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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
Q

IDA diet mngt

Replacement: based on_____

A

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

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25
Q

Replacement: based on elemental iron-

How much needed per day?
For how long?

A

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

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26
Q

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)

A

2-3 wks she will feel better

27
Q

RBC production timeline

Reticulocytosis
Inc Hgb
Replace iron stores

A

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
Q

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?

A

Measure serum Ferritan. Stored

But will take 4-6 months

29
Q

Exam

Thalassemia. What does it affect?

What type of cells typify on Hgb electrophoresis?

A

* 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
Q

Thalassemia

Is not an _______ problem like IDA

Has normal:

A

Iron- will kill them!

RBC is often polycythemic - can have inc H & H

Normal: RDW Serum Fe serum iron TIBC

31
Q

To diagnose any hemoglobinopathy:

A

Hemoglobin electrophoresis!!! For sickle cell and thalassemia

32
Q

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?

A

Thalassemia

Diagnose by Hgb electrophoresis

33
Q

Two types of thalassemia

Describe
Which to keep and which to refer?

Who do u screen?

A

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
Q

Thalassemia and IDA both have

Decreased:4 things

But different values of (4 things). Which one inc and which one nl?

A

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
Q

Anemia of chronic disease. ACD

What type of anemia? Associated with?
How to correct?

A

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
Q

Exam***
Anemia of chronic disease

ACD and IDA both have decreased

But ACD has normal _______
And IDA has dec ____. And inc ______

A

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
Q

Pt w Hgb 10 g. And Hct 30.6%

Which is normocytic normochromic anemia?

A 
ACD.   
MCV 93 (80-100). And MCH 29 (28-32)
38
Q

Macrocytic anemias?

A

Megaloblastic

Bit B12 and Folate deficiencies are macrocytic

39
Q

After finding Macrocytosis, order:

Look for these cells:
Macro-ovalocytes= folate defic and B12 defic ( Cbl- cobalamin is B12)
Microcytic target cells= liver disease

A

Retic count

Blood smear

40
Q

Macrocytic anemia etiologies:

A

ETOH abuse!!!
Liver disease. Esp from ETOH
Meds- methotrexate
Melodyspastic syndromes- leukemia. Stem cell probs

MCV >100

41
Q

Why is Macrocytosis a B12 and folate problem?

A

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
Q

More sensitive measures of B12 for microcytic anemia are:

A

Methylmalonic acid and homocysteine levels( they are metabolic intermediates and need B12 to metabolize). :
. both are elevated in B12 deficiency

43
Q

B12 deficiency (pernicious anemia) presents with what type of sxs?

What type of pts get?

A

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
Q

B12 deficiency also co exists with

A

Folate defic

MCV > 100. Macrocytosis

45
Q

Presentation folate deficiency:

A

Most asymptomatic.
Neuro stuff like B12 defic

Screen and treat for both!

46
Q

Mngt of B12 and Folate defic and expected course

MCV >100. Macrocytosis

A

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
Q

Tx for Vit B 12 defic and folate defic expected course

A

Fun to treat! Sxs resolve in 5-10 days
Requires lifelong tx B12
Treat folate 1-4 m

48
Q

Petechia and purpura on LE that won’t blanch think

A

Low playlet count- thrombocytopenia!!!

49
Q

Thrombocytopenia. Platlets:

A

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
Q

Thrombocytopenia etiology

Mngt?

A

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
Q

Leukocytes.
2 agranular
3 granular

A

2 agranular. Lymphocytes 20-25%, monocytes 3-8%
3 granular. Basophils 1%, neutrophils 60-70%, eosinophils 2-4%

Neutrophils-segs- polys

52
Q

60-70% WBCs are

20-25% of WBCs are

A

60-70% WBCs are Neutrophils
Also called segs and ploys

20-25% of WBCs lymphocytes

53
Q 
CBC interpretation
Order to look at
1 WBC if elevated think
2assess ploys and lymph 
 3 RBC Hgb. Hct
4 MCV MCH
A

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
Q

Which WBC are first responders 24 hrs
Which ones take 24 hrs
Indicate parasitic infxn
Indicate really bad infxn

A

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
Q

If WBCs elevated think

A

bacterial or mono EBV has lymphocytes is 12-18,00o common and atypical lymphs

56
Q

What would a bacterial infxn more than 24 hrs look like?

A

Elevated WBC count
Ploys and lymphs elevated -2 hrs
And mono elevated bc take 24 hrs

57
Q

If bacterial bc ploys and lymphs are far apart why wouldn’t WBC be elevated?

A

Early in course of illness

Immunosupressed pt

58
Q

Name these anemias
1.Microcytic hypochromic
2 normochromic normocytic
3.

A

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
Q

Macro ovalocytes

A

Measure B12 and folate

60
Q

Name 2 anemias that are hypochromic and microcytic

A

IDA and thalassemia

61
Q

What anemia is macrocytic

A

Folate and B12

62
Q

Iron store are nl

A

IDA and ACD
Don’t take bait of low serum iron.

ACD RBC are same size and color just not enough

63
Q

If IDA order

A

Stool occult blood

64
Q

Macrocytosis associated w deficiency in of —– production

Microcytosis associated w deficiency of —– production

A

Macrocytosis associated w deficiency in of RBC production

Microcytosis associated w deficiency of Hgb production

NP Cert Exam (9 decks)

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