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Hematology/Oncology > Anemia & Labs > Flashcards

Anemia & Labs Flashcards

1
Q

describe the trends in Hgb/Hct levels throughout the lifespan for both M/F

A

At birth high. Childhood drops, increases in adolescents at which stays same for females, but increases for males. During pregnancy gets lower. Postmenopause slightly higher.

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2
Q

What indicates anemia based upon RBC count, Hct, Hgb readings

A

Men < 14 & <4.2

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3
Q

how would you measure the mean cell volume (MCV) for a RBC indices

A

Hct/RBC count

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4
Q

what is a normal range for MCV

A

80-100

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5
Q

which anemia type would be classified <80 otherwise known as microcytic anemia

A

iron deficient

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6
Q

which anemia type would be due to a MCV > 100

A

Vit. B12 def. & Folate

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7
Q

the terms hypochromic and hyperchromic refer to:

A

concentration of Hgb in RBC’s (MCH/MCHC) typically range 32-36 or 26-34

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8
Q

which test would you order to check reticulocyte counts

A

blood smear

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9
Q

which types of d/o would result in +schistocyte’s on a peripheral b. smear

A

Anything with trauma fragmenting the RBCs such as: MAHA (TTP), HUS, DIC

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10
Q

What is the mainstay treatment for one with sickle cell anemia

A

hydroxyurea; along with oxygen, hydration, & pain control…

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11
Q

what does hydroxyurea do

A

triggers bone marrow to make more Hgb F (fetal) subsequenctly lowering Hgb S

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12
Q

This is the only anemia that has an increased MCHC

A

hereditary spherocytosis

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13
Q

What is the main diagnostic test for hereditary spherocytosis?

A

osmotic fragility test.

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14
Q

How would you treat hereditary spherocytosis

A

Daily folate, splenectomy is prime tx.

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15
Q

This type of anemia presents with difficulty to swallow cold, a positive Coombs test & acrocyanosis

A

IgM/Complement (cold)

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16
Q

This anemia presents with (triad) sudden onset hemolysis, jaundice, & enlarged spleen and a positive coombs test

A

IgG (warm)

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17
Q

The G6PD deficiency is most prevalent in which population

A

African or Mediterranean descent that is x-linked recessive

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18
Q

what is pernicious anemia

A

autoimmune disease where intrinsic factor is not produced

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19
Q

in which anemic state would you see neuropathy

A

vitamin B12 deficiency

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20
Q

The schilling test measures if body is absorbing vitamin B12 for PA. What is the more common test…

A

EGD, Biopsy for atrophy of gastric parietal cells/increased infiltration of goblet cells, & **measure anti-parietal cell antibodies

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21
Q

at what rate would you look to the Hct decline for an indication of anemia or blood loss

A

3% per week or more

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22
Q

A pt’s Hct has fallen 1% in the last week. Does this indicate anemia?

A

No, must be 3% or more per week

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23
Q

what Reticulocyte index would you look for as a sign of acute blood loss or anemia

A

> 2.5

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24
Q

In general, why do pts with sickle cell anemia eventually develop organ failure?

A

the sticky, viscosity of the RBC due to an influx of Ca and release of K changes the membrane to stiff- unable to pass capillaries, adhere to small venules making an ischemic state

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25
Q

why are pt’s with sickle cell most likely at increased risk for infections from encapsulated organisms

A

the spleen is frequently lost w/in first 18-36 months of life.

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26
Q

what other complications can you see from Sickle cell anemia due to the vaso-occlussive property

A

retinopathy, MI/Strokes, kidney failure, bone/jt-osteomyelitis & avascular necrosis. *Lungs-acute chest syndrome with cough/fever/sob/pain

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27
Q

Distinguish why the electrophoresis is better than the sickle-dex test

A

the sickle-dex test doesn’t help differentiate btw a carrier or someone who has the disease…

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28
Q

what percent of Hgb S will appear on electrophoresis btw a carrier and disease

A

Someone with the trait will have 40% whereas w/ disease >85%

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29
Q

this pt presents with aplastic crisis (fatigue, pallor, etc) and has been known to possess sickle cell dz…what is a likely pathogen

A

parvovirus B19

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30
Q

if someone is infected with salmonella develops osteomyelitis; why would you think sickle cell dz

A

spleen is impaired and can’t rid body of encapsulated organism.

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31
Q

what would u tx a patient with who is having a sickle cell crisis

A

ER, oxygen, hydrate, pain control (morphine)

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32
Q

what would you tx a chronic sickle cell pt with primary

A

hydroxyurea

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33
Q

This anemia is predominant in northern europeans

A

hereditary spherocytosis

34
Q

How would you visualize the presence of increased bilirubin due to hereditary spherocytosis

A

pigmented gallstones.

35
Q

this type of autoimmune d/o is often associated with SLE (lupus) and others like leukemia or lymphoma

A

IgG mediated (warm)

36
Q

this autoimmune HA most often affects extravascular organs like spleen. liver, etc

A

IgG (warm)

37
Q

this autoimmune HA affects intravascular structures like blood vessels themselves

A

IgM (cold)

38
Q

This is the only type of anemia that presents with pruritis as a symptom

A

polycythemia vera

39
Q

If you were to find a pt with an anemia who complains of itching, what else are you likely to find:

A

HA, dizziness, tinnitus, blurred vision, fatigue, dyspnea, abd pain

40
Q

in addition to the splenomegaly and hepatomegaly in pts with polycythemia vera, this unique findings may be present

A

gout

41
Q

what are some of the main treatments for polycythemia vera

A

*prevent thrombosis due to hyperviscosity. maintain Hct <45% myelosuppression with hydroxyurea. anagrelide 4 thrombocythemia, allobutrinol for hyperuricemia, antihistamine for pruritis splenectomy

42
Q

this anemia presents with pancytopenia

A

aplastic anemia

43
Q

café au lait spots and short stature is often associated with this:

A

Fanconi’s anemia

44
Q

this disorder is often characterized by bone marrow failure which results in pancytopenia & replacement of fat into the cavity & is acquired in a bimodal prevalence pattern

A

Aplastic anemia

45
Q

what are some treatments of aplastic anemia

A

bone marrow transplant BEST therapy for young when HLA-match; immunosuppressants (better w/ cyclosporin), red blood cell transfusions

46
Q

Describe the RDW & what its normal range should be? What is indicated above the range?

A

RBC distribution width, normal 11-15% and anything > 15% should indicate a variety of sizes aka anisocytosis (this is seen in microcytic anemia)

47
Q

Howell Jolly bodies on a smear can indicate this

A

absence of a spleen or leaving b.marrow while incompletely mature

48
Q

acanthocytes such as spur cells or burr cells indicate

A

liver dz and renal failure respectively

49
Q

rouleaux formation on a blood smear indicates plasma globulin causing RBCs to adhere to another looking stacked-what dz is this prevalent in

A

multiple myeloma

50
Q

what reticulocyte count # would indicate the B. marrow is compensating for anemia? Hypoproliferative?

A

> or equal to 2 compensated vs. <2 hypoproliferative

51
Q

where is iron distributed throughout the body?

A

65% Hgb, 4% myoglobin, 30% stored as Ferritin in liver/spleen/b.marrow and rest is in serum bound to apotransferrin

52
Q

how would you expect the total bilirubin and LDH to change in event of hemolysis, liver dz, and leukemia

A

It would be raised. (unconjugated w/ hemolysis; conjugated-liver dz)

53
Q

Sxs of PICA, glossitis, spooning of fingernails, anglular cheilosis, plummer-vinson syndrome would all indicate?

A

iron def. anemia

54
Q

what r some causes of iron def anemia

A

GI loss/trauma pregnancy, breast feeding, malnutrition, celiac, crohns gastric surgery

55
Q

what is the tx for iron def anemia

A

ferrous sulfate 325 mg BID/TID checking CBC 2-3 months, continuing supp. 3-6 mnths…. if GI upset give gluconate, furonate, or parenteral IV iron

56
Q

what are some common causes of tx failure in iron def anemics

A

compliance or misdiagnosis

57
Q

what are the lab results for pts with anemia due to chronic dz

A

ferritin normal/high with low serum Fe and TIBC

58
Q

how would u treat anemia due to chronic dz

A

purified recombinant erythropoiten (SQ)

59
Q

how many genes for alpha hemoglobin would you expect to be defected in a pt with Hgb H dz

A

3

60
Q

in a pt with one missing or defective alpha hemoglobin gene would you expect to see signs/sxs?

A

no

61
Q

what is the most likely prognosis for a pt with hydrops fetalis or Barts Hgb?

A

death, stillbirth

62
Q

which deficiency is most likely in a pt who was born in SE asia or china

A

alpha thesssalemia

63
Q

what is indicated with a Mentzer index < 13

A

thessalemia

64
Q

what is indicated with a Mentzer index > 13

A

iron def anemia

65
Q

how would you distinguish btw alpha thess. minor/trait vs .Hgb H dz?

A

trait would only have mild exercise intolerance vs. Hgb H or Barts would have pallor splenomegaly, more pronounced lab lowering on Hct (22-32%) low MCV, b. smear with poikulocytes and an increased reticulocyte count.

66
Q

how would you treat HGb H

A

Folic acid, regular trasnfusions + deferoxamine, splenectomy, allogenic BM transplant, *Avoid oxidative drugs

67
Q

how would you describe beta thessalemia intermediate

A

chronic HA, mild bony deformities, most live into adulthood, but need transfusions only after post-stressors

68
Q

what is indicated by Cooley’s anemia

A

beta thessalemia major

69
Q

what are some sings/sxs of cooleys anemia (Beta thessalemia major

A

growth failure, remarkable bony deformities, jaundice, ineffective erythropoietin

70
Q

hemosiderous refers to what complication often seen in beta thessalemia major pts/

A

iron overload

71
Q

what complications from beta-thessalemia major cause pts to die in their 30s

A

heart failulre, cirrhosis, endocrinopathies

72
Q

with Hgb less than 10 what are pts at an increased risk for developing in beta–thess. major

A

bony deformities

73
Q

what do you want to avoid giving pts with beta-thess major/cooley’s anemia

A

iron supplements b/c they are already at an increased risk for iron overload (hemosiderous)

74
Q

what are the tx modalities for a pt with cooley’s anemia/ beta-thess major

A

folic acid, transfusion dependent, splenectomy, allogenic BMT,

75
Q

describe the epidemiology for beta-thess

A

greeks/mediteraneans

76
Q

how would you distinguish btw alpha-beta thessalemia? which test would you order

A

electrophoresis would be normal for alpha but variable in beta with increased Hgb A2 and F

77
Q

describe the hemoglobin subtypes

A

adult hemoglobin 96-98% (2a2b) adult2 (1.5-3.2%)(2a2delta) fetal .5-.8 (2a2gamma)

78
Q

describe plummer vinson syndrome & what anemia is it associated with

A

pt w/ trouble swallowing b/c of tissue blocking some of the esophagus often associated with iron def. anemia

79
Q

what is an increased level of ZnPP (zinc protoporphyrin) a sign of

A

iron def. anemia

80
Q

what are some causes of aplastic anemia

A

inherited, idiopathic >50% medications/chemicals/chemotherapy (benzene, insecticides); infections radiation

Hematology/Oncology (4 decks)

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