30- Hematologic Problems Flashcards
Anemia- Dx
- CBC
- reticulocyte count
- peripheral blood smear
normocytic
MCV:80-95
MCH: 27-31pg
normochromic
normal color
normocytic, normochromic
aplastic anemia, sickle cell anemia
microcytic, hypochromic
iron deficiency
macrocytic, normochromic
B12 deficiency
anemia is classified by…
morphology (size + color)(more accurate) + etiology (cause)
mild, moderate, severe anemia
Hgb range
MILD: 10-12g/dL
MOD: 6-10g/dL
SEV: <6g/dL
mild anemia s/s
palpitations
mild fatigue
exertional dyspnea
Hgb 10-12g/dL
mod anemia s/s
bounding pulse, palpitations, fatigue dyspnea roaring in ears Hgb 6-10g/dL
severe anemia s/s
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
is anemia a normal finding in adults?
NO, but it occurs more often
3 main problems that lead to decreased RBC production
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
anemia due to defective DNA synthesis
cobalamin deficiency
anemia due to decreased Hgb production
iron-deficiency
hemolytic anemia that is intrinsic/hereditary
sick cell (abnormal hemoglobin)
anemia due to decreased number in RBC precursor
aplastic anemia
common causes of iron deficiency anemia
- malnutrition
- duodenal problems
- GI blood loss (peptic ulcers, esophagitis, diverticula, hemorrhoids, cancer, gastritis)
- GU blood loss (menstrual bleeding 45mL/22mg of Fe)
S/S of iron deficiency anemia
no early manifestations
most common: pallor, glossitis, cheilitis (inflammation of lips)
daily dose should provide ____ elemental iron
150-200mg
ex) 325mg ferrous sulfate has 56mg elemental iron
iron is best absorbed in an ___ environment
acidic
-citrus has absorbic acid
how to avoid GI side effects from oral iron?
sit upright for 30 min
to avoid heartburn, constipation, diarrhea
when to take iron
1 hr before meals
when can patients stop taking iron therapy?
2-3 months after Hgb levels return to normal
are macrocytic cells more fragile or sturdy
more fragile - easily destroyed cell membrane
serums ____ + _____ are high in B12 deficiency
methylmalonic acid MMA
hemocysteine
Tx for Intrinsic Factor deficiency or impaired ileum absorption
- parenteral vit B12 (cyanocobalamin, hydrococobalamin)
- intranasal (cyanocobalamin/Nascobal)
Tx for pernicious anemia with working GI absorption
-high dose of oral cobalamin or sublingual
dosage of parenteral/intranasal B12 meds
1k mcg/day for 2 weeks
then weekly until Hgb is normal
then monthly for life
aplastic anemia
- pancytopenia
- hypocellular bone marrow
- rare
70% of aplastic anemia is due to
autoimmune activity by overreactive T lymphocytes
-cytotoxic T cells target + destroy hematopoietic cells
other causes of aplastic anemia
- chemo/radiation
- antiseizure, antimetabolites, NSAID, antithyroid
- inherited stem cell defect - fanconi anemia
- toxic injury to bone marrow stem cells
- viral/bacterial infection
Dx of aplastic
- low reticulocyte
- low WBC
- low platelet
- low RBC
- normochromic, normocytic
- bone marrow biopsy reveals incr yellow fat
Tx of aplastic
- immunosuppressive therapy like antithymocyte globulin
- —-horse serum that has antibodies against human T cells
- HSCT hematopoietic stem cell transplant
- steroids or cyclosporine
sickle cell disease
inherited autosomal recessive disorder
- abnormal form of hemoblobin
- normochomic, normocytic
- most severe of allt he SCD syndromes
sickle cell can cause irreversible damage to ____
liungs, kidneys, brain, retina, bones
sickle cell morphology
stiff and angular
- more easily to becomes tuck in small capilaries
- leads to ACUTE/CHRONIC TISSUE INJURY
sickling episodes are most often triggered by…
low O2 tension in the blood
-hypoxia/deoxygentation
most common cause of low O2 tension that causes sickling episode
bacterial/viral infection
-other causes: high altitude, emo/phys stress, surgery, blood loss, dehydration, acidosis
cycle of sickling
hypoxia triggers even> causes sickling of cells> sickle cells causes tissue injury/occlusion> more hypoxia> more sickling
sickle cells are hemolyzed by the___
spleen
-causes anemia
is sickling reverisble?
- at first it is reversible w reoxygenation
- recurrent sickling leads to irreverisble
clinical hallmarks of SCD
vaso-occlusive phenomena + hemolysis
why is sickle cell anemia the most severe form of SCD
because they have a high percent of Hgb S
-increases the frequency, extent, + severity
s/s sickle cell
- 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
most common locations ofpain in sickling episode
back, chest, extremities, abdomen
common complications of sickle cell anemia
acute chest syndrome
-PNA, tissue infarction, fat embolism, fever, chest pain, cough
autosplenectomy
-shrinking from repeated scarring from tryiing to phagotize foreign substances
-gallstones
sickle cell Dx
- 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
pt w sickle cell should use ___
O2 therapy + incentive spirometer
any febrile illness with SCD is…
an emergency
treatment for acute chest pain in sickle cell
- abx
- folic acid supplement
- o2/fluid therapy
- transfusion
hydroxyurea
drug that increases the production of Hgb F + alters adhesion of sickled RBC
only treatment that can cure some pt with SCD
HSCT
Hematopoietic stem cell transplant
