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Step Up - Hematologic > Anemia > Flashcards

Anemia Flashcards

1
Q

What is pseudoanemia and what causes it?

A

Decrease in Hb or Hct secondary to dilution

Acute volume infusion or overload

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2
Q

What is not contained in packed red blood cells?

A

Clotting factors or platelets

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3
Q

What should packed red blood cells be infused along with? Why?

A

Normal saline

In order to increase infusion rate

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4
Q

Each unit of PRBC’s increased Hct by how much?

A

3 to 4 points

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5
Q

Over what time period should PRBC’s be infused?

A

1.5 to 2 hours

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6
Q

What is contained within fresh frozen plasma? What is not contained in fresh frozen plasma?

A

Contains all clotting factors

No RBC/s, WBC’s, platelets

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7
Q

After all PRBC transfusions, what test needs to be ordered?

A

CBC

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8
Q

For massive blood loss, what must be transfused?

A

Whole blood

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9
Q

What is contained in cryoprecipitate?

A

Factor VIII and fibrinogen

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10
Q

What three conditions is cryoprecipitate used for?

A

Hemophilia A
vWB disease
Disease

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11
Q

1 unit of platelets increases the platelet count by how much?

A

10,000

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12
Q

What are the two types of hemolytic transfusion reaction?

A

Intravascular & Extravascular

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13
Q

Which of the two types of hemolytic transfusion reactions is most deadly?

A

Intravascular

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14
Q

What causes intravascular hemolytic transfusion reaction?

A

ABO mismatched blood transfusion

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15
Q

What are five symptoms seen in intravascular hemolytic transfusion reaction?

A

fever/chills, nausea/vomitting, pain in the flanks/back, chest pain, dyspnea

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16
Q

What are three complications seen in intravascular hemolytic transfusion reaction?

A

hypovolemic shock, DIC, renal failure

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17
Q

Management of intravascular hemolytic transfusion reaction involves what four actions/treatments?

A
  1. Stop the transfusion reaction
  2. Aggressive fluid replacement to avoid renal failure and shock
  3. epinephrine for anaphylaxis
  4. dopamine/norepinephrine to maintain blood pressure
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18
Q

Extravascular hemolytic transfusion reaction typically occurs within what time period?

A

1 month

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19
Q

What two symptoms are seen in extravascular hemolytic transfusion reaction?

A

Fever, jaundice

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20
Q

What is the management of extravascular hemolytic transfusion reaction?

A

None, it is self limited

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21
Q

Why is it called extravascular hemolytic anemia?

A

Hemolysis occurs in the spleen

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22
Q

What is considered elevated reticulocyte index?

A

> 2%

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23
Q

What is considered decreased reticulocyte index?

A

<2%

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24
Q

A reticulocyte index >2% points to what two possible causes?

A

Blood loss or Hemolytic anemia

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25
Q

If Reticulocyte index is <2%, what is the next test to order?

A

Blood smear to discover MCV

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26
Q

If microcytic anemia is diagnosed on blood smear, what are the top four differential diagnoses?

A

Iron deficiency
Anemia of chronic disease
Thalassemias
Ringed sideroblastic anemia

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27
Q

What causes anemia of chronic disease?

A

Iron is at normal levels in the body, but is not available for Hgb synthesis due to iron trapping in macrophages

28
Q

If macrocytic anemia is diagnosed on blood smear, what are the top four differential diagnoses?

A

B12 deficiency
Folate deficiency
Liver disease
Stimulated erythropoiesis

29
Q

Why does stimulated erythropoiesis cause macrocytic anemia?

A

Reticulocytes are larger than mature RBC’s

30
Q

If normocytic anemia is diagnosed on blood smear, what are the top five differential diagnoses?

A 
Aplastic anemia
Bone marrow fibrosis
Tumor
Anemia of chronic (inflammatory) disease
Renal failure
31
Q

In microcytic anemia, if both Fe and TIBC are decreased, what is the cause of anemia?

A

Chronic (inflammatory) disease

32
Q

In microcytic anemia, if Fe is decreased and TIBC is increased, what is the cause of anemia?

A

Iron deficiency anemia

33
Q

In microcytic anemia, if Fe is normal and TIBC is normal or slightly decreased, what is the cause of anemia?

A

Lead poisoning

Thallesemia

34
Q

What is the most common cause of iron deficiency anemia in adults?

A

Menstrual bleeding

35
Q

In the absence of menstrual bleeding, what is the most probable cause of iron-deficiency anemia?

A

GI bleeding

36
Q

Iron deficiency anemia due to dietary deficiency or increased dietary demand is most commonly seen in what three age groups?

A

Infants and toddlers
Adolescents
Pregnant women

37
Q

Why is iron deficiency anemia seen in infants and toddlers?

A

Maternal milk is low in iron

Increased requirement due to accelerated growth

38
Q

What are the six clinical features of iron deficiency anemia?

A 
Pallor
Fatigue
Dyspnea on exertion
Orthostatic lightheadedness
Hypotension
Tachycardia
39
Q

What two labs should be run on a patient who is suspected to have Beta-thalassemia major?

A

Hemoglobin electrophoresis

Peripheral blood smear

40
Q

What are the six clinical findings that may be seen in a patient with beta-thalassemia major?

A

Severe anemia
Massive hepatosplenomegaly
Distortion of bones d/tExpansion of marrow space
Growth retardation and failure to thrive
Death in first years of life d/t CHF if left untreated
Skull X-ray shows “crew cut” appearance

41
Q

A patient with beta thalassemia major will have what hemoglobin electrophoresis results?

A

Hb F and Hb A2 are elevated

42
Q

A patient with beta thalassemia major will have what results on peripheral blood smear?

A

Microcytic hypochromic RBC’s

Target cells

43
Q

What is seen on Hgb electrophoresis in patients with alpha-thalassemia major?

A

Hgb H

44
Q

What is the treatment for a patient with Hgb H disease?

A

Frequent PRBC transfusions and sometimes splenectomy

45
Q

What should be ordered to check for B12 and folate deficiency?

A

Serum homocysteine level

Serum methylmalonic acid

46
Q

Serum homocysteine level is increased in what?

A

B12 and Folate deficiency

47
Q

Methylmalonic acid level is increased in what?

A

B12 deficiency

48
Q

How is haptoglobin level affected in hemolytic anemia? Why?

A

Haptoglobin decreases - binds to Hgb and Hgb is decreased because of hemolysis

49
Q

How is LDH level affected in hemolytic anemia? Why?

A

Increases - released by lysed RBC’s

50
Q

What does the Direct Coombs test actually test for?

A

Detects antibody or complement on the surface of RBC’s

51
Q

Spherocytes can be seen in what five conditions?

A 
Hereditary spherocytosis 
G6PD Deficiency
ABO incompatibility 
Hyperthermia
Autoimmune hemolytic anemia
52
Q

4 Lab tests for hereditary spherocytosis

A

Osmotic fragility test
Reticulocyte count
Peripheral blood smear
Direct Coombs test

53
Q

What is the result of a direct Coombs test in hereditary spherocytosis? Why is this a helpful test?

A

Negative

Distinguish it from autoimmune hemolytic anemia

54
Q

What is the treatment for hereditary spherocytosis?

A

Splenectomy

55
Q

What is seen on a peripheral blood smear in G6PD deficiency

A

Bite cells

56
Q

Name 3 precipitants of G6PD anemia

A

Sulfonamides, fava beans, infection

57
Q

What are Heinz Bodies?

A

Abnormal hemoglobin precipitates within RBC’s

58
Q

What causes Heinz Bodies to form?

A

Lack of G6PD leads to accumulation of H2O2 in cell which denatures hemoglobin, which then accumulate forming Heinz Bodies

59
Q

What are the three treatments for G6PD deficient hemolytic anemia?

A

Avoid offending agents
Hydration
Perform RBC transfusion when necessary

60
Q

What are the two types of autoimmune hemolytic anemia?

A

Warm and Cold

61
Q

What type of autoantibody is seen in warm autoimmune hemolytic anemia?

A

IgG

62
Q

Where does hemolysis occur in warm autoimmune hemolytic anemia?

A

Extravascular - within the spleen

63
Q

What autoantibodies are seen in cold autoimmune hemolytic anemia?

A

IgM

64
Q

Where does RBC sequestration occur in cold autoimmune hemolytic anemia? Where does hemolysis occur?

A

Liver

Intravascular hemolysis

65
Q

What is the mainstay of therapy for warm autoimmune hemolytic anemia?

A

Glucocorticoids

Step Up - Hematologic (1 decks)

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