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Med Surg > 30- Hematologic Problems > Flashcards

30- Hematologic Problems Flashcards

1
Q

Anemia- Dx

A
  • CBC
  • reticulocyte count
  • peripheral blood smear
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2
Q

normocytic

A

MCV:80-95
MCH: 27-31pg

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3
Q

normochromic

A

normal color

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4
Q

normocytic, normochromic

A

aplastic anemia, sickle cell anemia

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5
Q

microcytic, hypochromic

A

iron deficiency

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6
Q

macrocytic, normochromic

A

B12 deficiency

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7
Q

anemia is classified by…

A

morphology (size + color)(more accurate) + etiology (cause)

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8
Q

mild, moderate, severe anemia

Hgb range

A

MILD: 10-12g/dL
MOD: 6-10g/dL
SEV: <6g/dL

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9
Q

mild anemia s/s

A

palpitations
mild fatigue
exertional dyspnea
Hgb 10-12g/dL

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10
Q

mod anemia s/s

A 
bounding pulse,
palpitations,
fatigue
dyspnea
roaring in ears
Hgb 6-10g/dL
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11
Q

severe anemia s/s

A

tachycardia, incr pulse, systolic murmur, angina, HF, MI
blurred vision, retinal hemorrhage, sclera,
anorexia, hepatomega, splenomega, dysphagia, sore mouth
sensitivity to cold, pallor, jaundince, pruritus
glossititis, smooth tongue
bone ain
tachypnea, orthopnea, dyspnea at rest
headache, vertigo, LOC

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12
Q

is anemia a normal finding in adults?

A

NO, but it occurs more often

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13
Q

3 main problems that lead to decreased RBC production

A

1 decr hemoglobin synthesis
—-fr iron deficiency, thalassemia, sideroblastic anemia
2 defective DNA synth
—-cobalamin deficiency, folic acid deficiency
3 diminished availability of erythrocyte precursor> aplastic anemia + anemia of chronic disease

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14
Q

anemia due to defective DNA synthesis

A

cobalamin deficiency

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15
Q

anemia due to decreased Hgb production

A

iron-deficiency

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16
Q

hemolytic anemia that is intrinsic/hereditary

A

sick cell (abnormal hemoglobin)

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17
Q

anemia due to decreased number in RBC precursor

A

aplastic anemia

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18
Q

common causes of iron deficiency anemia

A
  • malnutrition
  • duodenal problems
  • GI blood loss (peptic ulcers, esophagitis, diverticula, hemorrhoids, cancer, gastritis)
  • GU blood loss (menstrual bleeding 45mL/22mg of Fe)
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19
Q

S/S of iron deficiency anemia

A

no early manifestations

most common: pallor, glossitis, cheilitis (inflammation of lips)

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20
Q

daily dose should provide ____ elemental iron

A

150-200mg

ex) 325mg ferrous sulfate has 56mg elemental iron

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21
Q

iron is best absorbed in an ___ environment

A

acidic

-citrus has absorbic acid

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22
Q

how to avoid GI side effects from oral iron?

A

sit upright for 30 min

to avoid heartburn, constipation, diarrhea

23
Q

when to take iron

A

1 hr before meals

24
Q

when can patients stop taking iron therapy?

A

2-3 months after Hgb levels return to normal

25
Q

are macrocytic cells more fragile or sturdy

A

more fragile - easily destroyed cell membrane

26
Q

serums ____ + _____ are high in B12 deficiency

A

methylmalonic acid MMA

hemocysteine

27
Q

Tx for Intrinsic Factor deficiency or impaired ileum absorption

A
  • parenteral vit B12 (cyanocobalamin, hydrococobalamin)

- intranasal (cyanocobalamin/Nascobal)

28
Q

Tx for pernicious anemia with working GI absorption

A

-high dose of oral cobalamin or sublingual

29
Q

dosage of parenteral/intranasal B12 meds

A

1k mcg/day for 2 weeks

then weekly until Hgb is normal
then monthly for life

30
Q

aplastic anemia

A
  • pancytopenia
  • hypocellular bone marrow
  • rare
31
Q

70% of aplastic anemia is due to

A

autoimmune activity by overreactive T lymphocytes

-cytotoxic T cells target + destroy hematopoietic cells

32
Q

other causes of aplastic anemia

A
  • chemo/radiation
  • antiseizure, antimetabolites, NSAID, antithyroid
  • inherited stem cell defect - fanconi anemia
  • toxic injury to bone marrow stem cells
  • viral/bacterial infection
33
Q

Dx of aplastic

A
  • low reticulocyte
  • low WBC
  • low platelet
  • low RBC
  • normochromic, normocytic
  • bone marrow biopsy reveals incr yellow fat
34
Q

Tx of aplastic

A
  • immunosuppressive therapy like antithymocyte globulin
  • —-horse serum that has antibodies against human T cells
  • HSCT hematopoietic stem cell transplant
  • steroids or cyclosporine
35
Q

sickle cell disease

A

inherited autosomal recessive disorder

  • abnormal form of hemoblobin
  • normochomic, normocytic
  • most severe of allt he SCD syndromes
36
Q

sickle cell can cause irreversible damage to ____

A

liungs, kidneys, brain, retina, bones

37
Q

sickle cell morphology

A

stiff and angular

  • more easily to becomes tuck in small capilaries
  • leads to ACUTE/CHRONIC TISSUE INJURY
38
Q

sickling episodes are most often triggered by…

A

low O2 tension in the blood

-hypoxia/deoxygentation

39
Q

most common cause of low O2 tension that causes sickling episode

A

bacterial/viral infection

-other causes: high altitude, emo/phys stress, surgery, blood loss, dehydration, acidosis

40
Q

cycle of sickling

A

hypoxia triggers even> causes sickling of cells> sickle cells causes tissue injury/occlusion> more hypoxia> more sickling

41
Q

sickle cells are hemolyzed by the___

A

spleen

-causes anemia

42
Q

is sickling reverisble?

A
  • at first it is reversible w reoxygenation

- recurrent sickling leads to irreverisble

43
Q

clinical hallmarks of SCD

A

vaso-occlusive phenomena + hemolysis

44
Q

why is sickle cell anemia the most severe form of SCD

A

because they have a high percent of Hgb S

-increases the frequency, extent, + severity

45
Q

s/s sickle cell

A
  • pt is anemic but asymptomatic except during sickling episode
  • pallor in mucus membranes
  • grayish skin or jaundice
  • prone to gallstones
  • PAIN* due to ischemia of tissue
46
Q

most common locations ofpain in sickling episode

A

back, chest, extremities, abdomen

47
Q

common complications of sickle cell anemia

A

acute chest syndrome
-PNA, tissue infarction, fat embolism, fever, chest pain, cough
autosplenectomy
-shrinking from repeated scarring from tryiing to phagotize foreign substances
-gallstones

48
Q

sickle cell Dx

A
  • peripheral blood smear
  • incr abnormal reticulocytes
  • Hgb electrophoresis to check amount og Hgb S
  • hemolysis (jaundice, high serum bilirubin)
  • sekelatal x ray (flattening + deformed bones)
  • MRI - stroke
49
Q

pt w sickle cell should use ___

A

O2 therapy + incentive spirometer

50
Q

any febrile illness with SCD is…

A

an emergency

51
Q

treatment for acute chest pain in sickle cell

A
  • abx
  • folic acid supplement
  • o2/fluid therapy
  • transfusion
52
Q

hydroxyurea

A

drug that increases the production of Hgb F + alters adhesion of sickled RBC

53
Q

only treatment that can cure some pt with SCD

A

HSCT

Hematopoietic stem cell transplant

Med Surg (18 decks)

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