate)
etoh abuse( 2nd most common cause do Macrocytosis )-Liver damage.
Stem cell leukemia

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23
Q

IDA

Decreased
Increased

A

Decreased: Hgb. Hct serum FE. MCV. MCH

Increased. TIBC. RDW (>15%)

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24
IDA diet mngt Replacement: based on_____
Organ red meat Dried peas beans Dark leafy greens Whole grains Replacement: based on elemental iron-not mg listed Ferrous sulfate. 325mg- 65 mg elemental Ferrous gluconate 325 mg- 28-36 mg elemental better tolerated for pregnant women
25
Replacement: based on elemental iron- How much needed per day? For how long?
150-200 mg replacement iron when deficient So give 3 tabs ferrous sulfate 325 QD Or 5-6 tabs ferrous gluconate for pregs QD Replace for 4-6 m
26
32 yo female taking 200mg elemental iron QD How long before an increase of her HGB is to be expacted? (...And she will feel better)
2-3 wks she will feel better
27
RBC production timeline Reticulocytosis Inc Hgb Replace iron stores
Reticulocytosis bone marrow makes in 3-10 days Inc Hgb- 2-4 weeks and pt feels better Replace iron stores 4-6 m and can stop Fe
28
Pt w IDA taking Fe for 8 wks and wants to stop Her values Norm. Hgb 12-15. Hct 37-51 8wks ago. Hgb 10. Hct 31 Today. Hgb 12. Hct 37 What action is due today?
Measure serum Ferritan. Stored But will take 4-6 months
29
Exam Thalassemia. What does it affect? What type of cells typify on Hgb electrophoresis?
*** most common genetic disorder in the world,**** Hereditary Affects synthesis of Hgb- causes overproduction of Hgb chains that cause RBC hemolysis Microcytic. Hypochromic (like IDA) * *Target cells- look like bullseye like sickle cells * * tear drop type cells (dacrocytes)
30
Thalassemia Is not an _______ problem like IDA Has normal:
Iron- will kill them! RBC is often polycythemic - can have inc H & H Normal: RDW Serum Fe serum iron TIBC
31
To diagnose any hemoglobinopathy:
Hemoglobin electrophoresis!!! For sickle cell and thalassemia
32
Pt has Hgb 10.6 Hct 32% and target cells and dacrocytes are seen on screening CBC What do u suspect and how do u diagnose?
Thalassemia Diagnose by Hgb electrophoresis
33
Two types of thalassemia Describe Which to keep and which to refer? Who do u screen?
Alpha thalassemia. Keep - mild but always a little bit anemic Asians. Mediterranean decent. Never African American Common!!!! -minima. Minor. Need no tx. NO IRON!!!!!!! ___________ Beta thalassemia: refer!!! Minor. Intermedia, major. NO IRON!!!!!!! Screen patients w positive family members
34
Thalassemia and IDA both have Decreased:4 things But different values of (4 things). Which one inc and which one nl?
Both Decreased Hgb. Hct. MCV microcytic. MCH. Hypochromic IDA. Has increased RDW. TIBC. And decreased serum Ferritan and serum Fe Thalassemia has nl TIBC RDW serum Ferritan and serum FE bc no probs with iron!
35
Anemia of chronic disease. ACD What type of anemia? Associated with? How to correct?
Normocytic normochromic MCV and MCH norm, 30% are microcytic and hypochromic RBC lifespan shortened bc of chronic disease, infxn, malignant disease. NO iron****. Fix disease!!! Decreased Hgb and Hct
36
Exam*** Anemia of chronic disease ACD and IDA both have decreased But ACD has normal _______ And IDA has dec ____. And inc ______
ACD and IDA both have decreased serum iron But ACD has normal serum Ferritan and TIBC And IDA has dec serum Ferritan and elevated TIBC
37
Pt w Hgb 10 g. And Hct 30.6% | Which is normocytic normochromic anemia?
``` ACD. MCV 93 (80-100). And MCH 29 (28-32) ```
38
Macrocytic anemias?
Megaloblastic Bit B12 and Folate deficiencies are macrocytic
39
After finding Macrocytosis, order: Look for these cells: Macro-ovalocytes= folate defic and B12 defic ( Cbl- cobalamin is B12) Microcytic target cells= liver disease
Retic count | Blood smear
40
Macrocytic anemia etiologies:
ETOH abuse!!! Liver disease. Esp from ETOH Meds- methotrexate Melodyspastic syndromes- leukemia. Stem cell probs MCV >100
41
Why is Macrocytosis a B12 and folate problem?
Problems with ABSORPTION- rarely a dietary defic bc B12 abundant in many foods ***EXAM-----B12 and folate problems often co-exist. -always order both! Like salt and pepper
42
More sensitive measures of B12 for microcytic anemia are:
Methylmalonic acid and homocysteine levels( they are metabolic intermediates and need B12 to metabolize). : . both are elevated in B12 deficiency
43
B12 deficiency (pernicious anemia) presents with what type of sxs? What type of pts get?
Nerve problems Neurological s/s: dementia (elders), weakness, paresthesias(younger adults-feet burn) But most are asymptomatic Elders , alcoholics, vegans, bariatric surgery pts if no supplementation
44
B12 deficiency also co exists with
Folate defic MCV > 100. Macrocytosis
45
Presentation folate deficiency:
Most asymptomatic. Neuro stuff like B12 defic Screen and treat for both!
46
Mngt of B12 and Folate defic and expected course | MCV >100. Macrocytosis
Vit B12 IM (oral won't work bc absorption prob)- QD x1wk, Qw x 1m, then month for life. Lifetime tx!!! Folic acid po. Only needs tx 1-4 m Neuro deficits usually reversible, sxs improve 5 d!
47
Tx for Vit B 12 defic and folate defic expected course
Fun to treat! Sxs resolve in 5-10 days Requires lifelong tx B12 Treat folate 1-4 m
48
Petechia and purpura on LE that won't blanch think
Low playlet count- thrombocytopenia!!!
49
Thrombocytopenia. Platlets:
Platlet count < 150,00 If <5,000 = Dx of thrombocytopenia Rest of CBC is usually normal From. Redux production in bone marrow, increased clearance or sequestering of platlets in spleen
50
Thrombocytopenia etiology Mngt?
Recent infxn- bacterial, Virus. Idiopathic- unknown SLE Leukemia. HELLP syndrome- w labor and sudden redux in platelets Refer hematology ITP idiopathic thrombocytopenia purpura- kids can get after virus Prednisone 4-6 wks, min activity to prevent bruising. No aspirin
51
Leukocytes. 2 agranular 3 granular
2 agranular. Lymphocytes 20-25%, monocytes 3-8% 3 granular. Basophils 1%, neutrophils 60-70%, eosinophils 2-4% Neutrophils-segs- polys
52
60-70% WBCs are | 20-25% of WBCs are
60-70% WBCs are Neutrophils Also called segs and ploys 20-25% of WBCs lymphocytes
53
``` CBC interpretation Order to look at 1 WBC if elevated think 2assess ploys and lymph 3 RBC Hgb. Hct 4 MCV MCH ```
WBC if elevated think. Bacterial 2assess ploys and lymph If numerically close think viral 3 RBC Hgb. Hct. If low think anemic 4 MCV MCH. Decide what type of anemia
54
Which WBC are first responders 24 hrs Which ones take 24 hrs Indicate parasitic infxn Indicate really bad infxn
Ploys and lymphs first responders take 2hrs to elevate Take 24 hrs monos So if CBC has inc monos pt has been sick >24 hrs Eosinophils paracytic or allergy
55
If WBCs elevated think
bacterial or mono EBV has lymphocytes is 12-18,00o common and atypical lymphs
56
What would a bacterial infxn more than 24 hrs look like?
Elevated WBC count Ploys and lymphs elevated -2 hrs And mono elevated bc take 24 hrs
57
If bacterial bc ploys and lymphs are far apart why wouldn't WBC be elevated?
Early in course of illness | Immunosupressed pt
58
Name these anemias 1.Microcytic hypochromic 2 normochromic normocytic 3.
1, iron defic anemia 2 Anemia of chronic disease 3 Thalassemia normocytic/ chromic w nl RDW and TIBC 4 Folate and Vit B12 defic.
59
Macro ovalocytes
Measure B12 and folate
60
Name 2 anemias that are hypochromic and microcytic
IDA and thalassemia
61
What anemia is macrocytic
Folate and B12
62
Iron store are nl
IDA and ACD Don't take bait of low serum iron. ACD RBC are same size and color just not enough
63
If IDA order
Stool occult blood
64
Macrocytosis associated w deficiency in of ----- production Microcytosis associated w deficiency of ----- production
Macrocytosis associated w deficiency in of RBC production Microcytosis associated w deficiency of Hgb production

NP Cert Exam (9 decks)

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